Buffy coat transfusions in neutropenic neonates with presumed sepsis: A prospective, randomized trial

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 (≤1,500 g or >1,500 g). Infants with necrotizing enterocolitis were randomized separately. Neutropenia was established by two successive absolute neutrophil counts ≤1,500 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) ≥0.80 was not predictive of an infant with a neutrophil storage pool ≤7%, 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 ≥0.80, or the nine infants with a neutrophil storage pool ≤7%. We conclude that the efficacy of buffy coat transfusions remains questionable and recommend that additional studies be performed prior to routine clinical application.