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  • Letter to the Editor
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Appropriate use of intravenous immunoglobulin in neonatal neutropenia

Journal of Perinatology volume 27, pages 196–197 (2007)Cite this article

We applaud the detail Christensen et al.1 provide in describing the evaluation and treatment of extremely low birth weight neonates with low blood neutrophil concentrations. One significant recommendation, previously adopted for their practice guidelines,2 involves the reasonable administration of intravenous immunoglobulin (IVIg) therapy in neutropenic neonates only with proven, or very likely bacterial sepsis and shock syndrome. This is a very important criterion that deserves further explanation.

Although the mechanism of action of IVIg in many disorders has yet to be determined, it is becoming clear that in certain disorders, such as idiopathic thrombocytopenic purpura,3 the immunomodulatory activity of IVIg is an important component of the therapeutic effect. Only recently has the mechanism of this modulation been established as the clearance of neutrophils. Patients treated with IVIg generally experience neutropenia4, 5 and in the case of patients with Kawasaki disease, these neutrophils are lost through an apoptotic mechanism.6 It is now known that IVIg preparations contain autoantibodies that bind the sialic acid-binding Ig-like lectin (Siglec-9) receptor found on neutrophils.7 In the presence of certain inflammatory cytokines, such as the rG-CSF advocated by Cristensen et al.1 for treatment of severe chronic neutropenia, the ligation of these IVIg-provided antibodies to the neutrophil ultimately results in death of the cell.7 As cellular apoptosis occurs without induction of inflammation, and is recognized to actively elicit systemic anti-inflammatory effects,8, 9 this approach to managing inflammatory diseases is mechanistically sound. This appears to be a very delicate balance as IVIg treatment lacking inflammatory cytokines causes neutrophil proliferation.10

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References

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Authors and Affiliations

  1. Talecris Biotherapeutics, Research Triangle Park, NC, USA

    E J Buenz

  2. Department of Neurology, Program in Translational Immunovirology and Biodefense, Program in Molecular Neuroscience, Mayo Clinic College of Medicine, Rochester, MN, USA

    C L Howe

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  1. E J Buenz
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  2. C L Howe
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Correspondence to E J Buenz.

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Buenz, E., Howe, C. Appropriate use of intravenous immunoglobulin in neonatal neutropenia. J Perinatol 27, 196–197 (2007). https://doi.org/10.1038/sj.jp.7211660

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