Tomicic Maja, Starcevic Mirta, Zach Vanja, Hundric-Haspl Zeljka
Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
Arch Med Res. 2007 Oct;38(7):792-6. doi: 10.1016/j.arcmed.2007.03.010. Epub 2007 Jun 21.
Alloimmunization to granulocyte-specific antigens can occur during pregnancy. Maternal IgG can cross the placenta and result in neonatal neutropenia. The clinical course of alloimmune neonatal neutropenia is usually self-limiting with only mild infection. However, in severe cases complicated with bacterial sepsis it is a potentially life-threatening disorder. The effect of intravenous (IV) immunoglobulin, prophylactic antibiotic therapy, and recombinant human granulocyte-colony stimulating factor is variable and may prove useful in some cases. Two cases of alloimmune neonatal neutropenia due to anti HNA-2a alloimmunization in two siblings are reported. The first neonate was administered IV gammaglobulins to increase the blood neutrophil count, at a standard dosage (0.4 g/kg body weight) for 5 days without response. The second neonate did not receive specific therapy for blood neutrophil count increase. Neutropenia persisted for 2 and 6 months, respectively. The choice and efficacy of specific therapy for neutrophil count increase in the management of alloimmune neonatal neutropenia have not yet been fully defined and require additional evaluation in the majority of cases.
孕期可发生对粒细胞特异性抗原的同种免疫。母体的IgG可穿过胎盘，导致新生儿中性粒细胞减少。同种免疫性新生儿中性粒细胞减少症的临床过程通常为自限性，仅有轻度感染。然而，在合并细菌性败血症的严重病例中，这是一种潜在的危及生命的疾病。静脉注射免疫球蛋白、预防性抗生素治疗和重组人粒细胞集落刺激因子的效果各不相同，在某些情况下可能有用。本文报告了两例因抗HNA - 2a同种免疫导致的两兄弟患同种免疫性新生儿中性粒细胞减少症的病例。首例新生儿接受了静脉注射丙种球蛋白以提高血液中性粒细胞计数，按标准剂量（0.4 g/kg体重）给药5天但无反应。第二例新生儿未接受提高血液中性粒细胞计数的特异性治疗。中性粒细胞减少分别持续了2个月和6个月。在同种免疫性新生儿中性粒细胞减少症的管理中，用于提高中性粒细胞计数的特异性治疗的选择和疗效尚未完全明确，在大多数情况下需要进一步评估。
