Neutropenia

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Neutropenia
Classification and external resources
Neutropenia.JPG
Blood film with a striking absence of neutrophils, leaving only red blood cells and platelets
ICD-10D70
ICD-9288.0
DiseasesDB8994
MeSHD009503
 
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Neutropenia
Classification and external resources
Neutropenia.JPG
Blood film with a striking absence of neutrophils, leaving only red blood cells and platelets
ICD-10D70
ICD-9288.0
DiseasesDB8994
MeSHD009503

Neutropenia or neutropaenia, from Latin prefix neutro- (neither, for neutral staining) and Greek suffix -πενία (deficiency), is a granulocyte disorder characterized by an abnormally low number of neutrophils. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infections by destroying bacteria in the blood. Hence, patients with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening and deadly (neutropenic sepsis).

Neutropenia can be acute or chronic depending on the duration of the illness. A patient has chronic neutropenia if the condition lasts longer than three months. It is sometimes used interchangeably with the term leukopenia ("deficit in the number of white blood cells"), as neutrophils are the most abundant leukocytes, but neutropenia is more properly considered a subset of leukopenia as a whole.

The numerous causes of neutropenia can roughly be divided between either problems in the production of the cells by the bone marrow and destruction of the cells elsewhere in the body. Treatment depends on the nature of the cause, and emphasis is placed on the prevention and treatment of infection.

Classification[edit]

A generally accepted reference range for absolute neutrophil count (ANC) in adults is 1500 to 8000 cells per microliter (µl) of blood. Three general guidelines are used to classify the severity of neutropenia based on the ANC (expressed below in cells/µl):[1]

Signs and symptoms[edit]

Neutropenia can go undetected, but is generally discovered when a patient has developed severe infections or sepsis. Some common infections can take an unexpected course in neutropenic patients; formation of pus, for example, can be notably absent, as this requires circulating neutrophil granulocytes.

Some common symptoms of neutropenia include fevers and frequent infections. These infections can result in conditions such as mouth ulcers, diarrhea, a burning sensation when urinating, unusual redness, pain or swelling around a wound, or a sore throat.

Diagnosis[edit]

Low neutrophil counts are detected on a full blood count. Generally, other investigations are required to arrive at the right diagnosis. When the diagnosis is uncertain, or serious causes are suspected, bone marrow biopsy is often necessary.

Other investigations commonly performed: serial neutrophil counts for suspected cyclic neutropenia, tests for antineutrophil antibodies, autoantibody screen and investigations for systemic lupus erythematosus, vitamin B12 and folate assays, and acidified serum (Ham's) test.[2]

Causes[edit]

Causes can be divided into these groups:

Often, a mild neutropenia is seen in viral infections. Additionally, a condition called morning pseudoneutropenia might be a side effect of certain antipsychotic medications.

Therapy[edit]

No ideal therapy for neutropenia exists, but recombinant Granulocyte-colony stimulating factor, such as filgrastim (Neupogen), can be effective in chemotherapy patients, in patients with congenital forms of neutropenia including severe congenital neutropenia, autosomal recessive Kostmann's syndrome, cyclic neutropenia, and myelokathexis. Guidelines given to neutropenic patients regarding diet are currently being studied.[4]

History[edit]

The relationship between a low neutrophil count and increased risk of infection was first demonstrated in patients with leukemia.[5]

See also[edit]

References[edit]

  1. ^ Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP (Apr 2007). "Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences". Ann. Intern. Med. 146 (7): 486–92. doi:10.7326/0003-4819-146-7-200704030-00004. ISSN 0003-4819. PMID 17404350. 
  2. ^ Levene, Malcolm I.; Lewis, S. M.; Bain, Barbara J.; Imelda Bates (2001). Dacie & Lewis Practical Haematology. London: W B Saunders. p. 586. ISBN 0-443-06377-X. 
  3. ^ American Society of Hematology Trisenox (arsenic trioxide) in Patients with Myelodysplastic Syndromes (MDS): Preliminary Results of a Phase I/II Study. Norbert Vey, MD1,*, Francois Dreyfus, MD1,*, Agnes Guerci, MD1,*, Pierre Fenaux, MD1, Herve Dombret, MD1, Alan K. Burnett, MD2, Andre Bosly, MD3, Walter Feremans, MD4, David T. Bowen, MD5 and Marja Heiskala, MD6
  4. ^ Jubelirer, S. J. (6 April 2011). "The Benefit of the Neutropenic Diet: Fact or Fiction?". The Oncologist 16 (5): 704–707. doi:10.1634/theoncologist.2011-0001. PMC 3228185. PMID 21471277. 
  5. ^ Bodey GP, Buckley M, Sathe YS, Freireich EJ (Feb 1966). "Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia". Ann. Intern. Med. 64 (2): 328–40. doi:10.7326/0003-4819-64-2-328. ISSN 0003-4819. PMID 5216294. 

External links[edit]