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Home , Granulocyte, Neutrophil

Neutrophil Testing

The American Red Cross National Laboratory is a worldwide leader in neutrophil testing and is internationally recognized in human neutrophil scientific research by providing a groundbreaking description of HNA-2 deficiency and genetics. The detection of neutrophil remains challenging. However, the Neutrophil Laboratory is one of the few facilities worldwide that perform this type of testing analysis. We are the only laboratory in the United States that routinely utilizes a combination of the immunofluorescence test (GIFT) and granulocyte agglutination test (GAT) for detecting HNA antibodies, which are recommended by the ISBT Granulocyte Immunobiology Working Party. Additionally, we’re the singular neutrophil laboratory in the United States to routinely offer a monoclonal immobilization of neutrophil (MAINA) assay, the recommended testing of neutrophil antibodies in children with a presumptive autoimmune diagnosis.

In collaboration with other testing facilities, our neutrophil testing laboratory serves patients ranging from infants in utero, pregnant women, transfusion patients, and conditions such as drug-induced neutropenia and TRALI cases. The Red Cross is also a founding member of the ISBT Working Party on Granulocyte Immunobiology, and the lab is one of two laboratories in the United States that participate in the International Granulocyte Workshop consortium.

Indications The presence of antibodies directed toward neutrophil results in their destruction and leads to a clinical condition known as neutropenia. Neutropenia is defined as an abnormally low concentration of . Neutrophils are the most abundant white cells found in the bloodstream and are essential in fighting off bacterial and fungal . These tests can aid in the clinical diagnosis of the following disorders:

• Transfusion-related acute lung injury (TRALI): TRALI is a pulmonary syndrome associated with transfusion. Often severe and potentially life-threatening, it is the most frequent cause of transfusion-associated mortality in the United States. TRALI has been associated with antibodies against neutrophil, HLA Class I and Class II in up to 89% of cases. Neutrophil antibody testing is an integral part of the investigation of TRALI cases.

12 • Alloimmune neonatal neutropenia (ANN): ANN is a potentially critical disorder of the neonate and young infant. This disease is caused by the passive transfer of neutrophil-specific material IgG antibodies across the placenta during pregnancy. These antibodies subsequently bind to fetal neutrophils in utero, which often results in severe neutropenia. Acute bacterial infections may result shortly after birth when the neonate is exposed to a plethora of . • Autoimmune neutropenia (AIN): AIN is a disorder that results when an individual forms antibody directed against their own neutrophils. It can present in a primary or secondary form. Primary AIN is not associated with other immunological or hematological abnormalities. In cases of secondary AIN, the neutropenia is the result of a more extensive autoimmune disorder or malignant lymphoproliferative disease. • Drug-induced neutropenia: Patients may become neutropenic during or soon after drug therapy, with quinine frequently implicated.

Description The lab follows the ISBT guidelines for detecting HNA antibodies, specifically a combination of the granulocyte agglutination test (GA) and granulocyte immunofluorescence test (GIF). Additional tests that are routinely available only at this neutrophil laboratory are the immobilization of neutrophil antigen assay (MAINA) which can distinguish neutrophil antibodies from HLA antibodies.

Test Methods • Granulocyte agglutination (GA) assay • Granulocyte immunofluorescence (GIF-flow cytometry) assay • Monoclonal antibody immobilization of neutrophil antigens (MAINA) assay • Neutrophil genotyping using SSP-PCR • Neutrophil phenotyping • HLA (PRA) Class I and Class II antibody detection using flow cytometry for TRALI investigations

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