title: Management and outcome of 35 cases with foetal/neonatal alloimmune neutropenia.
abstract: OBJECTIVE
  The aim of this study was to provide an overview of foetal/neonatal alloimmune neutropenia (FNAIN), together with advice on the clinical management.
  
  
  METHODS
  Neutrophil serology in the Netherlands is centralised at Sanquin Diagnostic Services. We examined FNAIN cases between January 1, 1991, and July 1, 2013, to determine the number of cases diagnosed, the relationship with human neutrophil antigen (HNA) antibody, the clinical presentation and therapeutic interventions.
  
  
  RESULTS
  We identified 35 FNAIN cases. The detected HNA antibodies were as follows: anti-HNA-1a (n = 7), anti-HNA-1b (n = 12), anti-HNA-1c (n = 2), anti-HNA-2 (n = 8), anti-HNA-3a (n = 1), anti-HNA-5a (n = 1) and anti-FcγRIIIb (n = 4). No infections were diagnosed in 14 neonates, and the other 21 neonates suffered from omphalitis (n = 6), urinary tract infection (n = 1), candida mucositis (n = 1), fever of unknown origin (n = 6) and sepsis (n = 7, 20%). Parity, gestational age, birthweight, neutrophil counts and antibody specificity were not significantly different for cases with, and without, infections. All the infected children were treated with antibiotics. No children died.
  
  
  CONCLUSIONS
  More than half (21) of the 35 cases of FNAIN presented with infections and most implicated were HNA-1a, HNA-1b and HNA-2. Treatment with antibiotics seemed adequate. A neonatal neutropenia workflow model for use in neonatal intensive care units is presented.
authors.affiliation: Department of Pediatrics, Bronovo hospital, Den Haag, The Netherlands.
authors.forename: Rita
authors.initials: R
authors.lastname: van den Tooren-de Groot
authors.affiliation: Department of Pediatrics Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Mark
authors.initials: M
authors.lastname: Ottink
authors.affiliation: Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
authors.forename: Elly
authors.initials: E
authors.lastname: Huiskes
authors.affiliation: Department of Clinical Chemistry, Bronovo hospital, Den Haag, The Netherlands.
authors.forename: André
authors.initials: A
authors.lastname: van Rossum
authors.affiliation: Department of Pediatrics, Bronovo hospital, Den Haag, The Netherlands.
authors.forename: Bibian
authors.initials: B
authors.lastname: van der Voorn
authors.affiliation: Department of Clinical Chemistry, MEDLON, Enschede, The Netherlands.|Department of Clinical Chemistry, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Jennichjen
authors.initials: J
authors.lastname: Slomp
authors.affiliation: Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
authors.forename: Masja
authors.initials: M
authors.lastname: de Haas
authors.affiliation: Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.
authors.forename: Leendert
authors.initials: L
authors.lastname: Porcelijn
mesh_terms: D003663:Decision Trees; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D006801:Humans; D007231:Infant, Newborn; D007519:Isoantigens; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D007519:Isoantigens; C104384:neutrophil-specific antigen SH
keywords: Foetal neonatal alloimmune neutropenia; Neonatal granulocytopenia; Neonatal immune neutropenia; Neonatal neutropenia; Neonatal neutropenia directives