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Neonatal alloimmune neutropenia attributed to maternal immunoglobulin G antibodies against the neutrophil alloantigen HNA‐1c (SH): a report of five cases
Author(s) -
Curtis Brian R.,
Reno Corey,
Aster Richard H.
Publication year - 2005
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/j.1537-2995.2005.00199.x
Subject(s) - neutropenia , antibody , immunology , medicine , neonatal alloimmune thrombocytopenia , immunoglobulin g , pregnancy , biology , fetus , chemotherapy , genetics
BACKGROUND: Neonatal alloimmune neutropenia (NAN) occurs when maternal immunoglobulin G (IgG) antibodies enter fetal circulation and destroy neonatal neutrophils. Whether antibodies specific for the neutrophil antigen HNA‐1c (SH) can cause NAN is uncertain, because in three of four reported cases, other neutrophil‐specific antibodies were present. In this report, we describe five cases of NAN, in which only anti‐HNA‐1c was detected in maternal serum. STUDY DESIGN AND METHODS: HNA‐1c antibodies were detected with flow cytometry immunofluorescence (FCI) and the monoclonal antibody (MoAb) immobilization of granulocyte antigens (MAIGA) assay. Genotyping for HNA‐1c was performed by allele‐specific polymerase chain reaction amplification of DNA. RESULTS: All five maternal serum samples contained IgG antibodies with specificity for HNA‐1c detected in both FCI and MAIGA assay. Of CD16‐specific MoAbs evaluated, only MBC238.7 was optimal for detection of antibody by MAIGA assay. Recombinant human granulocyte–colony‐stimulating factor (rHuG‐CSF) was effective in raising neutrophil counts in the two infants treated in this manner. CONCLUSION: Severe NAN can be caused by maternal antibodies specific for HNA‐1c (SH) alone. Use of an appropriate MoAb is critical for detection of anti‐HNA‐1c by MAIGA assay. rHuG‐CSF is an effective therapy in infants with NAN caused by anti‐HNA‐1c.