PEDIATRICS Vol. 80 No. 5 November 1987, pp. 712-720
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Buffy Coat Transfusions in Neutropenic Neonates With Presumed Sepsis: A Prospective, Randomized Trial

Jill E. Baley MD1, Eileen K. Stork MD1, Phyllis I. Warkentin MD1, and Susan B. Shurin MD1

1 From the Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland

Neonatal sepsis, accompanied by neutropenia, is associated with a high mortality. To determine whether granulocyte transfusions improve the survival of critically ill neutropenic infants, we prospectively randomized 25 infants to transfusion and nontransfusion groups, matching for birth weight (le1,500 g or >1,500 g). Infants with necrotizing enterocolitis were randomized separately. Neutropenia was established by two successive absolute neutrophil counts le1,500 cells prior to randomization. The transfusion (n = 12) and nontransfusion (n = 13) groups did not differ with respect to clinical or hematologic characteristics. In 23 of 25, bone marrow aspirations were performed to determine the percentage of neutrophil storage pool. Granulocyte transfusions of buffy coats from single units of whole blood (0.1 to 0.9 x 109 polymorphonuclear leukocytes per kilogram) were given daily until the absolute neutrophil count increased to more than 1,500/µL. Only five infants, mostly those with necrotizing enterocolitis, required more than one transfusion. A circulating immature to total neutrophil ratio (I:T) ge0.80 was not predictive of an infant with a neutrophil storage pool le7%, and neither an I:T <0.80 nor a neutrophil storage pool >7% were predictive of survival. Granulocyte transfusions did not improve survival when either comparing the whole group, those 17 infants with cultures positive for bacteria or viruses, the 19 infants with a circulating I:T ge0.80, or the nine infants with a neutrophil storage pool le7%. We conclude that the efficacy of buffy coat transfusions remains questionable and recommend that additional studies be performed prior to routine clinical application.

Key Words: neutropenia • bone marrow neutrophil storage pool depletion • granulocyte transfusion • neonatal septicemia • buffy coat transfusion

Submitted on May 5, 1986
Accepted on March 16, 1987