1
|
Parisi X, Bledsoe JR. Discerning clinicopathological features of congenital neutropenia syndromes: an approach to diagnostically challenging differential diagnoses. J Clin Pathol 2024; 77:586-604. [PMID: 38589208 DOI: 10.1136/jcp-2022-208686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
The congenital neutropenia syndromes are rare haematological conditions defined by impaired myeloid precursor differentiation or function. Patients are prone to severe infections with high mortality rates in early life. While some patients benefit from granulocyte colony-stimulating factor treatment, they may still face an increased risk of bone marrow failure, myelodysplastic syndrome and acute leukaemia. Accurate diagnosis is crucial for improved outcomes; however, diagnosis depends on familiarity with a heterogeneous group of rare disorders that remain incompletely characterised. The clinical and pathological overlap between reactive conditions, primary and congenital neutropenias, bone marrow failure, and myelodysplastic syndromes further clouds diagnostic clarity.We review the diagnostically useful clinicopathological and morphological features of reactive causes of neutropenia and the most common primary neutropenia disorders: constitutional/benign ethnic neutropenia, chronic idiopathic neutropenia, cyclic neutropenia, severe congenital neutropenia (due to mutations in ELANE, GFI1, HAX1, G6PC3, VPS45, JAGN1, CSF3R, SRP54, CLPB and WAS), GATA2 deficiency, Warts, hypogammaglobulinaemia, infections and myelokathexis syndrome, Shwachman-Diamond Syndrome, the lysosomal storage disorders with neutropenia: Chediak-Higashi, Hermansky-Pudlak, and Griscelli syndromes, Cohen, and Barth syndromes. We also detail characteristic cytogenetic and molecular factors at diagnosis and in progression to myelodysplastic syndrome/leukaemia.
Collapse
Affiliation(s)
- Xenia Parisi
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jacob R Bledsoe
- Department of Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Kløve-Mogensen K, Steffensen R, Masmas TN, Glenthøj A, Jensen CF, Ratcliffe P, Höglund P, Hasle H, Nielsen KR, Haunstrup TM. Genetic polymorphisms in IL-2, IL-10 and FOXP3 are associated with autoimmune neutropenia in early childhood and autoantibody specificity in a Danish cohort. Scand J Immunol 2024; 100:e13374. [PMID: 38750640 DOI: 10.1111/sji.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 07/16/2024]
Abstract
Autoimmune neutropenia (AIN) in early childhood is characterized by chronic neutropenia and positivity for human neutrophil antibodies (HNA), resulting in the excessive destruction of neutrophils. The association between regulatory T cells (Tregs) and AIN has been described, and in this study, we investigated three Treg-associated genes, IL-2, IL-10 and FOXP3. The frequencies of three single nucleotide polymorphisms (SNPs) in IL-2 -330T>G (rs2069762), +114G>T (rs2069763) and IVS3-116 A>G (rs2069772), four SNPs in IL-10 -3575T>A (rs1800890), -1082G>A (rs1800896), -819 C>T (rs1800871) and -592 C>A (rs1800872) and three SNPs in FOXP3 -3499 A>G (rs3761547), -3279 C>A (rs3761548) and -924 A>G (rs2232365) were compared between 166 Danish AIN patients and 358 healthy controls. Disease association was observed for IL-2 IVS3-116 GG (p = 0.0081, OR = 0.35 [0.15-0.80]), IL-10 -3575 TT (p = 0.0078, OR = 1.71 [1.16-2.54]) and IL-10 -1082 AA (p = 0.014, OR = 1.76 [1.14-2.72]) in all patients and FOXP3 -924 (p = 0.0005, A OR = 0.41 [0.25-0.68] and G OR = 2.42 [1.46-4.01]) in male patients. None of the associations were linked to antibody specificity. Disease-associated haplotypes were observed in IL-2 and FOXP3. IL-2 -330T/+114 T/IVS3-116A was associated with anti-FcγRIIIb-positive patients (p = 0.012, OR = 2.07 [1.18-3.62]). FOXP3 -3499A/-3279C/-924A was associated with anti-HNA-1a-positive male patients (p = 0.016, OR = 0.41 [0.20-0.83]), and ACG was associated with female patients, both in the combined group (p = 0.006, OR = NA) and the anti-FcγRIIIb-positive group (p = 0.002, OR = NA). We conclude that our findings reveal a correlation between SNP in Treg-associated genes and AIN, indicating that AIN could be driven by dysfunction of immune homeostatic-evolving Tregs.
Collapse
Affiliation(s)
- Kirstine Kløve-Mogensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rudi Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Tania Nicole Masmas
- Pediatric Hematopoietic Stem Cell Transplantation and Immunodeficiency, Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Glenthøj
- Department of Hematology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Friis Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Section of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescence Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Paul Ratcliffe
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Petter Höglund
- Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden
| | - Henrik Hasle
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Kaspar René Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Thure Mors Haunstrup
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
3
|
Goda S, Karakawa S, Okada S, Kawaguchi H, Kurita E, Noma M, Yamaoka A, Komatsu M, Yanai A, Kashihara M, Fujii T, Onodera R, Taniguchi K, Aizawa M, Kobayashi M. Clinical significance of human neutrophil antigen-1 antibodies in children with neutropenia. Int J Hematol 2023; 118:627-635. [PMID: 37735323 DOI: 10.1007/s12185-023-03661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
Primary autoimmune neutropenia in young children is characterized by chronic neutropenia and positivity for antibodies against human neutrophil antigens (HNAs). This study analyzed the clinical characteristics of 402 children with neutropenia to identify differences between those with and without HNA-1 antibodies (HNA1abs). HNAabs in sera were detected by granulocyte immunofluorescence testing using flow cytometry. Relative fluorescence intensity (RFI) values were used to divide patients into positive (PG, n = 302), borderline (BG, n = 34), and negative (NG, n = 66) groups. The antibodies reacted to HNA-1a alone (59%), HNA-1b alone (1%), and HNA-1a/1b (40%). The PG had a significantly lower absolute neutrophil count before definitive diagnosis and a 1.6- to 2-times greater risk of hospitalization during neutropenia than the other groups. The median duration of neutropenia was longest in the PG at 25 months, followed by 20 months in the BG and 14 months in the NG. This large-scale cohort characterizes clinically distinct groups using the RFI value for HNA1abs in young children with neutropenia. Detection of HNA1abs may aid in understanding the clinical characteristics of children with neutropenia.
Collapse
Affiliation(s)
- Satoshi Goda
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan.
| | - Shuhei Karakawa
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Satoshi Okada
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Hiroshi Kawaguchi
- Department of Pediatrics, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-Ku, Hiroshima, Japan
| | - Emi Kurita
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mitsunori Noma
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Aiko Yamaoka
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mayumi Komatsu
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Ayaka Yanai
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Mayu Kashihara
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Teruhisa Fujii
- Division of Transfusion, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan
| | - Rie Onodera
- Department of Medical Technology, Sanyo Women's College, Hatsukaichi, Japan
| | - Kikuyo Taniguchi
- Department of Medical Technology, Sanyo Women's College, Hatsukaichi, Japan
| | - Mika Aizawa
- Department of Applied Chemistry, Graduate School of Advanced Science and Engineering, Hiroshima University, Higashi-Hiroshima, Japan
| | - Masao Kobayashi
- Japanese Red Cross Chugoku-Shikoku Block Blood Center, Hiroshima, Japan
| |
Collapse
|
4
|
Bayat B, Lowack J, Audrain M, Croisille L, Curtis B, Dangerfield R, Esmaeili B, Grabowski C, Keller M, Kim H, Kroll H, Kvanka MM, Kwok J, Moritz E, Nathalang O, Nelson D, Nielsen KR, Pahn G, Poles A, Porcelijn L, Sachs UJ, Schönbacher M, Körmöczi GF, Kupatawintu P, Takahashi D, Uhrynowska M, Flesch B, Fung YL. World human neutrophil antigens investigation survey. Vox Sang 2023; 118:763-774. [PMID: 37608544 DOI: 10.1111/vox.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Human neutrophil antigens (HNAs) are categorized into five systems: HNA-1 to HNA-5. Given the importance of neutrophils in immunity, we sought to create awareness of the role of HNA diagnostic services in managing immune neutropenia and transfusion-related acute lung injury. To provide health communities all around the world with access to these services, we conducted a survey to create a directory of these HNA diagnostic services. MATERIALS AND METHODS An Excel table-based survey was created to capture information on the laboratory's location and was emailed to 55 individuals with known or possible HNA investigation activity. The collected data were then summarized and analysed. RESULTS Of contacted laboratories, the surveys were returned from 23 (38.2%) laboratories; 17 have already established HNA diagnostic (of them 12 were regular participants of the International Granulocyte Immunobiology Workshop [ISBT-IGIW]), 4 laboratories were in the process of establishing their HNA investigation and the remaining 2 responder laboratories, did not conduct HNA investigations. In established laboratories, investigation for autoimmune neutropenia (infancies and adults) was the most frequently requested, and antibodies against HNA-1a and HNA-1b were the most commonly detected. CONCLUSION The directory of survey respondents provides a resource for health professionals wanting to access HNA diagnostic services. The present study offers a comprehensive picture of HNA diagnostics (typing and serology), identifying weak points and areas for improvement for the first time. Identifying more laboratories involved in HNA diagnostics with limited access to international societies in the field will globally improve HNA diagnostics.
Collapse
Affiliation(s)
- Behnaz Bayat
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Jonas Lowack
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Marie Audrain
- Service d'Immunologie, Laboratoire de Biologie, Nantes, France
| | | | - Brian Curtis
- Platelet & Neutrophil Immunology Lab, Versiti, Milwaukee, Wisconsin, USA
| | - Rebecca Dangerfield
- American Red Cross Neutrophil Immunology Laboratory, St Paul, Minnesota, USA
| | - Behnaz Esmaeili
- Department of Basic Medical Sciences, Khoy University of Medical Sciences, Khoy, Iran
- Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Claudia Grabowski
- Institut für Transfusionsmedizin Dessau, DRK-Blutspendedienst NSTOB, Dessau, Germany
| | - Margaret Keller
- American Red Cross Neutrophil Immunology Laboratory, St Paul, Minnesota, USA
| | - Hyungsuk Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Hartmut Kroll
- Institut für Transfusionsmedizin Dessau, DRK-Blutspendedienst NSTOB, Dessau, Germany
| | | | - Janette Kwok
- Division of Transplantation and Immunogenetic, Department of Pathology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Elyse Moritz
- Clinical and Experimental Oncology, Escola Paulista de Medicinia, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Oytip Nathalang
- Faculty of Allied Health Sciences, Thammasat University, Pathumtani, Thailand
| | - Derrick Nelson
- Specialized Laboratory Services, South African National Blood Service, Johannesburg, South Africa
| | | | - Gail Pahn
- Platelet & Granulocyte Reference Laboratory, Australian Red Cross Lifeblood, Brisbane, Australia
| | - Anthony Poles
- Department of Histocompatibility & Immunogenetics, NHS Blood & Transplant, Bristol, UK
| | - Leendert Porcelijn
- Platelet/Leucocyte Serology Laboratory, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Ulrich J Sachs
- Institute for Clinical Immunology, Transfusion Medicine and Haemostasis, Justus-Liebig-University, Gießen, Germany
| | - Marlies Schönbacher
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | - Günther F Körmöczi
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Vienna, Austria
| | | | | | | | - Brigitte Flesch
- Laboratory for Immunogenetics/HLA, DRK Blutspendedienst West, Bad Kreuznach, Germany
| | - Yoke-Lin Fung
- School of Health, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| |
Collapse
|
5
|
Fioredda F, Skokowa J, Tamary H, Spanoudakis M, Farruggia P, Almeida A, Guardo D, Höglund P, Newburger PE, Palmblad J, Touw IP, Zeidler C, Warren AJ, Dale DC, Welte K, Dufour C, Papadaki HA. The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action. Hemasphere 2023; 7:e872. [PMID: 37008163 PMCID: PMC10065839 DOI: 10.1097/hs9.0000000000000872] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 04/03/2023] Open
Abstract
Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians' experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.
Collapse
Affiliation(s)
| | - Julia Skokowa
- Department of Oncology, Hematology, Immunology, Rheumatology, and Clinical Immunology, University Hospital Tübingen, Germany
| | - Hannah Tamary
- The Rina Zaizov Hematology/Oncology Division, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Michail Spanoudakis
- Department of Hematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Warrington, United Kingdom
| | - Piero Farruggia
- Pediatric Onco-Hematology, ARNAS Civico Di Cristina Benfratelli Hospital, Palermo, Italy
| | - Antonio Almeida
- Department of Hematology, Hospital da Luz Lisboa, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Daniela Guardo
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Petter Höglund
- Clinical Immunology and Transfusion Medicine Clinic, Karolinska University Hospital, Stockholm, Sweden
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jan Palmblad
- Center for Hematology and Regenerative Medicine (HERM), Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
- Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Ivo P. Touw
- Department of Hematology and Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Cornelia Zeidler
- Department of Oncology, Hematology, Immunology and Bone Marrow Transplantation, Hannover Medical School, Hannover, Germany
| | - Alan J. Warren
- Department of Hematology, University of Cambridge, United Kingdom
- Cambridge Institute for Medical Research, University of Cambridge, United Kingdom
- Wellcome Trust–Medical Research Council Stem Cell Institute, University of Cambridge, United Kingdom
| | | | - Karl Welte
- University Children’s Hospital Tübingen, Germany
| | - Carlo Dufour
- Unit of Hematology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Helen A. Papadaki
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete, Heraklion, Greece
- Department of Hematology, University Hospital of Heraklion, Crete, Greece
| |
Collapse
|
6
|
Ammon Shimano K, Noel P. Immunohematologic Disorders. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00062-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
|
7
|
Nepesov S, Yaman Y, Elli M, Bayram N, Ozdilli K, Ayaz A, Anak S. Chronic Neutropenia in Childhood: Laboratory and Clinical Features. Indian J Pediatr 2022; 89:894-898. [PMID: 35267133 DOI: 10.1007/s12098-022-04104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/12/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To describe the clinical characteristics of patients with chronic neutropenia. METHODS Data of 36 patients with chronic neutropenia, who were followed up in the authors' clinic between May 2013 and May 2020, were analyzed retrospectively. Patients were diagnosed based on their clinical and laboratory characteristics. RESULTS A total of 36 patients (23 females, 13 males) were included in the study. The mean age at diagnosis was 9.85 ± 9.17 mo while the mean follow-up time was 21.83 ± 20.03 mo. The mean absolute neutrophil count (ANC) at admission was 462.5 ± 388.8 cells/mm3 (median = 375 cells/mm3), and the lowest and highest ANC mean was 241.2 ± 262.1 cells/mm3 (median = 125 cells/mm3), and 1362.9 ± 1127.9 cells/mm3 (median = 925 cells/mm3), respectively. Idiopathic neutropenia was found in 28 (77.8%) patients, autoimmune neutropenia in 6 (16.7%) patients, and congenital neutropenia in 2 (5.6%) patients. Neutrophil normalization was observed in 19 (52.8%) of the patients. CONCLUSIONS Chronic neutropenia is a heterogeneous picture that presents with different clinical symptoms in childhood. The cause of neutropoenia in children is usually benign and resolves spontaneously but especially in those with severe neutropoenia genetic examination should be performed.
Collapse
Affiliation(s)
- Serdar Nepesov
- Department of Pediatric Allergy and Immunology, İstanbul Medipol University, İstanbul, 34214, Turkey.
| | - Yontem Yaman
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Murat Elli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Nihan Bayram
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Kursat Ozdilli
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| | - Akif Ayaz
- Department of Medical Genetics, İstanbul Medipol University, İstanbul, Turkey
| | - Sema Anak
- Department of Pediatric Hematology and Oncology, İstanbul Medipol University, İstanbul, Turkey
| |
Collapse
|
8
|
Late-onset and long-lasting autoimmune neutropenia: an analysis from the Italian Neutropenia Registry. Blood Adv 2021; 4:5644-5649. [PMID: 33206964 DOI: 10.1182/bloodadvances.2020002793] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/03/2020] [Indexed: 12/14/2022] Open
Abstract
Primary autoimmune neutropenia (pAN) is typified by onset in early infancy and a mild/moderate phenotype that resolves within 3 years of diagnosis. In contrast, secondary AN is classically an adult disease associated with malignancy, autoimmunity, immunodeficiency, viral infection, or drugs. This study describes a cohort of 79 children from the Italian Registry who, although resembling pAN, did not fully match the criteria for pAN because neutropenia either appeared after age 5 years (LO-Np) or lasted longer than 3 years (LL-Np). These 2 categories compared with classical pAN showed a far inferior rate of resolution (P < .001), lower severity of neutropenia (P = .03), leukopenia (P < .001), lymphopenia (P < .001) with low B+ (P = .001), increased need of granulocyte colony-stimulating factor (P = .04), and increased frequency of autoimmunity over the disease course (P < .001). A paired comparison between LO-Np and LL-Np suggested that LO-Np had a lower rate of resolution (P < .001) and lower white blood cell (P < .001) and lymphocyte (P < .001) values, higher occurrence of apthae (P = .008), and a stronger association with autoimmune diseases/markers (P = .001) than LL-Np, thus suggesting a more pronounced autoimmune signature for LO-Np. A next-generation sequencing panel applied in a small subgroup of LO-Np and LL-Np patients identified variants related to immune dysregulations. Overall, these findings indicate that there are important differences among pAN LL-Np and LO-Np. Forms rising after 3 years of age, with low tendency to resolution, require tight monitoring and extensive immune investigations aimed to early identify underlying immunologic disease.
Collapse
|
9
|
Nielsen KR, Bojsen SR, Masmas TN, Fjordside AL, Baech J, Haunstrup TM, Steffensen R. Association between human leukocyte antigens (HLAs) and human neutrophil antigens (HNAs) and autoimmune neutropenia of infancy in Danish patients. Pediatr Allergy Immunol 2021; 32:756-761. [PMID: 33421202 PMCID: PMC8248029 DOI: 10.1111/pai.13450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Autoimmune neutropenia of infancy (AIN) is a frequent cause of neutropenia in children. The disease is caused by antibodies against epitopes on the immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb). We investigated the possible association of human neutrophil antigens (HNA), human leukocyte antigen (HLA)-DR, and HLA-DQ alleles with AIN and the association of these genotypes with the presence of autoantibodies. METHODS Eighty AIN cases with a median age of 13.5 months were included. Controls were healthy unrelated Danish blood donors. Anti-HNA-1a autoantibodies were detected using a flow cytometric granulocyte immunofluorescence test (Flow-GIFT) with phenotyped donor cells for detection of antibody specificity. Molecular determination of HNA genotypes was determined using real-time polymerase chain reaction (q-PCR). High-resolution HLA-DRB1 and HLA-DQB1 were determined by next-generation sequencing. RESULTS Antibodies against HNA-1a were detected in 51% (n = 41) of AIN patients, and anti-HNA-1b was detected in 3% (n = 2) of cases. In 46% of cases, the antibodies were anti-FcγIIIb-reactive. FCGR3B*01+,*02-,*03- was more common (odds ratio, 6.70; P < .0001), and FCGR3B*01-,*02+,*03- was less common (odds ratio, 0.30; P < .0001) among AIN cases. HNA-1a antibodies were significantly more frequent among AIN cases with the FCGR3B*01+,*02-,*03- genotype (odds ratio, 3.86; P < .007). The HLA-DRB1*14 - HLA-DQB1*05:03 haplotype was significantly more common (odds ratio, 7.44; P < .0001) in AIN patients. CONCLUSION The HLA haplotype HLA-DRB1*14 - DQB1*05:03 is associated with Danish AIN cases. Among Danish AIN patients, anti-HNA-1a is the most common autoantibody, and the antibody is more common in cases with the FCGR3B*01+,*02-,*03- genotype.
Collapse
Affiliation(s)
- Kaspar René Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Signe Rolskov Bojsen
- Department of Clinical Genetics, Sygehus Lillebaelt Vejle Hospital, Vejle, Denmark
| | - Tania Nicole Masmas
- Pediatric Hematopoietic Stem Cell Transplantation and Immunodeficiency, The Child and Adolescent Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - John Baech
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Thure Mors Haunstrup
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Rudi Steffensen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
10
|
Diagnosis of autoimmune neutropenia in a 10-month-old boy - a case report. Cent Eur J Immunol 2021; 46:118-120. [PMID: 33897293 PMCID: PMC8056352 DOI: 10.5114/ceji.2021.104327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
Neutropenia, congenital or acquired, is related to impaired granulocyte production in the bone marrow or increased destruction by antibodies. Autoimmune neutropenia of infancy (AIN) is associated with the occurrence of antineutrophil antibodies. AIN is the most common cause of neutropenia in infants and young children. However, its incidence is low. Detection of anti-neutrophil antibodies is an important step in confirming the diagnosis of AIN, although their detection is difficult due to low titer and poor avidity. In differential diagnosis, another cause of neutropenia should be considered, such as a drug-induced mechanism, viral infection, autoimmune and metabolic disease, hematological conditions or immune deficiency syndromes. Despite the benign course of AIN, serious infectious complications can occur. Spontaneous remission of neutropenia was observed in 95% of patients during 24 months of follow-up. We present a case of a 10-month-old boy with deafness, heart defect and Morgagni-Larrey hernia diagnosed in our department because of formation of a skin abscess due to autoimmune neutropenia.
Collapse
|
11
|
Kirk SE, Grimes AB, Shelke S, Despotovic JM, Powers JM. The cost of a "benign" condition: Healthcare utilization and infectious outcomes in young children with primary autoimmune neutropenia. Pediatr Blood Cancer 2020; 67:e28146. [PMID: 31886613 DOI: 10.1002/pbc.28146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Autoimmune neutropenia (AIN) is a common cause of chronic neutropenia in childhood. Despite an expected benign clinical course, many patients undergo extensive evaluation. Data on healthcare utilization and rates of bloodstream infections in young patients with AIN are limited. METHODS All patients with a diagnosis code of leukopenia, neutropenia, or AIN followed within the outpatient hematology clinic of a single institution from 2014 to 2016 were identified. Patients aged ≤5 years with absolute neutrophil count (ANC) ≤500/µL persisting for ≥3 months, a clinical diagnosis of AIN, and documented resolution of neutropenia were included. Data on clinical management, including infectious outcomes and emergency center (EC) encounters, were collected. RESULTS Forty-three patients with AIN (18 male [42%], median age at diagnosis 12 months) met eligibility criteria. Children were followed by hematology for a median duration of 18 (range, 2-85) months. Diagnostic evaluations were variable. Thirty patients (70%) had ≥ 1 EC encounters for evaluation of isolated fever with a total of 113 EC encounters for the overall cohort. Patients with ANC < 500/µL and isolated fever were admitted for observation, which resulted in 24 hospitalizations in 16 patients. Of 138 blood cultures drawn, two were positive, both later determined to be contaminants. CONCLUSION At a large tertiary care center, no bloodstream infections were identified in a cohort of 43 children with AIN presenting to the EC for assessment of fever. A less-intensive, more cost-effective management paradigm, which continues to prioritize patient safety, among young children with AIN is needed.
Collapse
Affiliation(s)
- Susan E Kirk
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Amanda Bell Grimes
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | | | - Jenny M Despotovic
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| | - Jacquelyn M Powers
- Baylor College of Medicine, Department of Pediatrics, Section of Hematology/Oncology, Houston, Texas.,Texas Children's Cancer and Hematology Centers, Houston, Texas
| |
Collapse
|
12
|
The Role of Anti-Neutrophil Antibodies in the Etiologic Classification of Childhood Neutropenia: A Cross-Sectional Study in a Tertiary Center. J Pediatr Hematol Oncol 2020; 42:107-112. [PMID: 31895216 DOI: 10.1097/mph.0000000000001710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Infections, drugs, malignancies, immunodeficiency, and autoimmunity may cause neutropenia. In primary autoimmune neutropenia, anti-neutrophil antibodies (ANeuA) bind to membrane antigens of neutrophils, which give rise to peripheral destruction of neutrophils. However, it is not always easy to detect these antibodies. This study aims to investigate the etiology of neutropenia, and at the same time to evaluate the immune mechanisms by ANeuA testing using granulocyte indirect immunofluorescence test. In our study, 310 neutropenic patients who were between 3 months and 18 years of age were evaluated. ANeuA screening tests were performed in 108 neutropenic patients (group 1), and these patients were divided into 2 subgroups as persistent neutropenia (group 1P, n=12) and recovered neutropenia (group 1R, n=96). Besides, a control group in the same age range was formed, consisting of 39 non-neutropenic children (group 2). ANeuA serum levels were also checked in these groups, and no statistically significant difference could be found between groups 1 and 2, or between groups 1P and 1R, regarding ANeuA levels. As a conclusion, our study was the first comprehensive research in Turkey investigating the large-scale etiology of neutropenia. Moreover, while ANeuA screening tests did not provide sufficient insight for immune neutropenia, we argue that it is not necessary for routine use and that further research in the etiology of neutropenia is required.
Collapse
|
13
|
Unis GD, Carlson JC, Warrier RP. Febrile Neutropenia in an Infant. Clin Pediatr (Phila) 2019; 58:828-830. [PMID: 30939925 DOI: 10.1177/0009922819841020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Graham D Unis
- 1 Ochsner Children's Hospital, New Orleans, LA, USA.,2 University of Queensland, Brisbane, Queensland, Australia
| | | | - Rajasekharan P Warrier
- 1 Ochsner Children's Hospital, New Orleans, LA, USA.,2 University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
14
|
Timeus F, Crescenzio N, Foglia L, Doria A, Stillitano MG, Garelli E, Mazzone R, Vivalda L, Vallero S, Ramenghi U, Saracco P. Reduction of CFU-GM and circulating hematopoietic progenitors in a subgroup of children with chronic neutropenia associated with severe infections and delayed recovery. PLoS One 2019; 14:e0213782. [PMID: 30870474 PMCID: PMC6417780 DOI: 10.1371/journal.pone.0213782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/01/2019] [Indexed: 01/27/2023] Open
Abstract
Myelopoiesis was evaluated in 66 pediatric patients with chronic neutropenia who were positive for anti-neutrophil antibodies (median age at diagnosis: 11 months, median neutrophil count at diagnosis: 419/μl). Other causes of neutropenia were excluded. Bone marrow morphology, clonogenic tests and/or the peripheral blood CD 34+ cell count, and apoptotic rate were evaluated in 61 patients with neutropenia lasting > 12 months or severe infections. The peripheral blood CD 34+ cell count and apoptotic rate were evaluated in five patients with shorter neutropenia. The median follow-up time was 29 months (range 7-180 months). Forty-seven patients (71.2%) had a spontaneous recovery after 7-180 months (median 29 months). The group of patients younger than 24 months at diagnosis (n = 50) had a higher probability of recovery (40/50 vs. 7/16 χ2 p<0.01) with a shorter period of neutropenia (median 26 versus 47 months, Kaplan-Meier analysis p = 0.001). The colony-forming units-granulocyte-macrophage (CFU-GM) were significantly decreased in 26/35 patients (74%) evaluated for clonogenic tests. All patients with normal CFU-GM recovered (9/9 patients); whereas, neutropenia persisted in 12/26 patients with reduced CFU-GM (46%, Pearson χ2 p = 0.02). In 36/55 (65%) patients evaluated by flow cytometry we observed reduced circulating CD34+ cells compared with controls of the same age. An increase in the circulating CD34+ cell apoptotic rate was observed in 28/55 patients (51%). Infections requiring hospitalization were observed in 9/18 (50%; Pearson χ2, p = 0.03) patients with both decreased circulating CD34+ cells and increased CD34+ apoptotic rates. In the group aged < 24 months, we observed a significant correlation between the persistence of neutropenia and decreased circulating CD34+ cells (Pearson χ2 p = 0.008). In conclusion, reduced CFU-GM and circulating hematopoietic progenitors were observed in a subgroup of children with chronic neutropenia who were positive for anti-neutrophil antibodies and had a higher incidence of severe infections and delayed spontaneous remission.
Collapse
Affiliation(s)
- Fabio Timeus
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Turin, Italy
- * E-mail:
| | - Nicoletta Crescenzio
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Luiselda Foglia
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Alessandra Doria
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | | | - Emanuela Garelli
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Raffaela Mazzone
- Biochemistry Laboratory, Regina Margherita Children Hospital, Turin, Italy
| | - Laura Vivalda
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Stefano Vallero
- Pediatric Onco-Hematology, Regina Margherita Children Hospital, Turin, Italy
| | - Ugo Ramenghi
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Paola Saracco
- Pediatric Hematology, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| |
Collapse
|
15
|
Farruggia P, Fioredda F, Puccio G, Onofrillo D, Russo G, Barone A, Bonanomi S, Boscarol G, Finocchi A, Ghilardi R, Giordano P, Ladogana S, Lassandro G, Luti L, Lanza T, Mandaglio R, Marra N, Martire B, Mastrodicasa E, Motta M, Notarangelo LD, Pillon M, Porretti L, Serafinelli J, Trizzino A, Tucci F, Veltroni M, Verzegnassi F, Ramenghi U, Dufour C. Idiopathic neutropenia of infancy: Data from the Italian Neutropenia Registry. Am J Hematol 2019; 94:216-222. [PMID: 30456824 DOI: 10.1002/ajh.25353] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/27/2018] [Accepted: 11/12/2018] [Indexed: 01/13/2023]
Abstract
Autoimmune neutropenia of infancy (AIN) is characterized by low risk of severe infection, tendency to spontaneously resolve and typically onset at ≤4-5 years of age; it is due to auto-antibodies whose detection is often difficult. In case of negativity of 4 antineutrophils autoantibody tests, after having excluded ethnic, postinfection, drug induced, or congenital neutropenia, according to the Italian guidelines the patients will be defined as affected by "idiopathic neutropenia" (IN). We describe the characteristics of 85 IN patients enrolled in the Italian neutropenia registry: they were compared with 336 children affected by AIN. The 2 groups were clinically very similar and the main differences were detection age (later in IN), length of disease (longer in IN) and, among recovered patients, age of spontaneous recovery: the median age at resolution was 2.13 years in AINs and 3.03 years in INs (P = .00002). At bivariate analysis among AIN patients earlier detection age (P = .00013), male sex (P = .000748), absence of leucopenia (P = .0045), and absence of monocytosis (P = .0419) were significantly associated with earlier recovery; in the IN group only detection age (P = .013) and absence of monocytosis (P = .0333) were significant. At multivariate analysis detection age and absence of monocytosis were independently significant (P = 6.7e-05 and 4.4e-03, respectively) in the AIN group, whereas in the IN group only detection age stayed significant (P = .013).
Collapse
Affiliation(s)
- Piero Farruggia
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Francesca Fioredda
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | - Giuseppe Puccio
- Department of Sciences for Health Promotion; University of Palermo; Palermo Italy
| | - Daniela Onofrillo
- Pediatric Hematology and Oncology Unit, Department of Hematology; Spirito Santo Hospital; Pescara Italy
| | - Giovanna Russo
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Angelica Barone
- Department of Pediatric Onco-Hematology; University Hospital; Parma Italy
| | - Sonia Bonanomi
- MBBM Foundation, Department of Pediatrics; University of Milano - Bicocca; Monza Italy
| | - Gianluca Boscarol
- Department of Pediatrics; Central Teaching Hospital Bolzano; Bolzano Italy
| | | | - Roberta Ghilardi
- Department of Pediatrics; Ospedale Maggiore Policlinico IRCCS; Milan Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Saverio Ladogana
- Department of Hematology; IRCCS Casa Sollievo della Sofferenza; San Giovanni Rotondo Italy
| | - Giuseppe Lassandro
- Department of Biomedical Sciences and Human Oncology; Pediatric Section, University "A. Moro" of Bari; Bari Italy
| | - Laura Luti
- Pediatric Hematology Oncology; Bone Marrow Transplant, Azienda Ospedaliero Universitaria Pisana, S. Chiara Hospital; Pisa Italy
| | - Tiziana Lanza
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| | | | | | - Baldassare Martire
- Pediatric Science and Surgery Department; Pediatric Onco-Hematology Unit, Hospital Policlinico- Giovanni XXIII; Bari Italy
| | - Elena Mastrodicasa
- Pediatric Oncology Hematology Unit; S. Maria Della Misericordia Hospital; Perugia Italy
| | - Milena Motta
- Pediatric Hematology and Oncology Unit, Azienda Policlinico-Vittorio Emanuele; University of Catania; Catania Italy
| | - Lucia Dora Notarangelo
- Onco-Haematology and Bone Marrow Transplantation Unit; Children's Hospital; Brescia Italy
| | - Marta Pillon
- Pediatric Onco-Hematology Department; University of Padova; Padova
| | - Laura Porretti
- Flow Cytometry Service; Laboratory of Clinical Chemistry and Microbiology, IRCCS “Ca‘ Granda” Foundation, Maggiore Hospital Policlinico; Milan Italy
| | | | - Angela Trizzino
- Pediatric Hematology and Oncology Unit; A.R.N.A.S. Ospedale Civico; Palermo Italy
| | - Fabio Tucci
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Marinella Veltroni
- Department of Pediatric Onco-Hematology; Meyer Children's Hospital; Florence Italy
| | - Federico Verzegnassi
- Institute for Maternal and Child Health (I.R.C.C.S) Burlo Garofolo; Trieste Italy
| | - Ugo Ramenghi
- Department of Pediatric and Public Health Sciences; University of Torino; Italy
| | - Carlo Dufour
- Clinical and Experimental Unit G. Gaslini Children's Hospital; Genoa Italy
| |
Collapse
|
16
|
Flesch BK, Reil A. Molecular Genetics of the Human Neutrophil Antigens. Transfus Med Hemother 2018; 45:300-309. [PMID: 30498408 PMCID: PMC6257083 DOI: 10.1159/000491031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/17/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Antibodies to human neutrophil antigens (HNAs) have been implicated in transfusion-related acute lung injury and allo- and autoimmune neutropenia. To date, five HNA systems are assigned, and during the last decades enormous efforts have been undertaken to identify the underlying genes and to characterize the antigens. This review of the literature will provide the current genetic, molecular and functional information on HNAs. RECENT FINDINGS New information on alleles and antigens has been added to nearly each of the five HNA systems. HNA-1d has been added as the antithetical epitope to HNA-1c that is located on the glycoprotein encoded by FCGR3B*02 but not by FCGR3B. FCGR3B*04 and *05 now are included as new alleles. A CD177*787A>T substitution was demonstrated as the main reason for the HNA-2-negative phenotype on neutrophils. The target glycoprotein of HNA-3 antibodies could be identified as choline transporter-like protein 2 (CTL2) encoded by SLC44A2. The conformation sensitive epitope discriminates between arginine and glutamine at position 152 resulting in HNA-3a and HNA-3b. An additional Leu151Phe substitution can impair HNA-3a antibody binding. Recently an alloantibody against HNA-4b which discriminates from HNA-4a by an Arg61His exchange of the glycoprotein encoded by the ITGAM gene was reported in neonatal alloimmune neutropenia. An update of the current HNA nomenclature based on the new findings was provided in 2016 by the ISBT Granulocyte Immunobiology Working Party nomenclature subcommittee. CONCLUSIONS The molecular basis of each of the five HNA antigen systems has been decoded during the past decades. This enables reliable molecular typing strategies, antibody detection and specification as well as development of new assays based on recombinant antigens. However, research on HNA alleles, antigens, and antibodies is not finally terminated and also in the future will add new findings.
Collapse
|
17
|
Porretti L, Farruggia P, Colombo FS, Cattaneo A, Ghilardi R, Mirra N, Notarangelo LD, Martire B, Trombetta E, Milani S, Vener C, Rebulla P. Diagnostic value of cell bound and circulating neutrophil antibody detection in pediatric neutropenia. Pediatr Blood Cancer 2018; 65. [PMID: 29230955 DOI: 10.1002/pbc.26904] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic benign neutropenia of infancy includes primary autoimmune neutropenia (pAIN) and chronic idiopathic neutropenia (CIN). A diagnosis of CIN is supported by the absence of free and/or cell-bound neutrophil autoantibodies, which can be detected by flow cytometry with the indirect-granulocyte immunofluorescence test (I-GIFT) and direct-granulocyte immunofluorescence test (D-GIFT), respectively. Conclusive evidence is lacking on the diagnostic value of the D-GIFT, whose performance requires specific laboratory expertise, may be logistically difficult, and hampered by very low neutrophil count in patient samples. This study investigated whether the evaluation of D-GIFT improves the diagnostic accuracy of pediatric neutropenia. PROCEDURE I-GIFT and D-GIFT were performed in 174 pAIN, 162 CIN, 81 secondary AIN, 51 postinfection neutropenic, and 65 nonautoimmune neutropenic children referred to this laboratory during 2002-2014. RESULTS Using 90% specific median fluorescence intensity cut-off values calculated by receiver operating characteristic curves, D-GIFT was positive in 49% of CIN patients, who showed similar clinical features as those with pAIN. In 44 (27%) of 162 CIN patients, I-GIFT was repeated two to three times in a year, resulting positive in 12 and two patients at second and third screening, respectively. Interestingly, 10 of the latter 14 patients showed a positive D-GIFT at the first serological screening. False positive D-GIFT was shown by 12% and 22% of nonneutropenic and nonautoimmune neutropenic patients, respectively. CONCLUSIONS D-GIFT evaluation improves the diagnostic accuracy of pediatric neutropenia, but improvement of cell-bound antibody detection is needed to decrease false positive results.
Collapse
Affiliation(s)
- Laura Porretti
- Flow Cytometry Service, Service Department, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Piero Farruggia
- Pediatric Hematology and Oncology Unit, Oncology Department, A.R.N.A.S. Ospedale Civico Di Cristina e Benfratelli, Palermo, Italy
| | - Federico Simone Colombo
- Flow Cytometry Service, Service Department, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Cattaneo
- Flow Cytometry Service, Service Department, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Ghilardi
- Pediatric Hematology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nadia Mirra
- Pediatric Hematology, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Baldassarre Martire
- Pediatric Oncology and Onco-Hematology Unit, Azienda Ospedaliero Universitaria Policlinico Giovanni XXIII, Bari, Italy
| | - Elena Trombetta
- Flow Cytometry Service, Service Department, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Milani
- Laboratory of Medical Statistics, Biometry and Epidemiology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Claudia Vener
- Laboratory of Medical Statistics, Biometry and Epidemiology, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Paolo Rebulla
- Blood Transfusion Center, IRCCS Foundation Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
18
|
Yabushita T, Hiramoto N, Ono Y, Yoshioka S, Karakawa S, Kobayashi M, Ishikawa T. Adult-onset primary cyclic autoimmune neutropenia: a case report. Transfusion 2018; 58:884-890. [DOI: 10.1111/trf.14513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Tomohiro Yabushita
- Department of Hematology; Kobe City Medical Center General Hospital; Chuo-ku Kobe Japan
| | - Nobuhiro Hiramoto
- Department of Hematology; Kobe City Medical Center General Hospital; Chuo-ku Kobe Japan
| | - Yuichiro Ono
- Department of Hematology; Kobe City Medical Center General Hospital; Chuo-ku Kobe Japan
| | - Satoshi Yoshioka
- Department of Hematology; Kobe City Medical Center General Hospital; Chuo-ku Kobe Japan
| | - Shuhei Karakawa
- Department of Pediatrics; Hiroshima University Hospital; Hiroshima Japan
| | - Masao Kobayashi
- Department of Pediatrics; Hiroshima University Hospital; Hiroshima Japan
| | - Takayuki Ishikawa
- Department of Hematology; Kobe City Medical Center General Hospital; Chuo-ku Kobe Japan
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Neutropenia lasting for at least for 3 months and not attributable to drugs or a specific genetic, infectious, inflammatory, autoimmune or malignant cause is called chronic idiopathic neutropenia (CIN). CIN and autoimmune neutropenia (AIN) are very similar and overlapping conditions. The clinical consequences depend upon the severity of neutropenia, but it is not considered a premalignant condition. RECENT FINDINGS Long-term observational studies in children indicate that the disease often lasts for 3-5 years in children, then spontaneously remits, but it rarely remits in adult cases. The value of antineutrophil antibody testing in both children and adults is uncertain. Most recent data suggest that CIN and AIN are immune-mediated diseases, but there are no new clinical or genetic tests to aid in diagnosis. Treatment with granulocyte colony stimulating factor (G-CSF) is effective to increase blood neutrophils in almost all cases; this treatment is reserved, however, for patients with both neutropenia and evidence of recurrent fevers, inflammatory symptoms and infections. There is little or no evidence to indicate that G-CSF treatment predisposes to myeloid malignancies in this population. SUMMARY It is important to recognize CIN and AIN, the most common causes of chronic neutropenia in both children and adults. If the neutropenia is not severe, that is more than 0.5 × 10/l, most patients can be observed and not treated prophylactically with antibiotics or a growth factor. When neutropenia is severe, treatment with G-CSF is often beneficial.
Collapse
Affiliation(s)
- David C. Dale
- University of Washington, Department of Medicine, Seattle, WA
| | - Audrey Anna Bolyard
- Severe Chronic Neutropenia International Registry, University of Washington, Department of Medicine, Seattle, WA
| |
Collapse
|
20
|
Newburger PE. Autoimmune and other acquired neutropenias. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2016; 2016:38-42. [PMID: 27913460 PMCID: PMC5380382 DOI: 10.1182/asheducation-2016.1.38] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This educational review addresses the diagnostic evaluation of patients for autoimmune and other forms of acquired neutropenia, including the futility of deconstructing the overlap of chronic "autoimmune," "benign," and "idiopathic" categories. Isolated neutropenias caused by infection, drugs, and immunologic disorders are also addressed. Discussion of management options emphasizes a conservative approach, with largely supportive care for these mostly benign and self-limited disorders.
Collapse
Affiliation(s)
- Peter E Newburger
- Departments of Pediatrics and Molecular, Cell, and Cancer Biology, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
21
|
Suh MC, Suh JS, Won DI. A Novel Flow Cytometric Method for the Simultaneous Detection of Antibodies Against Platelet, Lymphocyte, And Neutrophil. CYTOMETRY PART B-CLINICAL CYTOMETRY 2016; 94:281-290. [DOI: 10.1002/cyto.b.21483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/30/2016] [Accepted: 09/09/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Myung Chul Suh
- Department of Clinical Pathology; Kyungpook National University School of Medicine; Daegu Republic of Korea
| | - Jang Soo Suh
- Department of Clinical Pathology; Kyungpook National University School of Medicine; Daegu Republic of Korea
| | - Dong Il Won
- Department of Clinical Pathology; Kyungpook National University School of Medicine; Daegu Republic of Korea
| |
Collapse
|
22
|
Farruggia P, Dufour C. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians. Ther Adv Hematol 2015; 6:15-24. [PMID: 25642312 DOI: 10.1177/2040620714556642] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3-4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management.
Collapse
Affiliation(s)
- Piero Farruggia
- Pediatric Onco-Hematology Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospitals, Piazza N. Leotta 4, Palermo, Italy
| | - Carlo Dufour
- Clinical and Experimental Hematology Unit, G. Gaslini Children's Hospital, Genoa, Italy
| |
Collapse
|
23
|
Kongmaroeng C, Kumkaen K. FCGR3B gene frequencies among ethnic Thai blood donors from a regional hospital in Eastern Thailand. ACTA ACUST UNITED AC 2015; 85:127-31. [PMID: 25626603 DOI: 10.1111/tan.12511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 11/10/2014] [Accepted: 12/14/2014] [Indexed: 01/07/2023]
Abstract
The FCGR3B gene encodes three human neutrophil antigens which consist of HNA-1a, HNA-1b, and HNA-1c. These antigens are encoded by three alleles in the FCGR3B locus: FCGR3B*01, FCGR3B*02, and FCGR3B*03 alleles, respectively. The frequencies of FCGR3B alleles have been reported in different ethnic populations. This study compared the FCGR3B gene frequencies among 230 unrelated healthy Eastern Thai blood donors in Rayong hospital with the previously published studies. The polymerase chain reaction-sequence-specific primers method was performed to determine FCGR3B genotypes. The results showed that the allele frequencies of FCGR3B*01, FCGR3B*02, and FCGR3B*03 were 0.722, 0.274, and 0.009, respectively. The FCGR3B*01 and FCGR3B*02 frequencies found in the Eastern Thais were similar to the previous reports investigating in Northern Thais, Chinese Han, Taiwanese, and Japanese populations. Interestingly, our data showed statistically significant difference (P < 0.05) to Central Thais, Korean, Indian, Turkish, Australian, Tunisian, American, German, and Italian populations. In addition, one FCGR3Bnull , which represents a gene deletion, was also found in this study. This information is important not only for the assessment of neutrophil antibody-mediated clinical conditions and for disease association studies but also for anthropological studies.
Collapse
Affiliation(s)
- C Kongmaroeng
- Division of Blood Bank, Faculty of Medical Technology, Huachiew Chalermprakiet University, Bangplee, Thailand
| | | |
Collapse
|
24
|
Abstract
Isolated neutropenia is a common clinical problem seen by primary care physicians and hematologists. The evaluation of neutropenia is dictated by the acuity of the clinical presentation and the duration, age, and clinical status of the patient. In this review, we provide a practical approach to the evaluation of the adult patient with neutropenia, with the major focus on the evaluation of neutropenia in the outpatient setting.
Collapse
|
25
|
Abstract
Neutropenia in infancy and childhood poses a diagnostic challenge as the aetiology ranges from acute life-threatening conditions to chronic benign diseases. Chronic benign neutropenia of infancy is a rare disorder occurring in 1:100,000. The neutrophil count continues to be low for a prolonged period until spontaneous resolution by the age of 3-4 years. Such infants are having higher incidences of minor infections requiring treatment with antibiotics and rare incidences of meningitis and sepsis. The authors describe an infant presenting with fever and cervical lymphadenitis, who was found to have isolated severe neutropenia and its persistence posing a diagnostic challenge. The prolonged course with minor infections and absence of serious underlying conditions finally confirmed chronic benign neutropenia of infancy.
Collapse
Affiliation(s)
- Ramesh Y Bhat
- Department of Paediatrics, Kasturba Medical College, Manipal, Karnataka, India
| | | | | |
Collapse
|
26
|
Abstract
Neutropenia, defined as an absolute neutrophil count (ANC) <1.5 × 10(9)/L, encompasses a wide range of diagnoses, from normal variants to life-threatening acquired and congenital disorders. This review addresses the diagnosis and management of isolated neutropenia, not multiple cytopenias due to splenomegaly, bone marrow replacement, or myelosuppression by chemotherapy or radiation. Laboratory evaluation generally includes repeat complete blood cell counts (CBCs) with differentials and bone marrow examination with cytogenetics. Neutrophil antibody testing may be useful but only in the context of clinical and bone marrow findings. The discovery of genes responsible for congenital neutropenias now permits genetic diagnosis in many cases. Management of severe chronic neutropenia includes commonsense precautions to avoid infection, aggressive treatment of bacterial or fungal infections, and administration of granulocyte colony-stimulating factor (G-CSF). Patients with severe chronic neutropenia, particularly those who respond poorly to G-CSF, have a risk of eventually developing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) and require monitoring for this complication, which also can occur without G-CSF therapy. Patients with cyclic, idiopathic, and autoimmune neutropenia have virtually no risk of evolving to MDS or AML. Hematopoietic stem cell transplantation is a curative therapy for congenital neutropenia with MDS/AML or with cytogenetic abnormalities indicating impending conversion.
Collapse
Affiliation(s)
- Peter E Newburger
- Departments of Pediatrics and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA.
| | | |
Collapse
|
27
|
Veldhuisen B, Porcelijn L, Ellen van der Schoot C, de Haas M. Molecular typing of human platelet and neutrophil antigens (HPA and HNA). Transfus Apher Sci 2014; 50:189-99. [PMID: 24685245 DOI: 10.1016/j.transci.2014.02.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Genotyping is an important tool in the diagnosis of disorders involving allo-immunisation to antigens present on the membranes of platelets and neutrophils. To date 28 human platelet antigens (HPAs) have been indentified on six polymorphic glycoproteins on the surface of platelets. Antibodies against HPAs play a role in foetal and neonatal alloimmune thrombocytopenia (FNAIT), post-transfusion purpura (PTP) and refractoriness to donor platelets. The 11 human neutrophil antigens (HNAs) described to date have been indentified on five polymorphic proteins on the surface of granulocytes. Antibodies to HNAs are implicated with foetal and neonatal alloimmune neutropenia (FNAIN), autoimmune neutropenia (AIN) and transfusion related acute lung injury (TRALI). In this report, we will review the molecular basis and techniques currently available for the genotyping of human platelet and neutrophil antigens.
Collapse
Affiliation(s)
- Barbera Veldhuisen
- Sanquin Diagnostic Services, Department of Diagnostic Immunohematology, Amsterdam, The Netherlands; Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - Leendert Porcelijn
- Sanquin Diagnostic Services, Department of Diagnostic Immunohematology, Amsterdam, The Netherlands
| | - C Ellen van der Schoot
- Sanquin Research, Department of Experimental Immunohematology, Amsterdam and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Masja de Haas
- Sanquin Diagnostic Services, Department of Diagnostic Immunohematology, Amsterdam, The Netherlands
| |
Collapse
|
28
|
Papadaki HA, Pontikoglou C. Pathophysiologic mechanisms, clinical features and treatment of idiopathic neutropenia. Expert Rev Hematol 2014; 1:217-29. [DOI: 10.1586/17474086.1.2.217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
29
|
Tzankov A, Dirnhofer S, Beham-Schmid C. Normales Knochenmark und häufige reaktive Veränderungen. DER PATHOLOGE 2012; 33:496-507. [DOI: 10.1007/s00292-012-1649-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
30
|
Nguyen XD, Scherpf R, Sassenhof F, Flesch B, Klüter H. Detection of granulocyte antibodies using simultaneous analysis of specific granulocyte antibodies assay (SASGA). Vox Sang 2011; 101:147-53. [PMID: 21463331 DOI: 10.1111/j.1423-0410.2011.01470.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Granulocyte-associated antibodies can cause several clinical granulocytopenic disorders. The monoclonal-antibody-specific immobilization of granulocyte antigens (MAIGA) is currently used as the standard assay to specify these antibodies. Here we describe an assay for specific analysis of granulocyte antibodies (SASGA) which is able to simultaneously detect and specify granulocyte IgG- and IgM-antibodies using flow cytometry. METHODS Bead populations with distinct fluorescence intensities were used as solid phase for immobilization of mAb. Typed granulocytes were incubated with human sera and a mix of three distinct mouse monoclonal antibodies against specific granulocyte antigens (for example CD16, CD11a, HLA class I). After cell lysis and incubation of lysate with beads, goat antibodies against human IgG and IgM antibodies were added. Seventy-one frozen sera of donors and patients previously implicated in transfusion reactions and various underlying disorders were analysed for specific granulocyte-binding antibodies using MAIGA and SASGA. RESULTS The SASGA assay was able to simultaneously detect granulocyte-specific antibodies for different glycoproteins. Overall, the results of MAIGA and SASGA were concordant in 92·9%. 5 sera containing anti-HNA-1b (n=2) and -HLA class I (n=3) were not detected by MAIGA, but were recognized by the SASGA. In serial dilution tests with sera containing anti-HNA-1a, -1b, -2a and HLA class I, the SASGA assay detected the antibodies at higher dilutions than MAIGA. CONCLUSION The SASGA assay permits reliable detection of specific granulocyte antibodies. Six distinct antibodies can be simultaneously determined. This method will potentially open the way to investigations on additional specific antibodies as it facilitates laboratory diagnosis.
Collapse
Affiliation(s)
- X D Nguyen
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, German Red-Cross Blood Service of Baden-Württemberg-Hessen, Germany.
| | | | | | | | | |
Collapse
|
31
|
|
32
|
Primary Autoimmune Neutropenia Uncovered by Methicillin-Resistant Staphylococcus aureus Osteomyelitis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181db80d8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
33
|
Wang LY, Wang CL, Chu CC, Lee HL, Ho HT, Liang DC, Liu HC, Lin M. Primary autoimmune neutropenia in children in Taiwan. Transfusion 2009; 49:1003-6. [PMID: 19210322 DOI: 10.1111/j.1537-2995.2008.02084.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Autoimmune neutropenia in children is caused by granulocyte-specific autoantibodies. These antibodies react to the patient's own neutrophils but disappear when the neutropenia spontaneously remits. This study reviewed our experience with autoimmune neutropenia in children and investigated possible associations with HLA-DR and HLA-DQ alleles. STUDY DESIGN AND METHODS From 1993 to 2006, our laboratory received 155 blood samples from children with neutropenia. Of these samples, 55 had granulocyte-specific autoantibodies on the indirect granulocyte immunofluorescence test. As the children had no other disorders associated with neutropenia, they were diagnosed with primary autoimmune neutropenia. HLA-DRB1 and -DQB1 allele typing was performed in 31 cases, and the results were compared with those of 190 normal healthy unrelated Taiwanese controls. RESULTS The mean ages of onset and resolution of neutropenia were 9.8 months (median, 9.0 months; range, 4-28 months) and 22.5 months (median, 20.0 months; range, 13-44 months), respectively. The male-to-female ratio was 1.2:1. The mean absolute neutrophil count was 190 per microL (standard deviation, 213/microL). Most patients (74%) had antibodies against HNA-1a. Autoimmune neutropenia in children in Taiwan was significantly associated with HLA-DQB1*0503 (odds ratio, 6.48; p = 0.0002; p(c) = 0.003) allele. CONCLUSION In Taiwan, autoimmune neutropenia in children is associated with HLA-DQB1*0503. The autoantibody in autoimmune neutropenia is most commonly anti-HNA-1a.
Collapse
Affiliation(s)
- Lin-Yen Wang
- Pediatric Hematology-Oncology, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Vlacha V, Feketea G. The clinical significance of non-malignant neutropenia in hospitalized children. Ann Hematol 2007; 86:865-70. [PMID: 17653547 DOI: 10.1007/s00277-007-0346-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 07/03/2007] [Indexed: 12/20/2022]
Abstract
Neutropenia in non-cancer patients is often discovered in the course of an evaluation for acute infection, and it is usually secondary to the infection itself rather than a predisposing factor of the infection. Although it is not a common finding in hospitalized pediatric patients, it causes a great concern to the treating physicians. The aim of this study was to determine the incidence, the etiology, and the clinical significance of neutropenia in previously healthy children admitted in a general pediatric ward. One thousand five hundred and forty-eight patients admitted during a period of 18 months were included in the study. The clinical characteristics, the complete blood count, and the sedimentation rate were recorded. A total of 143 (9.2%) pediatric patients were identified as neutropenic, with mean absolute neutrophilic count of 0.960 x 10(9)/l (SD 0.341 x 10(9)/l) and ranged from 0.200 to 1.499 x 10(9)/l. The neutropenic patients had lower hemoglobin of 11.2 mg/dl and ranged from 6.2 to 17.2 mg/dl compared to hemoglobin of 11.5 mg/dl, which ranged from 5.2 to 18.0 mg/dl of the individuals with normal neutrophils, p < 0.0001 and lower mean platelet count of 294 x 10(9)/l, which ranged from 122 to 929 x 10(9)/l compared to platelet count of 381 x 10(9)/l, which ranged from 90-165 x 10(9)/l of the individuals without neutropenia, p < 0.001. Additionally, those patients were significantly younger than the non-neutropenic ones. Infection was the most common cause of neutropenia, although none of them developed septicemia. The neutrophil count normalized in most of the patients before discharge. However, 12 (8.3%) of neutropenic patients were discharged with persistent findings. Two of those were finally diagnosed with autoimmune neutropenia. In conclusion, the acquired neutropenia in hospitalized patients without malignancy is mild to moderate. It has no influence on the clinical outcome. Importantly, it has short duration, and it is usually resolved before patient's discharge.
Collapse
Affiliation(s)
- Vasiliki Vlacha
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Patras School of Medicine, General University Hospital, 26504 Rion, Patras, Greece.
| | | |
Collapse
|
35
|
Yasui K, Miyazaki T, Matsuyama N, Kojima Y, Furuta RA, Fujisawa JI, Tani Y, Shibata H, Sato SI, Kato T, Ikeda H, Hirayama F. Establishment of cell lines stably expressing HNA-1a, -1b, and -2a antigen with low background reactivity in flow cytometric analysis. Transfusion 2007; 47:478-85. [PMID: 17319829 DOI: 10.1111/j.1537-2995.2006.01139.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antibodies to neutrophil antigens have been implicated in neonatal alloimmune neutropenia, autoimmune neutropenia, and transfusion-related acute lung injury. Most often, neutrophil-specific antibodies are directed toward human neutrophil antigen (HNA)-1 (Fcgamma receptor 3b) and HNA-2a (CD177) in these disorders. STUDY DESIGN AND METHODS To detect the alloantibodies in the serum samples, a panel of cell lines was established in which the HNA-1a, HNA-1b (polymorphisms of HNA-1), or HNA-2a gene was transduced with a retrovirus vector to confer stable transgene expression in K562 cells that exhibited low background reactivity to human serum samples obtained from healthy donors in flow cytometric analysis. RESULTS It was shown that several well-characterized human serum samples containing antibodies against HNA-1a, -1b, and -2a were unambiguously identified by the established panel cell lines and observed a lower background reactivity and longer shelf life of the K562 panel cell lines compared with isolated neutrophils, which have been used for the cell panel to identify antibodies against HNA in human serum samples. CONCLUSION These results indicate that the K562 panel cell lines provide a good panel for detecting HNA-reactive neutrophil antibodies in human serum samples.
Collapse
Affiliation(s)
- Kazuta Yasui
- Japanese Red Cross Osaka Blood Center, and the Kansai Medical University, Osaka, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
AbstractThis review of disorders of neutrophil number and function will discuss important research advances in the field and then provide a clinical diagnostic approach. The focus will be on two recent clinical developments in the field of phagocyte disorders. First, an important natural history study from the Severe Chronic Neutropenia International Registry has recently quantitated the incidence and risk factors for death from sepsis and for progression to myelodysplastic syndrome and acute myeloid leukemia in a large cohort of severe chronic neutropenia patients, many of whom were followed 10 or more years on treatment with granulocyte colony-stimulating factor. Second, in the past year, a multinational group has announced successful gene therapy of two adults with chronic granulomatous disease, the most common disorder of neutrophil function. However, monitoring of retroviral insertion sites revealed expansion of the multiclonal population of gene-modified cells, raising concerns about eventual leukemogenesis. The review also provides a pragmatic approach to the evaluation of a patient with a suspected disorder of neutrophil number or function.
Collapse
Affiliation(s)
- Peter E Newburger
- Department of Pediatrics, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA.
| |
Collapse
|