Neutropenia Causes

Aka: Neutropenia Causes, Agranulocytosis Causes

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II. Causes: Acquired

  1. Autoimmune Neutropenia
  2. Drug-Induced Neutropenia (including Chemotherapy-induced)
  3. Neutropenia due to Infection
  4. Nutritional deficiency
    1. May result in Pancytopenia
    2. Most common causes
      1. Vitamin B12 Deficiency
      2. Folate Deficicency
      3. Copper Deficiency
  5. Hematologic Malignancy
    1. Often associated with other CBC abnormalities (e.g. Thrombocytopenia, Anemia)
    2. Causes
      1. Myelodysplasia
      2. Acute Myelogenous Leukemia (AML)
      3. Large Granular Lymphocytic Leukemia
  6. Chronic Idiopathic Neutropenia
    1. Most common cause in childhood (1 per 100,000 children)
    2. Mild to moderate Neutropenia >= 3 months
    3. Negative antineutrophil antibodies and no causative condition identified
    4. Observed

III. Causes: Inherited

  1. Bone Marrow Failure (Fanconi Anemia)
  2. Severe Congenital Neutropenia
  3. Cyclic Neutropenia
    1. Neutropenia recurs every 21 days with a 3-4 day duration
    2. Mucosal and Skin Infections are common during neutropenic nadir
    3. Prevention with good hydgiene and lifestyle changes
    4. Consider Granulocyte Macrophage Colony Stimulating Factor (G-CSF)
    5. Consider Hematopoietic Stem Cell Transplant
  4. Benign ethnic Neutropenia
    1. Occurs in patients from Africa, Caribean, Middle East, West Indies
    2. Associated with absence of Duffy Antigen on RBCs (Duffy Null Phenotype)
    3. Assumes no secondary Neutropenia cause identified

IV. Causes: Decreased Neutrophil Production

  1. Marrow Infiltration
    1. Leukemia
    2. Myelodysplastic Syndrome
    3. Myelofibrosis (tumor invasion)
    4. Granulomatous infiltration (e.g. Tuberculosis)
  2. Marrow Injury
    1. Radiation
    2. Aplastic Anemia
    3. Paroxysmal Nocturnal Hemoglobinuria
    4. Medications
      1. See Drug-Induced Agranulocytosis
    5. Infection
      1. See Infectious Causes of Neutropenia

V. Causes: Increased Neutrophil Destruction

  1. Severe Sepsis (increased consumption)
  2. Antineutrophil Antibody
  3. Hypersplenism (Splenic trapping)
  4. Felty's Syndrome
  5. Systemic Lupus Erythematosus
  6. Chediak-Higashi Syndrome (rare Autosomal Recessive)
  7. Medications
    1. Phenylbutazone
    2. Phenothiazine

VI. Causes: Lower Clinical Significance

  1. Pseudoneutropenia (based on automated count)
  2. Maturation Defect
    1. Vitamin B12 Deficiency
    2. Folic Acid Deficiency
  3. Margination (distribution)
    1. Bacterial Infection (Endotoxin)
    2. Hemodialysis
    3. Cardiopulmonary bypass

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