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Kamada H, Takahashi D, Shimizu M, Uchida M, Watanabe Y, Nakajima F, Miyata S, Satake M. A novel immunocomplex capture fluorescence assay (ICFA) using fluorescent beads and transfected cells for specific identification of human neutrophil antigen (HNA)-1a and -1b antibodies. Transfusion 2024; 64:906-918. [PMID: 38530740 DOI: 10.1111/trf.17813] [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: 04/13/2023] [Revised: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND To identify specific human neutrophil antigen (HNA) antibodies, assays using neutrophils such as monoclonal antibody-specific immobilization of granulocyte antigens (MAIGA) are recommended. However, these assays are limited by labor-intensive neutrophil preparation and varying antigen expression levels. METHODS We evaluated a newly developed immunocomplex capture fluorescence assay (ICFA) for identifying HNA-1 antibodies and compared it to MAIGA and LABScreen Multi (LABM), which utilizes recombinant HNA-coated Luminex beads. For ICFA, HNA-1a or HNA-1b transfected cells replaced neutrophils. Cells incubated with serum were lysed, and immune complexes were captured using five CD16 monoclonal antibody-conjugated Luminex beads. Nine antisera with known specificity and 26 samples suspected of containing HNA antibodies were analyzed by ICFA and MAIGA using neutrophils or transfected cells (ICFA-N or ICFA-T, and MAIGA-N or MAIGA-T, respectively). RESULTS ICFA-T and MAIGA-N accurately determined the specificity of all antibodies in the nine antiserum samples. The ICFA-T detection limit was 2048-fold for anti-HNA-1a and 256-fold for anti-HNA-1b; the limits of MAIGA-T, MAIGA-N, and LABM were 32-, 4 ~ 64-, and 128-fold for anti-HNA-1a and 64-, 16 ~ 64-, and 32-fold for anti-HNA-1b, respectively. Twelve and 7 of the remaining 26 samples tested negative and positive, respectively, in both ICFA-T and MAIGA-N. Antibody specificity against HNA-1a or HNA-1b determined using ICFA-T agreed with that determined using MAIGA-N and LABM. Another seven samples tested positive in ICFA-T but negative in MAIGA-N. CONCLUSION The novel ICFA is highly sensitive and exhibits specificity similar to MAIGA and LABM for detecting HNA-1 antibodies.
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Affiliation(s)
- Hiromi Kamada
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Daisuke Takahashi
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Marie Shimizu
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Miyuki Uchida
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Yoshihisa Watanabe
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | | | - Shigeki Miyata
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
| | - Masahiro Satake
- Central Blood Institute, Blood Service Headquarters, Japanese Red Cross Society, Tokyo, Japan
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Parisi X, Bledsoe JR. Discerning clinicopathological features of congenital neutropenia syndromes: an approach to diagnostically challenging differential diagnoses. J Clin Pathol 2024:jcp-2022-208686. [PMID: 38589208 DOI: 10.1136/jcp-2022-208686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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.
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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
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Grabowski C, Reil A, Bux J, Bayat B, Sachs UJ. Anti-human neutrophil antigen-1d specificity is frequently observed in anti-human neutrophil antigen-1b alloantisera. Transfusion 2022; 62:2205-2211. [PMID: 36173690 DOI: 10.1111/trf.17118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/02/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Four amino acids are involved in epitope formation of human neutrophil antigens (HNA)-1 alleles, located at positions 36, 65, 78, and 82. HNA-1a and HNA-1b alloantibody epitopes were recently characterized. The HNA-1b allele also carries the HNA-1d epitope p.78A&p.82N. The current study aimed to identify compound antibody specificities in HNA-1b alloantisera, especially the presence of anti-HNA-1d. STUDY DESIGN AND METHODS For investigation of binding epitopes for HNA-1b alloantibodies, cells stably expressing different HNA-1 alleles were generated and tested against previously well-characterized HNA-1b antisera (n = 11) in an antigen capture assay. Sera with p.82N specificity or p.36S and p.82N specificity were additionally analyzed using adsorption and elution methods. RESULTS Three amino acids, p.36S, p.78A, and p.82N, are involved in epitope formation of HNA-1b. The following specificities were identified in 11 HNA-1b alloantisera: p.36S (6/11), p.82N (9/11), and p.78A&p.82N (8/11), of which p.36S was identified as a sole entity in 2/11, whereas 9/11 antisera contained a polyspecific mixture of anti-p.36S, p.82N (1/11), and anti-p.78A&p.82N in combination with anti p.82N (5/11) or compound specificities of anti-p.36S, p.82N, and p.78A&p82N (3/11). In seven of eight antisera with p.82N specificity, anti-p.78A&p.82N was detected. DISCUSSION Analysis of HNA-1b antisera indicates compound specificities for HNA-1b alloantibodies with a high variation between HNA-1b immunized individuals. Amino acids p.36S, p.82N, and p.78A&p.82N are necessary for HNA-1b epitope formation. The HNA-1d epitope is recognized by 73% (8/11) of HNA-1b immunized individuals.
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Affiliation(s)
- Claudia Grabowski
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany.,German Red Cross Blood Donation Service NSTOB, Dessau, Germany
| | - Angelika Reil
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | | | - Behnaz Bayat
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
| | - Ulrich J Sachs
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany.,Department of Thrombosis and Haemostasis, Giessen University Hospital, Giessen, Germany
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Silva M, Carvalho V, Raposo F, Lima M, Costa M. A case of neonatal alloimmune neutropenia with an uncommon presentation. J Clin Neonatol 2022. [DOI: 10.4103/jcn.jcn_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Donadieu J, Frenz S, Merz L, Sicre De Fontbrune F, Rotulo GA, Beaupain B, Biosse-Duplan M, Audrain M, Croisille L, Ancliff P, Klein C, Bellanné-Chantelot C. Chronic neutropenia: how best to assess severity and approach management? Expert Rev Hematol 2021; 14:945-960. [PMID: 34486458 DOI: 10.1080/17474086.2021.1976634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Neutropenia is a relatively common finding in medical practice and the medical approach requires a gradual and pertinent diagnostic procedure as well as adapted management. AREAS COVERED The area of chronic neutropenia remains fragmented between diverse diseases or situations. Here physicians involved in different aspects of chronic neutropenia gather both the data from medical literature till the end of May 2021 and their experience to offer a global approach for the diagnosis of chronic neutropenia as well as their medical care. EXPERT OPINION In most cases, the neutropenia is transient, frequently related to a viral infection, and not harmful. However, neutropenia can be chronic (i.e. >3 months) and related to a number of etiologies, some clinically benign, such as so-called 'ethnic' neutropenia. Autoimmune neutropenia is the common form in young children, whereas idiopathic/immune neutropenia is a frequent etiology in young females. Inherited neutropenia (or congenital neutropenia) is exceptional, with approximately 30 new cases per 106 births and 30 known subtypes. Such patients have a high risk of invasive bacterial infections, and oral infections. Supportive therapy, which is primarily based on daily administration of an antibiotic prophylaxis and/or treatment with granulocyte-colony stimulating factor (G-CSF), contributes to avoiding recurrent infections.
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Affiliation(s)
- Jean Donadieu
- Centre De Référence Des Neutropénies Chroniques, Registre National Des Neutropénies Congénitales, Service d'Hémato-oncologie Pédiatrique, Hôpital Armand Trousseau Aphp, Paris, France
| | - Stephanie Frenz
- Dr. Von Hauner Children's Hospital, Department of Pediatrics, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lauren Merz
- Brigham and Women's Hospital, Department of Internal Medicine, Boston, MA, USA
| | | | - Gioacchino Andrea Rotulo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (Dinogmi), University of Genoa, Italy
| | - Blandine Beaupain
- Centre De Référence Des Neutropénies Chroniques, Registre National Des Neutropénies Congénitales, Service d'Hémato-oncologie Pédiatrique, Hôpital Armand Trousseau Aphp, Paris, France
| | | | - Marie Audrain
- Service d'Immunologie Laboratoire De Biologie Chu De Nantes 9 Quai Moncousu
| | | | - Phil Ancliff
- Pediatric Hematology, Great Ormond Street Hospital London, UK
| | - Christoph Klein
- Dr. Von Hauner Children's Hospital, Department of Pediatrics, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
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Abbas SA, Lopes LB, Moritz E, Martins JO, Chiba AK, Kunioshi AM, Barbosa ES, Langhi Junior DM, Dos Santos AMN, Godinho CH, Bordin JO. Serologic and molecular studies to identify neonatal alloimmune neutropenia in a cohort of 10,000 neonates. Br J Haematol 2021; 192:778-784. [PMID: 33529380 DOI: 10.1111/bjh.17295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 01/05/2023]
Abstract
Neonatal alloimmune neutropenia (NAIN) is caused by maternal alloimmunisation to fetal human neutrophil antigens (HNAs). This study investigated maternal HNA/HLA alloantibodies involved with NAIN and identified the frequency of NAIN in Brazilian neonates. Neonatal neutropenia (neutrophil count < 1.5 × 109 /L) was investigated in samples from 10,000 unselected neonates, resulting in 88 neutropenic newborns (NBs) and their 83 mothers. Genotyping was performed by PCR-SSP (HNA-1/-4) and PCR-RFLP (HNA-3/-5). Serologic studies were performed by GAT (granulocyte agglutination test), Flow-WIFT (white blood cells immunofluorescence test) and LABScreen-Multi-HNA-Kit (OneLambda®) (LSM). Neonatal neutropenia was identified in 88/10,000 (0·9%) NBs. Genotyping revealed 60·2% maternal-fetal HNA incompatibilities (31·8% for HNA-1; 14·8% for HNA-3; 15·9% for HNA-4; 21·6% for HNA-5). Serologic studies revealed 37·3% of mothers with positive results with at least one technique. The detected anti-HNA specificities were confirmed in eight positive cases related to HNA-1/-3 systems. In cases with maternal-fetal HNA-4/-5 incompatibility, no specific neutrophil alloantibodies were found but anti-HLA I/II were present. Anti-HNA-2 was not identified. This is a large Brazilian study which involved the investigation of antibodies against all five HNA systems in neutropenia cases and showed a frequency of NAIN in 8/10,000 neonates. Among the HNA antibodies identified, we highlight the anti-HNA-1d and anti-HNA-3b, antibodies unusual in alloimmunised women, and rarely related to NAIN cases.
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Affiliation(s)
- Samira A Abbas
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Larissa B Lopes
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Elyse Moritz
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Juliana O Martins
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Akemi K Chiba
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | | | - Elisama S Barbosa
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | - Dante M Langhi Junior
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
| | | | | | - José O Bordin
- Department of Clinical and Experimental Oncology - Federal University of São Paulo - UNIFESP, São Paulo, Brazil
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7
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Grabowski C, Jorks S, Kroll H. Genotyping of human neutrophil antigens 1, 3, 4 and 5 using a novel multiplex polymerase chain reaction. Transfus Med 2019; 29:110-115. [PMID: 30974499 DOI: 10.1111/tme.12594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/01/2019] [Accepted: 03/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Our study aimed to establish a novel multiplex polymerase chain reaction (PCR) for rapid simultaneous detection of all relevant human neutrophil antigen (HNA)-1, -3, -4 and -5 alleles. BACKGROUND Granulocyte-reactive antibodies are involved in several diseases, such as neonatal alloimmune neutropenia, autoimmune neutropenia and transfusion-related acute lung injury. A panel of well-defined test granulocytes is required for diagnostic antibody detection and prospective blood donor screening. Several genotyping methods for the detection of HNA alleles have been described, but most approaches require separate amplification of each HNA allele or at least a separate amplification of the HNA-1 alleles. METHODS The new method is based on simultaneous detection in one reaction tube, where each HNA-1 allele is amplified by two allele-specific primers, one primer of which is labelled with a fluorescent dye (HEX, FAM). Allelic polymorphisms for HNA-3, -4 and -5 were amplified with one common unlabelled primer and two fluorescence-labelled (HEX, FAM) allele-specific primers. DNA fragments of HNA alleles are analysed on a Genetic Analyser 3130xl by amplicon size and fluorescent dye. A total of 110 blood donors with known genotypes were studied. RESULTS In the 110 DNA samples studied, all HNA-1, -3, -4 and -5 alleles could be detected precisely. All results matched perfectly with those from reference typing by PCR-sequence-specific primer. Amplification performed well even at low DNA concentrations (10 ng μL-1 ). CONCLUSION Our method enables fast and easy genotyping of all relevant HNA-alleles in one PCR reaction. Results are easy to analyse due to different amplicon sizes and fluorescent dyes. Furthermore, the method is suitable for high sample throughput.
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Affiliation(s)
- C Grabowski
- Institute for Transfusion Medicine Dessau, Red Cross Blood Transfusion Service NSTOB, Dessau, Germany
| | - S Jorks
- Institute for Transfusion Medicine Dessau, Red Cross Blood Transfusion Service NSTOB, Dessau, Germany
| | - H Kroll
- Institute for Transfusion Medicine Dessau, Red Cross Blood Transfusion Service NSTOB, Dessau, Germany
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8
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Porcelijn L, de Haas M. Neonatal Alloimmune Neutropenia. Transfus Med Hemother 2018; 45:311-316. [PMID: 31049048 DOI: 10.1159/000492949] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/16/2018] [Indexed: 12/17/2022] Open
Abstract
Neonatal alloimmune neutropenia (NAIN, NAIN or NIN) is a neutrophil blood group antagonism, analogous to hemolytic disease of the fetus and newborn (HDFN) and fetal/neonatal alloimmune thrombocytopenia (FNAIT). A limited number of prospective screening studies showed that granulocyte-specific antibodies were detectable in 0.35-1.1% of random postnatal maternal samples and that the incidence of NAIN was below 0.1%. Symptoms vary from none to mild skin infections, omphalitis or more severe infections like pneumonia, sepsis, and meningitis. Treatment of neonatal infection with antibiotics and granulocyte-colony stimulating factor is advised.
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Affiliation(s)
- Leendert Porcelijn
- Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands
| | - Masja de Haas
- Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands.,Department of Immuno-Hematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
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9
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Lopes LB, Abbas SA, Moritz E, Martins JO, Chiba AK, Langhi DM, Bordin JO. Antibodies to human neutrophil antigen HNA-3b implicated in cases of neonatal alloimmune neutropenia. Transfusion 2018; 58:1264-1270. [DOI: 10.1111/trf.14524] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Larissa Barbosa Lopes
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - Samira Ali Abbas
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - Elyse Moritz
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - Juliana Oliveira Martins
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - Akemi Kuroda Chiba
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - Dante Mário Langhi
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
| | - José O. Bordin
- Disciplina de Hematologia e Hemoterapia da Universidade Federal de São Paulo, UNIFESP; São Paulo Brazil
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Simtong P, Romphruk AV, Hofmann C, Reil A, Sachs UJ, Santoso S. Improvement of monoclonal antibody-immobilized granulocyte antigen assay for the detection of anti-HNA-1 alloantibodies. Transfusion 2017; 58:200-207. [DOI: 10.1111/trf.14428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Piyapong Simtong
- Biomedical Sciences Program; Graduate School; Khon Kaen Thailand
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University Giessen; Giessen Germany
| | - Amornrat V. Romphruk
- Blood Transfusion Center, Faculty of Medicine; Khon Kaen University; Khon Kaen Thailand
| | - Christine Hofmann
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University Giessen; Giessen Germany
| | - Angelika Reil
- German Red Cross Blood Donation Service West; Hagen Germany
| | - Ulrich J. Sachs
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University Giessen; Giessen Germany
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University Giessen; Giessen Germany
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12
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Bejjani N, Beaupain B, Bertrand Y, Bellanne-Chantelot C, Donadieu J. How to differentiate congenital from noncongenital chronic neutropenia at the first medical examination? Proposal of score: A pilot study from the French Severe Chronic Neutropenia registry. Pediatr Blood Cancer 2017; 64. [PMID: 28727239 DOI: 10.1002/pbc.26722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/30/2017] [Accepted: 06/13/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES We developed a diagnostic score to differentiate congenital from noncongenital neutropenia at the time of diagnosis using reliable data collected at the first visit of a patients with neutropenia. STUDY DESIGN In a pilot retrospective study, we included 120 patients diagnosed with chronic neutropenia; 61 had congenital and 59 had noncongenital neutropenia. We reviewed patient medical charts and collected the initial complete blood count (CBC) and other reliable data. We used logistic regression to determine the probability that the neutropenia was congenital. RESULTS On the initial CBC, the degree of neutropenia had no predictive value; only monocytosis >1.5 × 109 /l, hemoglobin <90 g/l, or mild thrombocytopenia <150 × 109 /l suggested congenital neutropenia. The most predictive factors for congenital neutropenia were a medical history (consanguinity and patient history of neutropenia), severe infections, and oral stomatitis or gingivitis at the time of diagnosis. The age at diagnosis had limited predictive value. CONCLUSION A diagnosis of congenital neutropenia may be reliably suspected based only on information from the CBC, some basic information from patient and parent interviews, and a clinical examination. A pilot score with six factors that could be readily, reliably collected, should facilitate the diagnosis of congenital neutropenia.
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Affiliation(s)
- Naim Bejjani
- AP-HP, Registre français des Neutropénies, Centre de référence des neutropénies chroniques, Service d'Hémato-Oncologie Pédiatrique, Hôpital Trousseau, Paris, France.,Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | - Blandine Beaupain
- AP-HP, Registre français des Neutropénies, Centre de référence des neutropénies chroniques, Service d'Hémato-Oncologie Pédiatrique, Hôpital Trousseau, Paris, France
| | - Yves Bertrand
- Institut d'Hématologie et d'Oncologie Pédiatrique, Lyon, France
| | | | - Jean Donadieu
- AP-HP, Registre français des Neutropénies, Centre de référence des neutropénies chroniques, Service d'Hémato-Oncologie Pédiatrique, Hôpital Trousseau, Paris, France
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13
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Donadieu J, Beaupain B, Fenneteau O, Bellanné-Chantelot C. Congenital neutropenia in the era of genomics: classification, diagnosis, and natural history. Br J Haematol 2017; 179:557-574. [PMID: 28875503 DOI: 10.1111/bjh.14887] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review focuses on the classification, diagnosis and natural history of congenital neutropenia (CN). CN encompasses a number of genetic disorders with chronic neutropenia and, for some, affecting other organ systems, such as the pancreas, central nervous system, heart, bone and skin. To date, 24 distinct genes have been associated with CN. The number of genes involved makes gene screening difficult. This can be solved by next-generation sequencing (NGS) of targeted gene panels. One of the major complications of CN is spontaneous leukaemia, which is preceded by clonal somatic evolution, and can be screened by a targeted NGS panel focused on somatic events.
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Affiliation(s)
- Jean Donadieu
- Service d'Hémato Oncologie Pédiatrique, Registre des neutropénies congénitales, AP-HP Hopital Trousseau, Paris, France
| | - Blandine Beaupain
- Service d'Hémato Oncologie Pédiatrique, Registre des neutropénies congénitales, AP-HP Hopital Trousseau, Paris, France
| | - Odile Fenneteau
- Laboratoire d'Hématologie, AP-HP Hôpital S Robert Debré, Paris, France
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14
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Simtong P, Puapairoj C, Leelayuwat C, Santoso S, Romphruk AV. Assessment of HNA alloimmunisation risk in Northeastern Thais, Burmese and Karen. Transfus Med 2017; 28:47-55. [PMID: 28589653 DOI: 10.1111/tme.12431] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 04/27/2017] [Accepted: 05/17/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVES This study aimed to determine human neutrophil antigen (HNA) frequency, estimate possible HNA incompatibilities and predict the risk of HNA alloimmunisation in the Northeastern Thai, Burmese and Karen populations. BACKGROUND Alloantibodies against HNA are implicated in a number of clinical conditions, including immune-mediated neutropenia and transfusion reactions. METHODS A total of 400 unrelated healthy Thais, 261 Burmese and 249 Karen was included in this study. DNA samples were typed for HNA-1, -3, -4 and -5 systems using polymerase chain reactions with sequence-specific primers (PCR-SSP). RESULTS In this cohort, HNA-1a was more prevalent than HNA-1b. Accordingly, the possible risk of HNA-1a alloimmunisation against HNA-1a is lower than HNA-1b (0·0802-0·1351 vs 0·2293-0·2497). This is in contrast to the situation reported in Caucasian and African populations. The predicted risk of HNA-3 incompatibility in Thais, Burmese and Karen were 28·09%, 30·66% and 22·77%, respectively. The possible risks of HNA-3a alloimmunisation were 0·0493 in Thais, 0·0608 in Burmese and 0·0196 in Karen, respectively. No individuals were found to be homozygous for HNA-4bb. The probability of developing alloantibodies against HNA-4a was low in these populations and every population in Asia. In contrast, the overall frequency of HNA-5bb homozygous individuals was high in this study, peaking at 0·192. CONCLUSIONS This is the first study that reported the allele frequencies of HNA-1, -3, -4, and -5 in a large sample of healthy unrelated individuals from ethnic Thais, Burmese and Karen. Our results indicated the high possible risk of HNA-1, -3 and -5 alloimmunisation in these populations.
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Affiliation(s)
- P Simtong
- Biomedical Sciences Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - C Puapairoj
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - C Leelayuwat
- Department of Clinical Immunology and Transfusion Sciences, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - S Santoso
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - A V Romphruk
- Blood Transfusion Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,The Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
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15
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Xia W, Simtong P, Santoso S. Neutrophil alloantigens and alloantibodies in different populations. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | - Piyapong Simtong
- Biomedical Sciences Program; Graduate School; Khon Kaen University; Khon Kaen Thailand
| | - Sentot Santoso
- Institute for Clinical Immunology and Transfusion Medicine; Justus Liebig University; Giessen Germany
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16
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Abstract
BACKGROUND Anti-neutrophil antibodies are a well-recognized cause of neutropenia, producing a potential increase in risk of infection: in the majority of patients antibodies react against antigens located on the IgG Fc receptor type 3b (FcRIIIb), but other target antigens have been identified. DATA SOURCES In this review the most important papers of auto and alloimmune neutropenias of infancy and childhood were analyzed. PubMed, Google Scholar and Thompson ISI Web of Knowledge were searched for identifying relevant papers. RESULTS Primary autoimmune neutropenia of infancy is mostly a benign condition with self-limited course, whereas isolated alloimmune neonatal neutropenia or secondary autoimmune neutropenia may be occasionally complicated by severe infections. CONCLUSION Granulocyte colony stimulating factor is an effective therapy for patients affected by all types of autoimmune and alloimmune neutropenia, even though most of them do not need any therapy.
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17
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Mraz G, Crighton G, Christie D. Antibodies to human neutrophil antigen HNA-4b implicated in a case of neonatal alloimmune neutropenia. Transfusion 2016; 56:1161-5. [PMID: 26749553 DOI: 10.1111/trf.13463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 12/01/2022]
Affiliation(s)
- G.A. Mraz
- Victorian Transplantation & Immunogenetics Service, Australian Red Cross Blood Service; West Melbourne Victoria Australia
| | - G.L. Crighton
- Victorian Transplantation & Immunogenetics Service, Australian Red Cross Blood Service; West Melbourne Victoria Australia
- Royal Children's Hospital; Parkville Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - D.J. Christie
- Albury-Wodonga Health; Albury New South Wales Australia
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18
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Curtis BR, Roman AS, Sullivan MJ, Raven CS, Larison J, Weitekamp LA. Two cases of maternal alloimmunization against human neutrophil alloantigen-4b, one causing severe alloimmune neonatal neutropenia. Transfusion 2015; 56:101-6. [DOI: 10.1111/trf.13287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/02/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Brian R. Curtis
- Platelet & Neutrophil Immunology Laboratory; BloodCenter of Wisconsin; Milwaukee Wisconsin
- Blood Research Institute; BloodCenter of Wisconsin; Milwaukee Wisconsin
| | | | - Mia J. Sullivan
- Platelet & Neutrophil Immunology Laboratory; BloodCenter of Wisconsin; Milwaukee Wisconsin
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19
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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.
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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
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20
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Elloumi HZ, Holland SM. Diagnostic assays for chronic granulomatous disease and other neutrophil disorders. Methods Mol Biol 2014; 1124:517-35. [PMID: 24504972 DOI: 10.1007/978-1-62703-845-4_31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Inasmuch as neutrophils are the primary cellular defense against bacterial and fungal infections, disorders that affect these white cells typically predispose individuals to severe and recurrent infections. Therefore, diagnosis of such disorders is an important first step in directing long-term treatment/care for the patient. Herein, we describe methods to identify chronic granulomatous disease, leukocyte adhesion deficiency, and neutropenia. The assays are relatively simple to perform and cost effective and can be performed with equipment available in most laboratories.
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Affiliation(s)
- Houda Zghal Elloumi
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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21
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Lee J, Kim JS, Park JW, Park CW, Park JS, Jun JK, Yoon BH. Chronic chorioamnionitis is the most common placental lesion in late preterm birth. Placenta 2013; 34:681-9. [PMID: 23684379 DOI: 10.1016/j.placenta.2013.04.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/15/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The pathogenesis of late preterm birth remains elusive for the mechanisms of disease responsible. Placental examination can often provide important clues for the pathogenesis of pregnancy complications. This study was conducted to determine placental pathologic findings according to the gestational age and the clinical circumstances of preterm birth. STUDY DESIGN Placental pathologic findings and obstetrical and neonatal outcomes were reviewed in a consecutive preterm birth cohort from a single tertiary center (N = 1206). Placentas of term births (N = 300) were used as normal controls. RESULTS Acute chorioamnionitis (22.7% vs. 16.7%), maternal vascular underperfusion (6.4% vs. 0.5%), and chronic chorioamnionitis (20.8% vs. 10.5%) were significantly more frequent in preterm births than in term births (P < 0.05, for each). Among preterm births, chronic chorioamnionitis was the most common pathology of late preterm birth (gestational age <37 and ≥34 weeks), while acute chorioamnionitis was the most common lesion of extremely preterm birth (gestational age <28 weeks). While the frequency of acute chorioamnionitis decreased with advancing gestation, that of chronic chorioamnionitis increased (P < 0.001, for each). The upward trend of the frequency of chronic chorioamnionitis was related to advancing gestation in both spontaneous and indicated preterm births (P < 0.001, for each). CONCLUSIONS Chronic chorioamnionitis is a common pathology of late preterm birth. It is suggested that chronic chorioamnionitis, a feature of maternal anti-fetal rejection, is an important etiology of preterm birth, especially of late preterm birth.
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Affiliation(s)
- J Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, 28 Yeongeon-dong, Chongno-gu, Seoul 110-744, Republic of Korea.
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22
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Reil A, Sachs UJ, Siahanidou T, Flesch BK, Bux J. HNA-1d: a new human neutrophil antigen located on Fcγ receptor IIIb associated with neonatal immune neutropenia. Transfusion 2013; 53:2145-51. [DOI: 10.1111/trf.12086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/22/2012] [Accepted: 11/26/2012] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE To describe a case of neonatal alloimmune neutropenia (NAN), a very rare disease of the newborn and the first ever reported in our neonatal intensive care unit, with emphasis in its management and outcome. DESCRIPTION We report a case of NAN due to anti-human neutrophil antigen-1b alloimmunization in a 29-week preterm admitted to our neonatal intensive care unit. In this case, the neutropenia was severe and persisted for almost 2 months. There was a good response to the administration of intravenous immunoglobulin. COMMENTS NAN is caused by maternal production of neutrophil-specific alloantibodies in response to antigens from paternal heritage present on the newborn neutrophiles. The course of the disease is usually mild and self-limiting. The optimal therapy is yet a debate, with some authors finding the use of intravenous immunoglobulin effective, prophylactic antibiotic therapy or recombinant human granulocyte colony-stimulating factor.
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24
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Werth S, Bayat B, Tjahjono Y, Eskandar J, Berghöfer H, Bein G, Sachs UJ, Santoso S. Rapid enzyme-linked immunosorbent assay for the detection of antibodies against human neutrophil antigens -1a, -1b, and -1c. Transfusion 2012; 53:193-201. [PMID: 22554254 DOI: 10.1111/j.1537-2995.2012.03675.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Several methods exist for the detection of neutrophil antibodies; most of them, however, require fresh neutrophils. In this study, an enzyme-linked immunosorbent assay (ELISA) using recombinant HNA-1 antigens (rHNAs) was developed to detect HNA-1a, -1b, and -1c alloantibodies in serum samples. STUDY DESIGN AND METHODS Soluble rHNA-1a, -1b, and -1c were isolated from culture supernatant of transfected insect cells. Purified rHNA antigens were immobilized on microtiter wells using antibody against V5-Tag protein. Sera were added, and bound antibodies were detected by enzyme-labeled secondary antibodies. In parallel, monoclonal antibody-immobilized granulocyte antigen (MAIGA) was performed with two different monoclonal antibodies (MoAbs) against FcγRIIIb (3G8 and BW209). RESULTS Fifteen MAIGA-positive sera containing HNA-1a alloantibodies were tested in ELISA. Thirteen of 15 (86.7%) MAIGA-positive sera captured by MoAbs 3G8 and/or BW209 reacted specifically with rHNA-1a. Four (26.7%) HNA-1a sera showed additional reaction with rHNA-1c. When anti-HNA-1b alloantibodies were analyzed in ELISA, 13 of 15 (86.7%) showed specific positive reaction with rHNA-1b, and 12 of 15 (80.0%) cross-reacted with rHNA-1c. Two HNA-1c sera reacted specifically with rHNA-1c. Immunoprecipitation analysis of all ELISA-negative HNA-1a and -1b sera did not show any specific band indicating false-positive reaction of these sera in MAIGA assay. CONCLUSIONS These results suggested that rapid ELISA using recombinant neutrophil antigens may provide a valuable method for rapid screening of human alloantibodies against HNA-1a, -1b, and -1c in patients with neutropenia and in blood donors.
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Affiliation(s)
- Silke Werth
- Institute for Clinical Immunology and Transfusion Medicine, Justus Liebig University, Giessen, Germany
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25
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Lee J, Romero R, Xu Y, Kim JS, Park JY, Kusanovic JP, Chaiworapongsa T, Hassan SS, Kim CJ. Maternal HLA panel-reactive antibodies in early gestation positively correlate with chronic chorioamnionitis: evidence in support of the chronic nature of maternal anti-fetal rejection. Am J Reprod Immunol 2011; 66:510-26. [PMID: 21951517 PMCID: PMC3234997 DOI: 10.1111/j.1600-0897.2011.01066.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PROBLEM Maternal tolerance of the fetus is essential for viviparity, yet anti-fetal rejection occurs in several pregnancy complications. Chronic chorioamnionitis is a feature of anti-fetal cellular rejection. There is a robust association between chronic chorioamnionitis and maternal seropositivity for anti-human leukocyte antigen (HLA) panel-reactive antibodies (PRA) at the time of delivery. This longitudinal study was performed to assess maternal HLA PRA status in early gestation and the temporal evolution of maternal HLA PRA in the context of chronic chorioamnionitis and, thereby, to determine whether HLA PRA during the course of pregnancy is useful for the detection of anti-fetal rejection. METHOD OF STUDY Maternal sera obtained before 16 weeks of gestation and at delivery were analyzed for HLA PRA in cases with (N = 100) and without (N = 150) chronic chorioamnionitis. RESULTS IgG (but not IgM) HLA class I and II PRA positivity at delivery was higher in cases with chronic chorioamnionitis than in those without chronic chorioamnionitis. IgG HLA class I PRA positivity before 16 weeks of gestation was higher in cases with chronic chorioamnionitis than in those without (30.3 versus 13.3%; P = 0.001). Positive conversion (negative HLA PRA before 16 weeks of gestation but positive at delivery) of IgG HLA class I and II PRA was significantly associated with chronic chorioamnionitis. Fetal HLA class I antigen-specific antibodies were confirmed in 12 of 16 mothers tested who were sensitized to HLA class I antigens before 16 weeks of gestation. CONCLUSION Positive maternal HLA PRA before 16 weeks of gestation and the temporal evolution of maternal HLA PRA are associated with the presence of chronic chorioamnionitis at the time of delivery. Maternal IgG HLA PRA has the potential to be a monitoring tool of anti-fetal rejection. Furthermore, the findings herein indicate that subsets of fetuses are exposed to alloimmune HLA antibodies for months, especially in cases with chronic chorioamnionitis.
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Affiliation(s)
- JoonHo Lee
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Roberto Romero
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Yi Xu
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
| | - Jung-Sun Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Young Park
- Department of Laboratory Medicine, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Juan Pedro Kusanovic
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Sótero del Rio Hospital, Santiago, Chile
- Department of Obstetrics and Gynecology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tinnakorn Chaiworapongsa
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sonia S. Hassan
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Chong Jai Kim
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan, USA
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26
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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.
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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.
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27
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Curtis BR, Sullivan MJ, Holyst MT, Szabo A, Bougie DW, Aster RH. HNA-3a-specific antibodies recognize choline transporter-like protein-2 peptides containing arginine, but not glutamine at Position 154. Transfusion 2011; 51:2168-74. [PMID: 21517890 DOI: 10.1111/j.1537-2995.2011.03145.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antibodies specific for the neutrophil antigen HNA-3a cause severe, sometimes fatal transfusion-related acute lung disease (TRALI) when transfused, but it has not been possible to screen blood donors for anti-HNA-3a because using neutrophils as targets was impractical and molecular properties of the antigen were unknown. Recently it was shown that HNA-3a is carried on choline transporter-like protein-2 (CTL2) and that the HNA-3a/b phenotype is closely correlated with an R154Q amino acid polymorphism in CTL2. However, it has not been shown by direct experiment that R154 is essential for the HNA-3a epitope. STUDY DESIGN AND METHODS Preliminary attempts to express recombinant full-length CTL2 (R154) recognized by anti-HNA-3a were unsuccessful. We therefore tested HNA-3a-specific antibodies from donors implicated in TRALI reactions for reactivity against chemically synthesized linear and cyclic CTL2 peptides containing R154 or Q154. RESULTS Nine of 20 HNA-3a antibodies recognized the R154, but not the Q154 version of a cyclic 36-residue CTL2 peptide (D131-K166). However, 11 others failed to distinguish between the two versions of this peptide. CONCLUSION The findings provide direct evidence that R154 in the context of CTL2 D131-K166 is necessary to create the HNA-3a epitope but, in the context of cyclic CTL2 peptide D131-K166, is sufficient to detect only about one-half of the HNA-3a-specific antibodies implicated in TRALI. It is likely that fragments of CTL2 longer than can be made on a large scale with an automated synthesizer will be needed to produce a target capable of detecting all examples of anti-HNA-3a in donated blood.
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Affiliation(s)
- Brian R Curtis
- Platelet & Neutrophil Immunology Lab, BloodCenter of Wisconsin, Milwaukee, Wisconsin 53201-2178, USA.
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28
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Drouet C, Khoy K, Masson D, Bardy B, Giannoli C, Dubois V. [The immunological conflict in the transfusion-related acute lung injury or TRALI]. Transfus Clin Biol 2011; 18:224-9. [PMID: 21470890 DOI: 10.1016/j.tracli.2011.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
Abstract
Despite its underrated incidence, transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related morbidity and mortality worldwide. The pulmonary edema in TRALI occurs in the course of the transfusion of apheresis products or erythrocyte concentrates. Its pathogenesis is attributed to the infusion of donor antibodies that recognize leucocyte antigens in the transfused host, with subsequent sequestration of leucocytes in the pulmonary vessels. It is also associated with the passive transfer of lipids and other biological response modifiers that accumulate during the storage or processing of blood components. The innate immunity and inflammatory kinins are key components. The knowledge of its etiopathogenesis must come into play for improving prevention and diagnosis and for application of adapted care of the patient.
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Affiliation(s)
- C Drouet
- GREPI/AGIM CNRS FRE 3405, CHU de Grenoble, BP 217, 38043 Grenoble, France.
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29
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Gottschall JL, Triulzi DJ, Curtis B, Kakaiya RM, Busch MP, Norris PJ, Glynn SA, Carrick D, Wright DJ, Kleinman S. The frequency and specificity of human neutrophil antigen antibodies in a blood donor population. Transfusion 2010; 51:820-7. [PMID: 20977484 DOI: 10.1111/j.1537-2995.2010.02913.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transfusion-related acute lung injury (TRALI) has been associated with both human leukocyte antigen (HLA) and human neutrophil antigen (HNA) antibodies. HNA antibody frequency, specificity, and demographic associations have not been well defined in the blood donor population. STUDY DESIGN AND METHODS A subset of 1171 donors (388 nontransfused males, 390 HLA antibody-negative females with three or more pregnancies, and 393 HLA antibody-positive females with three or more pregnancies) from a larger Leukocyte Antibody Prevalence Study was tested for immunoglobulin (Ig)G and IgM HNA antibody using a granulocyte immunofluorescence flow cytometry assay. Additional testing on selected samples included monoclonal antibody immobilization of granulocyte antigen-flow cytometry and granulocyte genotyping. RESULTS Eight samples were HNA antibody positive (prevalence, 0.7%; 95% confidence interval [CI], 0.3%-1.3%]). Three HNA antibodies (one IgG and two IgM) were found in nontransfused males (prevalence, 0.8%; 95% CI, 0.2%-2.2%); all were panreactive or nonspecific. One HLA antibody-negative previously pregnant female had an IgG HNA antibody with HNA-1a specificity (prevalence, 0.3%; 95% CI, 0.01%-1.4%). Four HLA antibody-positive previously pregnant females demonstrated HNA antibodies, three IgG and one IgM (prevalence, 1%; 95% CI, 0.3%-2.6%). Two of these were HNA-1a specific, one HNA-4a specific, and one nonspecific. CONCLUSIONS HNA antibodies occur with low frequency in the donor population and are present in both male and female donors. Despite the implementation of TRALI reduction strategies, HNA antibodies are still present in donor blood products. Although our data do not create a case for urgent implementation of donor HNA antibody testing, future new developments for high-throughput HNA antibody screening, including for HNA-3a, may warrant reconsideration.
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30
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Wiedl C, Walter AW. Granulocyte colony stimulating factor in neonatal alloimmune neutropenia: a possible association with induced thrombocytopenia. Pediatr Blood Cancer 2010; 54:1014-6. [PMID: 20135695 DOI: 10.1002/pbc.22315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Neonatal alloimmune neutropenia (NAIN) is a rare cause of congenital neutropenia seen in <1% of births. Significant morbidity, usually infections, may result from this disease. The pathophysiology of NAIN, mediated by maternal antibodies crossing the placenta to destroy fetal cells expressing paternal antigens, is similar to that of neonatal alloimmune thrombocytopenia, as well as Rh/ABO hemolytic disease of the newborn. The use of high-dose granulocyte colony stimulating factor in patients with NAIN may cause a reversible thrombocytopenia in some patients.
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Affiliation(s)
- Christina Wiedl
- Department of Pediatric Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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31
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Severe autoimmune neutropenia associated with acute autoimmune hepatitis. Int J Hematol 2010; 91:673-8. [DOI: 10.1007/s12185-010-0557-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 02/18/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Czuchlewski DR, Brackney M, Ewers C, Manna J, Fekrazad MH, Martinez A, Nolte KB, Hjelle B, Rabinowitz I, Curtis BR, McFarland JG, Baumbach J, Foucar K. Clinicopathologic features of agranulocytosis in the setting of levamisole-tainted cocaine. Am J Clin Pathol 2010; 133:466-72. [PMID: 20154286 DOI: 10.1309/ajcpopqnbp5thkp1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Levamisole is a known contaminant of cocaine and, via this route, has been associated with otherwise unexplained agranulocytosis. Levamisole is currently present in the majority of cocaine samples seized by the US Drug Enforcement Agency. We identified 20 cases of unexplained agranulocytosis in our practice locations of Albuquerque, NM, and Vancouver, Canada. Epidemiologic investigation revealed recent or ongoing cocaine use in 14 cases (70%). Certain morphologic features, including circulating plasmacytoid lymphocytes, increased bone marrow plasma cells, and mild megakaryocytic hyperplasia, were associated with the cocaine-exposed group. Of 5 patients tested, 3 (60%) were HLA-B27+ and showed antineutrophil antibodies, consistent with known associations of levamisole-induced agranulocytosis. One patient, who was positive for cocaine and levamisole by toxicology testing, died of infectious complications. Inadvertent consumption of levamisole via cocaine is a severely under-appreciated risk factor for agranulocytosis, and specific laboratory features are suggestive of this etiology.
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The neutrophil alloantigen HNA-3a (5b) is located on choline transporter-like protein 2 and appears to be encoded by an R>Q154 amino acid substitution. Blood 2009; 115:2073-6. [PMID: 20040764 DOI: 10.1182/blood-2009-11-248336] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The molecular basis of the HNA-3a/b (5b/a) leukocyte antigen system has not yet been defined despite evidence that HNA-3a-specific antibodies are particularly prone to cause severe, often fatal, transfusion-related lung injury. We used genome-wide single nucleotide polymorphism scanning and sequencing of DNA from persons of different HNA-3a/b phenotypes to identify a single single nucleotide polymorphism in exon 7 of the CLT2 gene (SLC44A2) that predicts an amino acid substitution in the first extracellular loop of choline transporter-like protein 2, a member of the choline transporter-like protein family of membrane glycoproteins, and correlates perfectly with HNA-3a/b phenotypes (R154 encodes HNA-3a; Q154 encodes HNA-3b). Mass spectrometric analysis of proteins immunoprecipitated from leukocytes by anti-HNA-3a provided direct evidence that anti-HNA-3a recognizes choline transporter-like protein 2. These findings will enable large-scale genotyping for HNA-3a/b to identify blood donors at risk to have HNA-3a-specific antibodies and should facilitate development of practical methods to detect such antibodies and prevent transfusion-related lung injury.
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Nguyen XD, Flesch B, Sachs UJ, Kroll H, Klüter H, Müller-Steinhardt M. Rapid screening of granulocyte antibodies with a novel assay: flow cytometric granulocyte immunofluorescence test. Transfusion 2009; 49:2700-8. [PMID: 19659676 DOI: 10.1111/j.1537-2995.2009.02330.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND White blood cell (WBC)-associated antibodies can lead to severe pulmonary transfusion reactions (transfusion-related acute lung injury [TRALI]). Investigation of a large number of blood donor samples using the standard granulocyte immunofluorescence test (GIFT) and granulocyte agglutination test (GAT) proved to be difficult to perform due to the time-consuming process and the large quantity of test cells required. This study describes the novel flow cytometric GIFT (Flow-GIFT) method for a rapid detection of granulocyte antibodies by flow cytometric analysis. STUDY DESIGN AND METHODS A total of 141 sera were analyzed for the presence of granulocyte antibodies that were previously associated with suspected TRALI. As test cells whole blood samples from human neutrophil antigen (HNA)-typed donors were isolated using cell sedimentation in a ficoll density gradient. WBCs were incubated with the respective serum and binding of antibodies to the test cells was detected using fluorescein isothiocyanate-conjugated anti-human antibody. Standard GIFT and GAT were performed as reference methods. RESULTS Seven sera containing anti-HNA-3a, CD16, and HLA Class I were negative in the standard GIFT and eight sera containing anti-HNA-2a, anti-CD16, and anti-HLA Class I were not detected in the GAT. The novel Flow-GIFT was able to detect all granulocyte antibodies, which were only detectable in a combination of standard GIFT and GAT. In serial dilution tests, the Flow-GIFT detected the antibodies at higher dilutions than the reference methods GIFT and GAT. CONCLUSION The Flow-GIFT method permits rapid detection of granulocyte antibodies requiring fewer donor test cells. This method is ideal for automation and will potentially open the way for screening of granulocyte antibodies in a large donor population.
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Affiliation(s)
- Xuan Duc Nguyen
- Institute of Transfusion Medicine and Immunology, Medical Faculty Mannheim, Heidelberg University, Red-Cross Blood Service of Baden-Württemberg-Hessen, Mannheim, Germany.
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Hoftman AC, Hernandez MI, Lee KW, Stiehm ER. Newborn illnesses caused by transplacental antibodies. Adv Pediatr 2008; 55:271-304. [PMID: 19048734 DOI: 10.1016/j.yapd.2008.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Alice Chang Hoftman
- Division of Immunology/Allergy/Rheumatology, Mattel Children's Hospital at UCLA, UCLA Center for Health Sciences, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
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Tomicic M, Starcevic M, Zach V, Hundric-Haspl Z. Alloimmune neonatal neutropenia due to anti-HNA-2a alloimmunization with severe and prolonged neutropenia but mild clinical course: two case reports. Arch Med Res 2007; 38:792-6. [PMID: 17845901 DOI: 10.1016/j.arcmed.2007.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 03/29/2007] [Indexed: 11/23/2022]
Abstract
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.
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Affiliation(s)
- Maja Tomicic
- Department of Immunohematology, Croatian Institute of Transfusion Medicine, Zagreb, Croatia.
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Elloumi HZ, Holland SM. Diagnostic assays for chronic granulomatous disease and other neutrophil disorders. Methods Mol Biol 2007; 412:505-23. [PMID: 18453131 DOI: 10.1007/978-1-59745-467-4_31] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Inasmuch as neutrophils are the primary cellular defense against bacterial and fungal infections, disorders that affect these white cells typically predispose individuals to severe and recurrent infections. Therefore, diagnosis of such disorders is an important first step in directing long-term treatment/care for the patient. Herein, we describe methods to identify chronic granulomatous disease (CGD), leukocyte adhesion deficiency (LAD), and neutropenia. The assays are relatively simple to perform, cost-effective, and can be performed with equipment available in most laboratories.
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Affiliation(s)
- Houda Zghal Elloumi
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
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Curtis BR, McFarland JG. Mechanisms of transfusion-related acute lung injury (TRALI): anti-leukocyte antibodies. Crit Care Med 2006; 34:S118-23. [PMID: 16617255 DOI: 10.1097/01.ccm.0000214293.72918.d8] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There is abundant evidence that leukocyte antibodies in blood donor products are somehow involved in transfusion-related acute lung injury (TRALI). Human leukocyte antigen (HLA) class I, HLA class II, and neutrophil-specific antibodies in the plasma of both blood donors and recipients have been implicated in the pathogenesis of TRALI. The case for a relationship between leukocyte antibodies and TRALI is more compelling if concordance between the antigen specificity of the leukocyte antibodies in the donor plasma and the corresponding antigen on the cells of the affected recipient is demonstrated. Such antibody-antigen concordance can be investigated by typing the recipient for the cognate leukocyte antigens or by cross-matching the donor plasma against the recipient's leukocytes. Two proposed pathophysiologic mechanisms for TRALI have received the most attention: the antibody hypothesis and the two-event hypothesis. The final common pathway in all of the proposed pathogenic mechanisms of TRALI is increased pulmonary capillary permeability, which results in movement of plasma into the alveolar space causing pulmonary edema. A typical TRALI serologic workup consists of tests for HLA class I and II and neutrophil-specific antibodies. The use of flow cytometry and HLA-coated microbeads is recommended for detection of HLA antibodies in plasma of implicated blood donors and a combination of the granulocyte agglutination test and granulocyte immunofluorescence test for detection of neutrophil-specific antibodies. Genotyping for class I and II HLA and for a limited number of neutrophil antigens may also be helpful in establishing antibody-antigen concordance.
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Affiliation(s)
- Brian R Curtis
- Platelet & Neutrophil Immunology Laboratory, BloodCenter of Wisconsin, Milwaukee, WI, USA
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