Granulozytentransfusion: Update 2020

Zusammenfassung

Die therapeutische Anwendung von Granulozytenkonzentraten erfolgt im klinischen Alltag im Gegensatz zu der anderer Blutprodukte nur selten und unregelmäßig. Der zurückhaltende Einsatz beruht unter anderem auf dem Fehlen einer breiten Evidenz, logistischen und wirtschaftlichen Problemen und dem Vorhandensein anderer potenter Therapieoptionen neutropener Infektionen. Dennoch gab es in den letzten Jahren neue wissenschaftliche Erkenntnisse nicht nur zu Physiologie und Pathophysiologie der Granulozyten, wie neu charakterisierten zellulären Verteidigungsstrategien oder deren Mitwirkung bei thrombotischen oder malignen Ereignissen, sondern auch zu deren therapeutischem Effekt. Dieser wird von einer Vielzahl an Parametern, wie der Art der Infektion, dem Transfusionszeitpunkt und der Dosis, beeinflusst. Das macht die Indikationsstellung zu einer komplexen Einzelfallentscheidung und es gilt, die heterogene Datenlage systematisch zusammenzufassen. Außerdem wurden die etablierten Indikationen neutropener bzw. neutropathischer Infektionen um experimentelle, mögliche neue Anwendungsgebiete wie die Mukositis oder Leukämiebehandlung erweitert. Die erfolgreiche Anwendung setzt eine geeignete, moderne Herstellungsweise voraus. Neben der Apherese, bei der eine relativ hohe Spenderbelastung unter anderem durch Nebenwirkungen von Mobilisationsregime und Sedimentationsbeschleunigern berücksichtigt werden muss, existieren weitere Verfahren wie die Gewinnung von Granulozyten aus Buffy Coats von Vollblutspenden. Diese versprechen eine Reduktion logistischer Probleme und unerwünschter Wirkungen auf den Spender. Unerwünschte Wirkungen bei Empfängern von Granulozytentransfusionen sollten nach wie vor berücksichtigt und gegen einen erhofften therapeutischen Effekt abgewogen werden.

Abstract

The prescription of granulocyte transfusions as a therapeutic approach in the clinical routine is – in contrast to other blood components – inconsistent and rare. This restrained application practice is due to the lack of broad evidence, logistical and financial problems, and the availability of other potent therapy options of neutropenic infections, amongst others. Nevertheless, in the last few years newsworthy scientific findings regarding this topic arose. Not only the characterization of cellular defense strategies, but also of the pathophysiological role of granulocytes, like a contribution to thrombotic and malignant events, got developed. Moreover, the therapeutic effect of these cells has been further elaborated. This effect depends on a multitude of parameters, e.g. the sort of infection, the timing and the dose of transfusions. This makes the indication a complex decision for each individual case and the heterogenous data needs to be systematically reviewed. Furthermore, the well-established indications of neutropenic and neutropathic infections got complemented by experimental, potential new application areas like mucositis or treatment of leukemia. Successful application requires a suitable, modern manufacturing process. Common apheresis procedures expose donors to relatively high physical stress, for example due to adverse effects of the mobilization regime or sedimentation agents. New protocols, like the extraction of granulocytes from buffy coats or whole blood, promise a reduction of logistical problems and adverse events in donors. Undesirable effects on recipients of granulocyte transfusions should still be taken into consideration and being weighed up against an expected therapeutic effect.

Schlüsselwörter

Granulozyten - Apherese - Sepsis - Transfusion

Key words

granulocytes - apheresis - sepsis - transfusion

Publikationsverlauf

Artikel online veröffentlicht:
25. August 2020

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