Chronic neutropenia
Overview
A blood disorder characterized by a reduced number of neutrophils (type of white blood cell) which affects the body's ability to fight infection.
Symptoms
* Recurring infections * Low blood level of neutrophils
Causes
* Decreased production in the bone marrow: * aplastic anemia * cancer, particularly blood cancers * certain medications * hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia) * radiation * Vitamin B12 or folate deficiency. * Increased destruction: * autoimmune neutropenia. * chemotherapy treatments, such as for cancer and autoimmune diseases * Marginalisation and sequestration: * Hemodialysis
Diagnosis
Low neutrophil counts are detected on a full blood count. Generally, some 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
Treatment
* If a self-limited viral infection is suspected, repeat CBC in 3–4 weeks * If cyclic neutropenia suspected, repeat three times per week for 4 weeks * If febrile (?100.4 F [38.0 C]) and/or presenting with acute illness –Cultures of blood, urine, sputum if applicable, throat if symptomatic –Appropriate broad-spectrum empiric antibiotic therapy * Chronic neutropenia –May be cyclic or idiopathic (not associated with specific etiology or infection) –Granulocyte colony stimulating factor (GCSF) may be helpful * Drug-induced neutropenia usually resolves with removal of the offending agent