Neutropenia

Aka: Neutropenia, Granulocytopenia, Agranulocytosis, Schultz's Disease, Pseudoneutropenia

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II. Definition: Neutropenia (Neutrophil Count < 1500/mm3)

  1. Agranulocytosis (severe Neutropenia)
    1. Complete absence of Neutrophils
  2. Neutropenia: Based on Absolute Neutrophil Count (ANC)
    1. Mild Neutropenia: ANC 1000 to 1500 Neutrophils/mm3
    2. Moderate Neutropenia: ANC 500 to 1000 Neutrophils/mm3
    3. Severe Neutropenia: ANC <500 Neutrophils/mm3

III. Precautions

  1. See Neutropenic Fever
  2. Avoid Rectal Exam in Neutropenia (theoretic risk of bacteremia)

IV. Causes

  1. See Neutropenia Causes

V. Differential Diagnosis: Pseudoneutropenia (automated)

  1. Blood examined after long delay after phlebotomy
  2. Margination (see Neutropenia Causes)
  3. Neutrophil clumping
    1. Paraproteinemia
    2. Anticoagulant use

VI. Signs: Recurrent infection

  1. General
    1. Typical inflammation signs less commonly seen
    2. Swelling and heat less often seen with Neutropenia
  2. Organisms
    1. Staphylococcus aureus (skin)
    2. Gram Negative (Gastrointestinal, Genitourinary)
  3. Early severe Neutropenia
    1. Oropharyngeal infections
    2. Skin Infections or delayed Wound Healing
  4. Persistent severe Neutropenia
    1. Pulmonary infection
    2. Gastrointestinal infection
    3. Sepsis

VII. Labs

  1. Complete Blood Count with Platelet Count
  2. Peripheral Blood Smear

VIII. Evaluation: Bone Marrow Biopsy

  1. Indications
    1. Indicated in most Neutropenia cases
    2. Not required in mild Drug-Induced Neutropenia
  2. Increased Granulocytes in Bone Marrow
    1. Suggests increased destruction (e.g. immune)
  3. Decreased Granulocytes in Bone Marrow
    1. Increased cells seen in marrow
      1. Suggests marrow infiltration (e.g. Leukemia)
    2. Decreased cells seen in marrow
      1. Suggests marrow injury (e.g. medications)

IX. Complications

  1. Severe Neutropenia predisposes to serious infection

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