Laboratory testing for the diagnosis of neonatal and pediatric immune neutropenias: a narrative review

Abstract

Objectives: This review focuses on the role of anti-neutrophil antibodies in neonatal and pediatric neutropenias with particular regard to laboratory tests useful to detect them. Background: Neutropenia is a common medical problem for infants and children that can predispose them to the risk of bacterial infections. There are many causes for pediatric neutropenia, but at birth and for the first years of life, neutropenia is often attributable to immune mechanisms, either by the presence of auto or alloantibodies directed against human neutrophil antigens (HNA). The detection of these antibodies is a useful diagnostic tool to define immune-mediated neutropenia, which includes a variety of clinical conditions. Methods: PubMed was used to carry out a literature search for the last 10 years. In addition, pivotal papers on this topic, before 2010, were also considered. Conclusions: The detection and identification of anti-neutrophil antibodies with the techniques currently available are often laborious, difficult, and performed in specialized laboratories. Moreover, since neutrophils are fragile cells and difficult to preserve, several advances in laboratory procedures have been developed in the last years. The recent availability of new commercial assays, which do not require fresh cells, may represent an important step forward in neutrophil serology, as it could improve the standardization and availability of serological and genomic tests that can also be used in non-specialized laboratories. However, these assays still need to complete the necessary validations before replacing classical serological methods. 13