Intravenous immunoglobulins for neonatal alloimmune neutropenia refractory to recombinant human granulocyte colony-stimulating factor.
Neonatal alloimmune neutropenia (NAN) results from neutrophil destruction by transplacental maternal neutrophil-specific immunoglobulin G (IgG) antibodies directed against the antigen inherited from the father. Treatment is usually based on recombinant human granulocyte colony-stimulating factor (G-CSF) and prevention or treatment of infection. We report the case of neutropenia in a newborn discovered because of fetomaternal infection. The bone marrow biopsy showed normal cellularity. Granulocyte typing, granulocyte cross-matching, and serum assays showed anti-neutrophil antibodies specific for human neutrophil antigen-1c, an antigen rarely involved in this disease. This NAN was refractory to G-CSF but responded to intravenous immunoglobulin (IVIG). IVIG should be considered as a second-line treatment in NAN refractory to G-CSF. Clinical trials, however, are required to define the optimal management of NAN, a rare but probably underestimated life-threatening situation for newborns.
Centre Hospitalier Régional Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, Service de Pédiatrie Néonatale, Montpellier, France.
Aurélie
A
Desenfants
Eric
E
Jeziorski
Odile
O
Plan
Michel
M
Rodière
Marie
M
Rimbert
Jean Yves
JY
Muller
Jacques
J
Taïb
Gilles
G
Cambonie
D000328:Adult; D004927:Escherichia coli Infections / Q000150:complications*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007231:Infant, Newborn; D007519:Isoantigens / Q000097:blood; D008297:Male; D009503:Neutropenia / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D009504:Neutrophils / Q000276:immunology*; D011994:Recombinant Proteins
D016756:Immunoglobulins, Intravenous; D007519:Isoantigens; D011994:Recombinant Proteins; C104384:neutrophil-specific antigen SH; D016179:Granulocyte Colony-Stimulating Factor