Antibodies to human neutrophil antigen HNA-3b implicated in cases of neonatal alloimmune neutropenia

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Lopes, Larissa Barbosa [UNIFESP]
Abbas, Samira Ali [UNIFESP]
Moritz, Elyse [UNIFESP]
Martins, Juliana Oliveira [UNIFESP]
Chiba, Akemi Kuroda [UNIFESP]
Langhi Júnior, Dante Mário [UNIFESP]
Bordin, Jose Orlando [UNIFESP]
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BACKGROUNDNeonatal alloimmune neutropenia results from maternal alloimmunization to human neutrophil antigens. The alloantibodies involved in neonatal alloimmune neutropenia are against human neutrophil antigens HNA-1a, HNA-1b, HNA-1c, HNA-1d, HNA-2, HNA-3a, HNA-4a, HNA-4b, and HNA-5a
however, to date, antibodies specific to HNA-3b have not been reported. STUDY DESIGN AND METHODSBlood samples from 10,000 unselected neonates were analyzed, resulting in the selection of 88 neutropenic newborns (neutrophil count <1.5 x 10(9)/L) from 83 mothers (three pairs of twins and one triplet). HNA-3 genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism to identify the cases of maternal-fetal HNA-3 incompatibility. Serologic studies for detecting maternal HNA-3 alloantibodies were performed with the granulocyte agglutination test, the white blood cell immunofluorescence test, and a LABScreen Multi-HNA Kit. RESULTSGenotyping studies identified 13 of 88 (14.8%) instances of maternal-fetal HNA-3 incompatibility, with all mothers typed as HNA-3a/a and neonates typed as HNA-3a/b. Serologic studies revealed that five of 13 (38.5%) mothers carried anti-HNA-3b plus human leukocyte antigen antibodies and that three of 13 (23.1%) mothers had anti-HNA-3b without human leukocyte antigen antibodies. CONCLUSIONHere, we report the first three cases of neonatal alloimmune neutropenia associated with HNA-3b antibodies resulting in a neonatal alloimmune neutropenia incidence of one in 3333 live births.
Transfusion. Hoboken, v. 58, n. 5, p. 1264-1270, 2018.