Isolated neutropenia is a common clinical problem seen by primary care physicians and hematologists. The evaluation of neutropenia is dictated by the acuity of the clinical presentation and the duration, age, and clinical status of the patient. In this review, we provide a practical approach to the evaluation of the adult patient with neutropenia, with the major focus on the evaluation of neutropenia in the outpatient setting.
The normal adult leukocyte count ranges from approximately 4,000 to 10,000 cells/mm3. Consequently, a total leukocyte count above this range constitutes the presence of leukocytosis. Furthermore, leukocytosis may be defined by the type of leukocyte that is increased in number above the normal absolute count for that particular cell type. For instance, neutrophilia exists when the absolute count of mature and immature neutrophils exceeds greater than 70% of the total leukocyte count, which is approximately 7,000 cells/mm3. Significant neutropenia is said to exist when the absolute neutrophil count (ANC=WBC (cells/microL)x(% PMNs+% bands)÷100) is less than 1,000 cells/ mm3 with the risk of bacterial infection markedly increasing with an absolute neutrophil count of less than 500 cells/mm.
So...after living with my own Cyclic Neutropenia for 30 years and caring for my neutropenic children, I've often wondered how our lives may differ from yours.
Where her voice is heard and Cyclic Neutropenia is more than a word.
Severe Chronic Neutropenia is a rare disease affecting less than three thousand people in the country. The National Neutropenia Network (NNN) exists to help individuals and families impacted by neutropenia to live the healthiest and most fulfilling life possible.
Increasing the understanding of neutropenia by providing information and support for care givers, patients and their families.
The Severe Chronic Neutropenia International Registry (SCNIR) was established in 1994 to monitor the clinical course, treatment, and disease outcomes in patients with severe chronic neutropenia (SCN). The Registry has the largest collection of long-term data on patients with this condition in the world. Participation in the Registry benefits patients, their families and the physicians who treat them by providing the most up to date information to them on the natural history of SCN and its treatment options.
Leukine® (sargramostim) is a man-made form of granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF (you may also hear this referred to as CSF) is a type of protein known as a growth factor that your body produces to help increase the number and function of white blood cells (WBCs).
Living with the ups and downs of Neutropenia.
Neulasta® (pegfilgrastim) is a prescription medicine used to help reduce the chance of infection due to a low white blood cell count, in people with certain types of cancer (non-myeloid), who receive anti-cancer medicines (chemotherapy) that can cause fever and low blood cell count.
NEUPOGEN® (filgrastim) is a prescription medication used to reduce the risk of infection in patients with some tumors, who are receiving strong chemotherapy that may cause severe neutropenia with fever.
Depending on the type or dose of chemotherapy, your neutrophil counts generally start to drop about a week after each round of chemotherapy begins and usually reach a low point (called the nadir) about seven to 14 days after treatment. At this point, you are most likely to develop an infection. Your neutrophil count then starts to rise again as your bone marrow resumes normal production of neutrophils. However, it may take three to four weeks to reach a normal level again.
With fewer neutrophils, a person is more prone to infection. Even things the body would normally be able to fight off without much trouble, like skin infections or ear infections, become much more serious and long-lasting when someone is in a "neutropenic state."
The most common causes of leukopenia are recent infection, chemotherapy, radiation therapy, and HIV (Merck 2012a), but it can also be caused by certain medications such as the antipsychotic clozapine (Clozaril®) and the antibiotic minocycline (Minocin®) (Ahmed 2007; Latif 2012). Leukopenia is a common side effect of anti-cancer drugs, as such drugs attack rapidly dividing cells (including neutrophils) (Merck 2012a).
The threshold for a low white blood cell count varies from one medical practice to another. Some healthy people have white cell counts that are lower than what's considered normal. A count lower than 4,000 white blood cells per microliter of blood is generally considered a low white blood cell count. The threshold for a low white blood cell count in children varies with age and sex.
Neutropenia can be present (though it is relatively uncommon) in normal healthy individuals, notably in some persons of African or Arabic descent and Yemenite Jews. Neutropenia may arise as a result of decreased production of neutrophils, destruction of neutrophils after they are produced, or pooling of neutrophils (accumulation of the neutrophils out of the circulation).
Agranulocytosis and neutropenia usually occur later in life, as the result of another condition or treatment (acquired), but can sometimes be present from birth (congenital).
Depending on the cause, your white blood cell count may recover over time.
Given that neutropenia is caused by cancer treatments, there is not much you can do to prevent it from occurring, but you can decrease the risk of getting an infection while your count is low.
Neutropenic patients can therefore be divided into three clinical groups:
•Otherwise well patients with neutropenia. These patients may be known to be neutropenic previously or presenting de novo and require investigation to look for an underlying diagnosis.
•(Previously) immunocompetent patients, now presenting with neutropenia and compromised, requiring urgent treatment.
•(Known) immunocompromised patients presenting with neutropenia and compromised, requiring urgent treatment.
Deficiency of absolute number of leukocytes, which may be granulocytes (neutrophils, eosinophils, basophils) or lymphocytes (T-cells, B-cells). The majority of cases of leukopenia are actually neutropenia since neutrophils constitute the majority of leukocytes. As the principal function of white cells is to combat infection, a decrease in the number of these cells can place patients at increased risk for infection.