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Alloimmune, or isoimmune, neonatal neutropenia
Last reviewed: 07.07.2025
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The incidence of alloimmune or isoimmune neutropenia in newborns is 2 cases per 1000 live births.
Alloimmune, or isoimmune, neutropenia of newborns occurs in the fetus due to antigenic incompatibility of the fetus's and mother's neutrophils. The mother's isoantibodies belong to the IgG class, they penetrate the placental barrier and destroy the child's neutrophils. Isoantibodies are usually leukoagglutinins, they react with the cells of the patient and his father, do not react with the mother's cells.
Alloimmune, or isoimmune, neutropenia of newborns is diagnosed in the neonatal period and the first 3 months of life. The diagnosis is confirmed by the presence of isoantibodies in the patient's blood serum.
Diagnostic criteria for autoimmune neutropenia:
- autoantigranulocyte antibodies in the patient's blood serum;
- association of neutropenia with previous infectious (usually viral) diseases and/or medication intake (sulfonamides, NSAIDs, etc.);
- an increase in the content of plasma cells in the peripheral blood and an inverse correlation between their number and the number of neutrophils;
- spread of the immune conflict to other blood cells.
The main criterion is autoantibodies to neutrophils.
In young children, acute moderate forms of autoimmune neutropenia predominate. In this variant, the number of leukocytes, platelets, and red blood counts are normal, absolute neutropenia is 0.5-1.0x10 9 /l. Iron deficiency anemia may be observed. In the myelogram, the neutrophilic sprout is normal or increases, the number of band and segmented neutrophils decreases, and the lymphocyte content may increase. Other bone marrow indicators are normal.
Treatment of infection in alloimmune or isoimmune neutropenia of newborns is carried out using conventional means. In moderate forms, the use of immunoglobulins (IgG) for intravenous administration (IVIG) is indicated, in rare severe forms - granulocyte colony-stimulating factor in combination with IVIG and broad-spectrum antibiotics. In the absence of infections, treatment is not carried out. The disease resolves itself by 3-4 months of age. Preventive vaccinations are performed one year after achieving full remission.
Treatment of autoimmune neutropenia is determined by the severity of the condition and the course of the disease. No special treatment is required for mild forms. In moderate and severe autoimmune neutropenia, glucocorticosteroids are used at a dose of 2-5 mg/kg per day, normal human immunoglobulin (IVIG - octagam, sandoglobulin, biaven) at a course dose of 1.5-2 g/kg. The drugs of choice are growth factors of granulocyte colony-stimulating factor at a dose of 8-10 mcg/kg per day in combination with basic therapy (antibacterial, antifungal and/or antiviral). In chronic autoimmune neutropenia, granulocyte colony-stimulating factor and IVIG are effective. In children with autoimmune neutropenia, the issue of prophylactic vaccination is decided depending on its cause. After mild acute primary autoimmune neutropenia, vaccinations should be postponed for up to 1 year. In severe forms and chronic course, tactics are individual.
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