(P-HC-12) Successful treatment of refractory severe sepsis with high doses of granulocytes in a neutropenic patient.

Background/Case Studies: Infections remain a major cause of morbidity and mortality in oncohematological patients with severe neutropenia either as a consequence of disease or treatment. The transfusion of allogeneic granulocytes have been used to treat refractory documented infections (bacterial and fungal) in this set of patients for a long time. However, granulocyte transfusion (GTX) therapy is still controversial. 
The objective of this work is describing the characteristics and results of granulocyte transfusion treatment in a oncohematological patient with severe neutropenia and refractory severe sepsis.

Study

Design/Methods: We perform an observational, retrospective, and descriptive study to describe the characteristics and results of granulocytes transfusion treatment in a neutropenic oncohematological patient with severe refractory sepsis (Case Report).

Results/Findings: We present a 52 year old patient with diagnosis of acute myeloid leukaemia.  At the time of admission he was febrile, lucid, tachypneic, and tricytopenic. Cultures were performed and therapy with broad spectrum antibiotics was initiated. The patient evolved with septic shock with requiring mechanical respiratory assistance and with multi organ failure (Kidney, liver and cardiac failure). He persisted with severe tricytopenia and high transfusion requirements despite treatment with granulocytes colony stimulating factor. Presented multiple septic impact on the skin and subcutaneous tissues with equal rescue in lesion culture. After 11 days of suitable antibiotic treatment, with persistence  of severe neutropenia, lack of response to the treatment and worsening of clinical status, it was decided to start therapy with donor granulocytes.The average dose was of 30 x 10e9 granulocytes per transfusión, and the mean dose per transfusion per kg was 0.4 x 10e9.
The donors were mobilized with Dexamethasone 8 mg and granulocytes colony stimulating factor.The patient received a total of 11 granulocytes transfusions. The result in WBC count and absolute neutrophils counts are shown in the table 1/Graph 1. A progressive increase in the absolute neutrophils counts and WBC counts was observed after the start of GTX, managing to overcome neutropenia after the tenth transfusion. The patient had a progressive clinical improvement, recovering the functions of affected organs. He was weaned from mechanical ventilation 8 days after the last GTX and was discharged from hospital 10 days later.
A mild rash following one of GTX performed was the one adverse event reported.

Conclusions: As a result of granulocytes transfusion an objective increase in the number of WBC and absolute neutrophils count was observed concomitantly with the clinic improvement of the patient. Both granulocytes transfusion and the multidisciplinary approach to a patient with such a complex status managed to overcome neutropenia and get through infection contributing to the patien´s clinical improvement.