Intravenous Immunoglobulins for Neonatal Alloimmune Neutropenia Refractory to Recombinant Human Granulocyte Colony-Stimulating Factor

Abstract

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.

A case of neonatal alloimmune neutropenia in premature infants with response to intravenous immunoglobulins

“…Some studies report this treatment to be effective in neonates with NAN [6]. In the case presented, the patient responded immediately to the administration of immunoglobulin iv., an outcome similar to that reported in a previous article, in which antibodies to antigen 1c were detected [7]. Most studies consider that immunoglobulin iv., should be reserved for second-line treatment [6,7].…”

Neonatal Alloimmune Neutropenia

“…Some case reports have been published in which benefits for the neonate have been achieved with second-line treatment with intravenous immunoglobulins (IVIg) [71]. However, there is not enough evidence to advice IVIg first-line treatment [72].…”

A One-Day-Old Girl With Neutropenia

“…There are cases reported of NAN refractory to G-CSF in which intravenous immunoglobulin has been used successfully. 5 The typical course of the condition is eventual return to a normal ANC as maternal immunity wanes in the infant.…”