Davoren Anne, Saving Kay, McFarland Janice G, Aster Richard H, Curtis Brian R
Blood Center of Southeastern Wisconsin, Inc., Milwaukee, Wisconsin, USA
Transfusion. 2004 Jul;44(7):1041-6. doi: 10.1111/j.1537-2995.2004.03410.x.
Passively acquired neonatal neutropenia is an infrequently reported complication of maternal autoimmune neutropenia (AIN). Two affected siblings are described. The firstborn developed Citrobacter meningitis and was permanently disabled. The second was success-fully managed with pre- and postnatal injections of recombinant human granulocyte colony-stimulating factor (rHuG-CSF).
Neutrophil-specific antibodies were evaluated by flow cytometry (FC), monoclonal antibody immobilization of granulocyte antigens, and granulocyte agglutination assays.
A neutrophil-reactive antibody was detected by FC in samples of the mother's serum spanning a 4-year time frame. This antibody reacted with neutrophils from the mother, father, and their first infant and with 18 of 20 target neutrophils tested. In serologic studies, it was shown that the antibody was not specific for the commonly recognized neutrophil-specific alloantigens HNA-1a (NA1), HNA-1b (NA2), HNA-1c (SH), HNA-2a (NB1), or HNA-3a (5b).
Severe neonatal neutropenia in the two siblings appears to have been caused by placental transfer of a maternal neutrophil-reactive autoantibody of undetermined specificity. Neutrophil counts should be evaluated in infants born to mothers with chronic neutropenia of possible autoimmune origin so that neutropenic infants can be carefully monitored and antibiotics and/or rHuG-CSF administered if indicated.
被动获得性新生儿中性粒细胞减少症是一种关于母体自身免疫性中性粒细胞减少症（AIN）的较少报道的并发症。本文描述了两名受影响的兄弟姐妹。第一个出生的孩子患了柠檬酸杆菌脑膜炎并终身残疾。第二个孩子通过产前和产后注射重组人粒细胞集落刺激因子（rHuG-CSF）得到了成功治疗。
通过流式细胞术（FC）、粒细胞抗原的单克隆抗体固定法和粒细胞凝集试验评估中性粒细胞特异性抗体。
在母亲血清样本中，通过流式细胞术在跨越4年的时间范围内检测到一种中性粒细胞反应性抗体。该抗体与母亲、父亲及其第一个婴儿的中性粒细胞以及所检测的20个目标中性粒细胞中的18个发生反应。在血清学研究中，表明该抗体对常见的公认中性粒细胞特异性同种异体抗原HNA-1a（NA1）、HNA-1b（NA2）、HNA-1c（SH）、HNA-2a（NB1）或HNA-3a（5b）不具有特异性。
这两名兄弟姐妹中的严重新生儿中性粒细胞减少症似乎是由一种特异性未明的母体中性粒细胞反应性自身抗体经胎盘转移所致。对于可能具有自身免疫起源的慢性中性粒细胞减少症母亲所生的婴儿，应评估其中性粒细胞计数，以便对中性粒细胞减少的婴儿进行仔细监测，并在有指征时给予抗生素和/或rHuG-CSF。
