Читать книгу Transfusion Medicine - Jeffrey McCullough - Страница 175

Another approach to increase the granulocyte yield is to increase the donor’s circulating granulocyte count. Corticosteroids have been the drug of choice, and dexamethasone was selected because it could be given either orally several hours before leukapheresis or parenterally at the beginning of the procedure. Dexamethasone 60 mg can be given orally the evening before, or hydrocortisone 4 mg/m² can be given intravenously 6–12 hours before leukapheresis. This is a very effective method to increase the granulocyte yield, even more than is accomplished by adding HES to the separation system [64]. It has been suggested that corticosteroids may cause cataracts in granulocyte donors [68], although this was not substantiated in a larger study [69].

G‐CSF has also been given to normal donors to increase the peripheral granulocyte count to improve the yield of granulocytes for transfusion. Depending on the dose schedule, the granulocyte count increases to between 20,000 and 40,000 per microliter after several days of G‐CSF treatment [70–74]. Using G‐CSF‐stimulated normal donors, it is possible to obtain granulocyte concentrates containing about 4 × 10¹⁰ granulocytes or more [72–75]. More recently, use of dexamethasone has been combined with G‐CSF to provide even higher granulocyte levels in the donor, resulting in granulocyte concentrates containing up to 6 × 10¹⁰ granulocytes [72]. A large multicenter randomized trial to evaluate these high‐dose granulocyte concentrates has been completed.