A 3-day-old, 59-kg Thoroughbred colt was presented to the Lloyd Veterinary Medical Center (Ames, Iowa) for suspected neonatal isoerythrolysis (NI). The colt's dam was a 5-year-old primiparous mare without reported medical disorders during gestation or parturition. Upon initial examination, the colt was quiet and lethargic but still responsive, with a rectal temperature of 38.0°C, heart rate of 160 beats/min, and respiratory rate of 80 breaths/min. Marked jaundice of the mucous membranes and sclera was observed. interval: 0.5-3.9 mg/dl). Agglutination of red cells was not observed on the blood smear. After identification of an appropriate donor via major and minor cross-match, a blood transfusion consisting of 1.5 liters of packed red cells was performed over 6 hr; no adverse reactions were observed. Administration of amikacin (25 mg/kg, intravenously [IV], every 24 hr) and ceftiofur (5 mg/kg, IV, every 12 hr) also was initiated. The colt rapidly appeared much brighter and energetic with the hematocrit rising to 19% shortly after blood transfusion was complete. The hematocrit slowly increased during hospitalization and was 29% at the time of discharge on day 30 (Fig. 1). Blood typing of the mare identified the Aa, Ca, Qa, Qb, and Qc antigens on maternal red blood cells; Ca, Ka, Qa, Qb, and Qc antigens were identified on the colt's red blood cells, suggesting the Ka erythrocyte antigen as the cause of NI in this colt.Despite the gradually increasing hematocrit, leukopenia characterized by marked neutropenia was identified on both automated a and manual evaluation of blood smears during the initial 5 days of hospitalization (Fig. 1). A thorough diagnostic investigation to identify a possible source of infection that could result in persistent neutropenia was conducted including repeated physical examinations and thoracic and abdominal ultrasonography. The colt was consistently bright and alert and maintained a normal body temperature; no abnormal findings were observed via ultrasonography, and blood cultures did not yield bacterial growth. Because an obvious source of infection could not be identified in conjunction with continued and profound neutropenia along with the absence of immature or toxic neutrophils, an immune-mediated neutropenia was considered. On day 5 of hospitalization, Abstract. A 3-day-old Thoroughbred colt was originally presented for treatment of neonatal isoerythrolysis, which was treated with a blood transfusion. However, persistent neutropenia was observed despite the absence of detectable infection. Subsequently, a granulocyte agglutination test was performed by incubating the colt's neutrophils with the mare's serum; results were positive, leading to a clinical diagnosis of alloimmune neonatal neutropenia. The diagnosis was further supported via flow cytometric analysis. The colt was hospitalized and treated prophylactically with antimicrobials and 4 separate doses of recombinant human granulocyte colony-stimulating factor (rhG-CSF; 1.4-3.5 µg/kg, subcutaneously) in attempts to maintain the...