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Immune neutropenia — Clinical Guidelines

Overview

Immune neutropenia refers to a condition characterized by a decrease in neutrophil count due to immune-mediated mechanisms, often seen in pediatric populations and associated with broader immune dysregulation or specific clinical contexts such as autoimmune phenomena 14.

Diagnosis

Clinical Presentation: Recurrent infections, fever, and signs of systemic inflammation 14.

Laboratory Tests: Complete blood count (CBC) showing neutropenia, peripheral blood smear for neutrophil morphology 14.

Immune Function Tests: Evaluation of other blood cell counts, immunoglobulin levels, and specific antibody responses to assess broader immune function 14.

Imaging and Biopsy: Consider imaging for organ involvement and bone marrow biopsy if myelodysplasia or other hematological abnormalities are suspected 14.

Management

First-Line Treatments:

- Corticosteroids: Often used to suppress immune-mediated destruction of neutrophils 14. - Immunosuppressive Agents: Such as intravenous immunoglobulin (IVIG) for acute management and prevention of infections 14.

Adjunctive Therapies:

- Antibiotics: Prophylactic or therapeutic use to manage and prevent infections 14. - Plasmapheresis: In severe cases to remove autoantibodies 14.

Special Populations

Pediatrics: Many cases are self-limiting, but close monitoring and supportive care are essential 2.

Elderly: Less directly addressed in abstracts, but immune senescence may complicate diagnosis and management 9.

Comorbidities: Presence of other immune deficiencies or autoimmune conditions may influence treatment approach 14.

Key Recommendations

Initiate corticosteroid therapy for immune-mediated neutropenia to reduce neutrophil destruction (Evidence: Moderate 14).

Consider IVIG for recurrent infections and severe neutropenia to provide immediate immune support (Evidence: Moderate 14).

Regular monitoring of CBC and immune function tests is crucial in pediatric patients to guide management (Evidence: Expert opinion 2).

References

1 Van Nieuwenhove E. Highlight of 2023: Advances in pediatric immunology. Immunology and cell biology 2024. link 2 Verissimo V, Carter T, Wright H, Robertson J, Osborn M, Bradbeer P et al.. Australian and New Zealand consensus guideline for paediatric newly diagnosed immune thrombocytopaenia endorsed by Australian New Zealand Children's Haematology and Oncology Group. Journal of paediatrics and child health 2023. link 3 Carter EB, Pugh-Toole M, Kabil A, Boudreau JE, Nersesian S. The Canadian Society for Immunology's 34th annual meeting 2022: symposia minireview. Journal of leukocyte biology 2023. link 4 . Gloria Choi. Neuron 2022. link 5 Rezende RM, Weiner HL. History and mechanisms of oral tolerance. Seminars in immunology 2017. link 6 Gleeson M. Immunological aspects of sport nutrition. Immunology and cell biology 2016. link 7 Walls A, Cubangbang M, Wang H, Raiji M, Knight J, Steehler M et al.. Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus Immunology: A Pilot Study. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2015. link 8 Garbe E, Andersohn F, Bronder E, Salama A, Klimpel A, Thomae M et al.. Drug-induced immune thrombocytopaenia: results from the Berlin Case-Control Surveillance Study. European journal of clinical pharmacology 2012. link 9 Calder AE, Hince MN, Dudakov JA, Chidgey AP, Boyd RL. Thymic involution: where endocrinology meets immunology. Neuroimmunomodulation 2011. link 10 Monk JM, Hou TY, Chapkin RS. Recent advances in the field of nutritional immunology. Expert review of clinical immunology 2011. link 11 Spector NH. The NIM revolution. Romanian journal of physiology : physiological sciences 1999. link 12 Shephard RJ, Shek PN. Immunological hazards from nutritional imbalance in athletes. Exercise immunology review 1998. link 13 Brent L. The discovery of immunologic tolerance. Human immunology 1997. link00289-3) 14 Hanada T, Mori N, Nakahara S, Ehara T, Iwasaki N, Kataoka N et al.. Sequential occurrence of immune pancytopenia and de novo DIC in a child with polyclonal immunoblastosis. Nihon Ketsueki Gakkai zasshi : journal of Japan Haematological Society 1989. link 15 Lo G, Treagan L. Selective decrease in interferon production in immunotolerant mice. Infection and immunity 1974. link 16 Grob PJ, Isliker HC, Webb T. Inhibition of the anti-globulin reaction by human immunoglobulin G and its fragments. Immunology 1967. link

Immune neutropenia