Granulocyte transfusions To the editor: I would like to draw your attention to certain statements in the recent editorial on granulocyte transfusions (Can Med Assoc J 113: 1020, 1975) - particularly two inaccurate statements and the conclusion. First, the editorial referred to a paper by Lowenthal and colleagues' that apparently illustrated the value of filtration leukapheresis: in fact, this paper deals exclusively with granulocyte procurement by the continuousflow blood cell separator. A second misstatement concerns transfusion reactions. It is correct to state that they "are more common with cells from leukemic donors". However, the "prior (my emphasis) treatment with steroids or etiocholanolone" and the use of "heparin and physiologic fluids" has absolutely nothing to do with the management of this complication. The former two agents are frequently given to normal donors to improve granulocyte transfusions.2'3 Etiocholanolone in particular would be of no use in the management of transfusion reactions and is contraindicated because it almost invariably provokes a febrile response.3 Heparin is used as an anticoagulant in all donors whether filtration or centrifugation techniques are being used, and its use is totally unrelated to the management of reactions. The use of physiologic fluids is neither reported (to my knowledge) nor rational when one considers that a major complication of transfusions is pulmonary edema. Finally, the severe reaction described in the editorial has been seen almost exclusively after transfusion of cells obContributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and should not exceed 1½ pages in length.

tamed by the filtration technique, not by continuous-flow centrifugation.4 There are other statements that invite comment. One cannot deny that granulocytes "contain a large variety of antigens", both shared with other tissues and exclusive to granulocytes. However, these antigens are only of concern if the recipient has previously been sensitized to them and has preformed antibody. It is of the utmost importance, therefore, to search for such antibodies prior to transfusion to ensure both the safety and efficacy of the technique.5'6 The editorial glosses over the controversy concerning HL-A matching. Higby and colleagues presented no data to warrant the statement that the "outcome was not related to HL-A match" and they themselves state that the "importance of HL-A typing... is not yet clear".7 I would accept that statement, although some authors have been successful in relating response to degree of histocompatibility.8'9 Similarly, the risk of graft-v.-host disease has been understated. This has been well documented and has occasionally been fatal. Most centres are now irradiating cells before transfusion to avoid this dreaded complication.3'6 Finally, I take issue with the editorial's conclusion. If the technique referred to as showing "undoubted clinical efficacy" is filtration leukapheresis, then this statement is categorically incorrect. [The technique referred to was granulocyte transfusions in general Ed.] The filtration technique is not innocuous for the donor10 and often produces febrile and occasionally fatal reactions in the recipient.11 It may impair granulocyte function and post-transfusion granulocyte yields are poor.11 I might also add that, although the centrifugation technique suffers from few of the above drawbacks, the current

state of the art hardly allows one to proclaim its undoubted clinical efficacy. We and others are continuing to assess granulocyte transfusions in the supportive care of neutropenic patients, and while the evidence to date strongly supports their use, their role is still not firmly established. L. GROSSMAN, MD, CRCP (MED & HEM)

Director, cell separator unit Vancouver General Hospital Vancouver, BC

References I. LOWENTHAL

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3. 4.

5. 6. 7. 8. 9.

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11.

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GROSSMAN

L,

GOLDMAN

JM, et al: Granulocyte transfusions in treatment of infections in patients with acute leukaemia and aplastic anaemia. Lancet 1: 353, 1975 HIosY DJ, MISHLita JM, RHOMBERO W, et al: The effect of a single or double dose of dexamethasone on granulocyte collection with the continuous flow centrifuge. Vox Sang 28: 243, 1975 HiGs'.' DJ, HENDERSON ES: Granulocyte transfusion therapy. Annu Rev Med 26: 289, 1975 SCHIFFER CA, BUcHHOLZ DH, AISNER J: Clinical experience with transfusion of granulocytes obtained by continuous flow filtration leukopheresis. Am J Med 58: 373, 1975 Bocos DR: Transfusion of neutrophils as prevention or treatment of infection in patients with neutropenia. N Engi J Med 290: 1055, 1974 GOLDMAN JM: Leucocyte separation and transfusion. Br J Haematol 28: 271, 1974 Hioav DJ, YAmS JW, HENDERSON ES, et al: Filtration leukapheresis for granulocyte transfusion therapy. N Engi I Med 292: 761, 1975 GRAW RG, HERzIG G, PERRY 5, et al: Normal granulocyte transfusion therapy. N Engi I Med 287: 368, 1972 HIOBY DJ, MISHLER JM, COHEN E, et al: Increased elevation of peripheral leukocyte counts by infusion of histocompatible granulocytes. Vox Sang 27: 186, 1974 BUcHHOLZ DH, SCHIFFER CA, WlaaNnt PH, et al: Granulocyte harvest for transfusion: donor response to repeated leukapheresis. Transfusion 15: 96, 1975 LEVINE AS, SCHIMPFF SC, GRAw RG, et al: Hematological malignancies and other marrow failure states: progress in the management of complicating infections. Semin Hematol 11: 141, 1974

Congenital absence of vas deferens To the editor: In the Journal of Dec. 13, 1975 I read once again about congenital absence of the vas deferens in association with vasectomy (Can Med Assoc J 113: 1022, 1975). Drs. Ho and Rao seemed somewhat surprised about such a finding and I

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