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Case Reports in Medicine
Volume 2009 (2009), Article ID 717545, 4 pages
http://dx.doi.org/10.1155/2009/717545
Case Report

A Case of Neonatal Neutropenia Due to Anti-Fc Gamma Receptor IIIb Isoantibodies Treated with Recombinant Human Granulocyte Colony Stimulating Factor

1Department of Platelet and Leukocyte Immunology, Croatian Institute of Transfusion Medicine, HR-10000 Zagreb, Croatia
2Department of Neonatology, University Department of Pediatrics, Sestre Milosrdnice University Hospital, HR-10000 Zagreb, Croatia
3Department of Molecular Immunogenetics, Croatian Institute of Transfusion Medicine, HR 10000, Zagreb, Croatia
4Department of Immunohematology, Croatian Institute of Transfusion Medicine, HR 10000, Zagreb, Croatia

Received 8 June 2009; Accepted 18 July 2009

Academic Editor: Frans J. Walther

Copyright © 2009 Maja Tomicic et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Alloimmunization to granulocyte-specific antigens can occur during pregnancy. Maternal antibodies of IgG class can cross the placenta to result in alloimmune neonatal neutropenia. Antibodies to human neutrophil antigens anti-HNA-1a, HNA-1b, and HNA-2a have been most commonly reported to cause alloimmune neonatal neutropenia. Isoantibodies to Fc gamma RIIIb (CD16) if mother is a HNA-null phenotype are rarely involved in neonatal neutropenia. We report on a case of severe neutropenia (440 neutrophils/ L) due to anti-Fc gamma RIIIb (CD16) isoimmunization. On day 14 severe omphalitis developed, which was treated for 7 days by an antibiotic (ceftriaxone in a dose of 80 mg/kg/d) according to umbilical swab finding. Omphalitis persisted for 10 days in spite of antibiotic therapy and only resolved upon the introduction of rhG-CSF therapy. Therapy with rh-GCSF proved efficient and led to neutrophil count increase to 1970/ L and cure of omphalitis. However, therapeutic effect on granulocyte count was of transient nature, as granulocyte count fell to 760 n/ L on day 4 of therapy discontinuation. Neutropenia persisted for 2 months. The newborn was discharged from the hospital on day 26 with normal clinical status with clinical and laboratory control examinations at 2-week intervals. No additional infections were observed during the course of neutropenia.