October-December 2005
October-December 2005
By Aida B. Narvios, Marilyn Greer, Sheena Sharma, Robert Armand, David Beery, and Benjamin Lichtiger
Granulocyte transfusions have been used to support patients with neutropenia associated with severe infections refractory to standard antimicrobial agents. Patients with cancer who are immunocompromised are prone to such infections, and recovery from these infections is slow and difficult when they are complicated by neutropenia. Infections treated with granulocyte transfusions have ranged from fungal and bacterial pneumonias to soft-tissue infections and congenital neutropenia associated with infection. Granulocyte transfusion has been proven to be most effective in the early stages of infection. Family members are the usual dedicated granulocyte donors for these patients.
Recent studies have shown that granulocyte transfusion is highly effective only when given at a high dose, which can only be achieved with the use of normal volunteer donors of granulocyte colony-stimulating factor (G-CSF)-mobilized granulocytes (1). Recruiting donors for patients needing granulocyte infusion is difficult because of the additional preparatory steps required prior to collection compared with other blood components such as RBC and platelets. Because granulocytes can only be stored at room temperature for a maximum of 24 hours, these donors must undergo all required infectious disease screening, liver function testing, and urine beta human chorionic gonadotropin testing prior to stimulation with G-CSF. The standard dose of G-CSF that we have used is 5-micrograms/ kilogram administered 8-10 hours prior to granulocyte collection. Oral administration of 8 mg of dexamethasone the night prior to the first collection of granulocytes in addition to the administration of G-CSF is the standard preparation of donors in our blood bank. We mobilize granulocytes in succeeding donations only with the use of G-CSF. Furthermore, we explain and discuss granulocyte collection with potential donors and obtain the donors' written informed consent to undergo the procedure and receive G-CSF. Finally, we allow donors to donate granulocytes every other day over 4-5 days.
Use of one lineage-specific G-CSF in particular, filgrastim, has been shown to decrease the incidence of febrile neutropenia by 50% (2,3). Filgrastim mainly affects neutrophils. It also enhances neutrophil functional activity. However, some adverse effects have been reported, such as bone pain, headache, fatigue, and nausea (4). Furthermore, use of G-CSF and granulocyte-macrophage colony-stimulating factor is now considered to be preventive against potentially life-threatening febrile neutropenia (5).
Bux et al. (6) evaluated 507 granulocyte donations from 183 donors and found no severe G-CSF--related side effects. Three donors had severe itching following infusion of hydroxyethyl starch, and 85% of the donors indicated that they would donate granulocytes again.
We conducted the survey described herein to meet three objectives: To assess the highest customer satisfaction with the services offered by our blood bank, determine the health status of donors since their last white blood cell (WBC) donation, and most importantly, determine the health status of WBC donors who had undergone stimulation with G-CSF.
Methods
This survey was a joint effort by the department of Institutional Research and Blood Bank at The University of Texas M. D. Anderson Cancer Center. A written survey and reminder postcard were mailed to all individuals (n = 531) who had completed at least one granulocyte donation at the M. D. Anderson Cancer Center Blood Bank over a period of 3 years (2001-2004). Thirty-six surveys were returned due to incorrect addresses. A total of 124 donors responded to the survey, resulting in a response rate of 25%. The identified donors were also provided with the address of a Web site where they could complete the survey online. The data collected were analyzed by using frequency distributions. Missing and unknown responses were removed from the analysis. The data were analyzed with the use of the SPSS software program for Windows (release 11.5 and standard version; SPSS Inc., Chicago, IL). The M. D. Anderson Institutional Review Board approved this study.
Results
We analyzed the survey results based on the three objectives of this study.
Nineteen percent of the respondents had given their last WBC donation within the previous 12 months, 38% had done so within the previous 2 years, 22% had within the previous 4 years, and 21% had more than 4 years before the survey. Also, 67% had undergone mobilization with the use of G-CSF (filgrastim), whereas 7% could not remember whether they had undergone mobilization with G-CSF.
Answers to the survey questions regarding donor satisfaction showed that the donors were either very satisfied or satisfied with the following: courtesy of staff, explanation of procedure by health care provider, and information provided in the donor packet. Interestingly, 70% of the respondents were willing to donate WBCs again, and 67% were willing to donate with G-CSF stimulation.
Respondents were asked to describe their health as very good (59%), good (34%), neither good nor poor (5%), or poor (3%) in an effort to determine their overall health status since their last WBC donation. Eighty-one percent of them had undergone laboratory tests over the previous 2 years; specifically, 75% had a normal cholesterol test, 80% had a normal complete blood count, 53% had a normal glucose tolerance test, and 54% had a normal Papanicolaou smear. Forty percent of the respondents indicated that the prostate- specific antigen test was not applicable to them, and 44% indicated that they did not undergo a stress test. Additionally, hypertension, cancer, and diabetes developed in 6%, 3%, and 2% of the respondents, respectively. Finally, a condition other than those listed in the survey, such as depression, developed in 25% of the respondents.
Respondent characteristics are shown in Table 1.
Table 1. Characteristics of WBC Donors
|
Gender |
|
|
Male |
61 (50.0%) |
|
Female |
61 (50.0%) |
|
Child-bearing age |
17 (27.9%) |
|
Menopausal |
15 (24.6%) |
|
Postmenopausal |
29 (47.5%) |
|
Age (years) |
|
|
≤21 |
0 (0.0%) |
|
22-30 |
5 (4.1%) |
|
31-45 |
36 (29.3%) |
|
46-60 |
56 (45.5%) |
|
61-75 |
26 (21.1%) |
|
>75 |
0 (0.0%) |
|
Ethnicity |
|
|
African-American/Non-Hispanic |
0 (0.0%) |
|
Asian/Pacific Islander |
3 (2.5%) |
|
Hispanic |
6 (4.9%) |
|
Native American/American Indian |
0 (0.0%) |
|
White |
5 (4.1%) |
|
Other |
5 (4.1%) |
Discussion
In spite of our efforts to reach to obtain replies from all of our previous WBC donors with this survey, only 25% responded. Speculating about the various reasons that could explain this result is difficult. Most likely, some of the donors were from another country or state and used a temporary address during their stay here. Therefore, the results may or may not reflect the overall perception of all of all of our WBC donors. A response rate of 70% would have been more representative of the majority of the donors.
The donor-satisfaction results of the survey were very satisfactory. The willingness of donors to donate WBCs with G-CSF mobilization is essential for our blood bank, especially in dealing with the often difficult recruitment of WBC donors. The fact that 93% of the respondents described their overall health status as either very good or good is the most vital aspect of this study.
Some of the specific comments that this donor had are highly commendable to the overall WBC operation. Several comments stated that they were very pleased with the Blood Bank personnel because they were friendly and helpful.
Conclusions
We believe that the WBC donation process in our institution is safe and that the overall donor experience during WBC donation is very satisfactory. Additionally, a 3-year follow- up study revealed no significant adverse reactions among the survey respondents who received G-CSF.
References
CURRENT ISSUES IN TRANSFUSION MEDICINE
Volume 13, Number 4
Copyright 2005 The University of Texas M. D.
Anderson Cancer Center, Houston, Texas
Newsletter homepage URL: http://www3.mdanderson.org/~citm/homepage.html