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Caitlin Raymond: Granulocyte Transfusions for the Overworked Fellow
Caitlin Raymond/LinkedIn
Apr 12, 2026, 17:34

Caitlin Raymond: Granulocyte Transfusions for the Overworked Fellow

Caitlin Raymond, Assistant Professor of Pathology and Transfusion Medicine at University of Wisconsin-Madison, shared a post on Linkedin:

“New post: Granulocyte Transfusions for the Overworked Fellow.

Someone suggests granulocytes for your profoundly neutropenic, fungal-infected, not-responding patient. You nod. You place the consult. And somewhere in the back of your mind, a small voice asks: does this actually work?

That voice deserves an honest answer.

Here’s what the literature actually gives us:

  • The biological rationale is sound. No neutrophils, no innate immune response. Supplementing from the outside makes mechanistic sense.
  • The RING trial was the most rigorous attempt to test this — randomized, adequately powered, mortality endpoint. It didn’t show a survival benefit.
  • But RING had a problem: delivered doses were consistently below what’s considered therapeutic. If you can’t reliably deliver the intervention, you can’t cleanly interpret the result.
  • The amphotericin timing rule? Traced back to a single 1981 paper. Subsequent studies failed to replicate it. The practice outlived the evidence.
  • The 1 × 10¹⁰ dose target is real — but collection yields are variable, and hitting it is not guaranteed even with G-CSF and dexamethasone stimulation.

We have not arrived at a definitive answer on whether granulocyte transfusions improve survival. We tried hard to find out. The best trial we have had a fatal flaw in its ability to deliver the intervention reliably.

Knowing the limits of the evidence is not a failure of clinical knowledge. It is the clinical knowledge.”

Caitlin Raymond

Other posts featuring Caitlin Raymond on Hemostasis Today.

amphotericin Blood Caitlin Raymond Granulocyte Transfusion Health Hematology Hemostasis Hemostasis News Hemostasis Today Medicine Neutrophils RING Trial
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