Neutrophils are a type of white blood cell that plays a crucial role in fighting infections, and a reduced neutrophil count, also known as neutropenia, can make individuals more susceptible to bacterial and fungal infections.
Neutropenia refers to low levels of neutrophils, which are part of the body’s defense system to fight infection. This can be caused by various factors, like infections, autoimmune diseases and nutritional deficiencies. It can also be caused by hemolytic disease of the fetus and newborn (HDFN), in which maternal antibodies destroy the baby’s red blood cells during pregnancy and post-delivery. This is not to be confused with neonatal alloimmune neutropenia in which white blood cells are destroyed by a mother’s antibodies.
Learn more about HDFN symptoms and risks
Close monitoring is required when a patient is diagnosed with neutropenia, but it is usually benign and self-limiting in newborns.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
What is neutropenia?
Neutropenia refers to low level of neutrophils in the blood. They are produced in the bone marrow and then join the bloodstream. These white blood cells are part of the body’s immune system and help fight off bacterial and fungal infections and heal damaged tissue. They travel around the body, going to places where infection is found and fighting the bacteria. When neutrophil levels are low, the risk for infection is higher.
Managing neutropenia in HDFN
In babies affected by HDFN, neutropenia occurs in 45% of cases. The body doesn’t produce enough white blood cells, as it is too busy replacing the red blood cells that have been destroyed by the maternal antibodies. It is diagnosed via a blood test – a full blood count with a differential – and in many cases, no treatment is required.
In some rare severe cases, granulocyte colony-stimulating factor (G-CSF) is administered to help increase the production of neutrophils. A white blood cell transfusion may also be an option.
While neutropenia is not a serious complication of HDFN, it can increase the risk of the baby becoming sick with an infection. In many cases, neutropenia resolves in the weeks and months post-birth, but it can last up to one year.
A newborn with HDFN and neutropenia is at a higher risk of sepsis and bacterial and fungal infections.
As neutropenia can persist even after discharge from the hospital, it is important to closely monitor your baby for signs of infection and to seek help immediately if they appear.
Signs of infection may include:
- Feeding difficulties
- Breathing difficulties
- Irritability
- Excessive sleepiness
- Floppiness
- Fever
- Low body temperature and chills
- Skin irritation
Early detection is important to ensure timely treatment and a full recovery.
To avoid infection in an HDFN-affected newborn with neutropenia, focus on regular hand washing and limiting access to people who are or may be sick.
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