Neonatal immune neutropenia following the administration of intravenous immune globulin.
BACKGROUND
In adults--but not neonates--neutropenia has been reported to complicate treatment with intravenous immunoglobulin, but the mechanism is unknown.


OBJECTIVE
To describe for the first time the case of a newborn infant who, after intravenous immunoglobulin, demonstrated serum antineutrophil antibodies and neutropenia.


METHODS
The 1,425-g, 36-week-gestation boy was healthy except for intrauterine growth retardation. Intravenous immunoglobulin (1g/dose x 3) was administered to treat alloimmune thrombocytopenia. Neutrophil-specific antibodies were detected by a granulocyte immunofluorescence assay.


RESULTS
After the intravenous immunoglobulin, the platelet count normalized but the neutrophil count declined to 450/mm3. Neutrophil-specific antibodies were detected in the serum of the infant but not in the maternal serum. Furthermore, cross-matching revealed that the maternal serum did not react with the infant's granulocytes. Two of three random lots of intravenous immunoglobulin contained detectible anti-neutrophil antibodies.


CONCLUSIONS
After intravenous immunoglobulin, the infant's serum contained one or more anti-neutrophil antibodies that were not maternal in origin. We speculate that the neutropenia resulted from the administration of intravenous immunoglobulin containing antineutrophil antibodies.
Lassiter
H A
HA
Division of Neonatology, University of Louisville School of Medicine, KY 40292.
Bibb
K W
KW
Bertolone
S J
SJ
Patel
C C
CC
Stroncek
D F
DF
D000328:Adult; D000918:Antibody Specificity; D016824:Antigens, Human Platelet / Q000276:immunology; D000954:Antigens, Surface / Q000276:immunology; D005260:Female; D005317:Fetal Growth Retardation; D006801:Humans; D007112:Immunity, Maternally-Acquired; D016756:Immunoglobulins, Intravenous / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology; D008297:Male; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D009504:Neutrophils / Q000276:immunology*; D011247:Pregnancy / Q000097:blood / Q000276:immunology; D013921:Thrombocytopenia / Q000151:congenital / Q000276:immunology / Q000628:therapy*
D016824:Antigens, Human Platelet; D000954:Antigens, Surface; D016756:Immunoglobulins, Intravenous; D007518:Isoantibodies