Exchange transfusion as an alternative to granulocyte concentrate administration in neonates with bacterial sepsis and profound neutropenia.

A high rate of mortality is observed in the subset of neonates with early-onset bacterial sepsis who develop profound neutropenia and depletion of the marrow neutrophil reserve. Several studies suggest that transfusion of apheresis-collected adult neutrophils into such subjects can be beneficial, yet inherent delays in preparation of neutrophil concentrates can limit their clinical utility. In six neonates with sepsis and profound neutropenia, we performed double-volume exchange transfusions using freshly drawn donor blood and determined that a net gain of 0.3-0.7 X 10(9) neutrophils/kg body weight had occurred. The blood neutrophil count of the patients increased from 220 to 1,660/mm3 before the transfusion to 1,650-5,140/mm3 immediately afterward. We next attempted to further increase the number of neutrophils delivered by exchange transfusion by subjecting blood donors to 2 min of physical exercise in order to induce neutrophilia. After such exercise, 30% (range 18-55%) more neutrophils were harvested. The metabolic burst activity and in vitro migration of neutrophils after exercise did not differ from paired preexercise values.