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

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

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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Related Studies

Ontology: Agranulocytosis (C0001824)

Definition (NCI_NCI-GLOSS) A condition in which there is a lower-than-normal number of granulocytes (a type of white blood cell).
Definition (NCI) A decrease in the number of mature granulocytes (neutrophils, eosinophils, and basophils) in the peripheral blood.
Definition (CSP) decrease in the number of granulocytes (basophils, eosinophils, and neutrophils).
Definition (MSH) A decrease in the number of GRANULOCYTES; (BASOPHILS; EOSINOPHILS; and NEUTROPHILS).
Concepts Disease or Syndrome (T047)
MSH D000380
ICD10 D70
SnomedCT 191350006, 154830007, 165508008, 142919000, 310589001, 191336001, 17182001, 72885007, 417672002
English Agranulocytoses, Agranulocytosis, Granulocytopenia, Granulocytopenias, AGRANULOCYTOSIS, GRANULOCYTOPENIA, Agranulocytosis NOS, agranulocytosis (diagnosis), agranulocytosis, granulocytopenia (diagnosis), granulocytopenia, Agranulocytosis [Disease/Finding], granulopenia, agranulocytoses, Agranulocytosis NOS (disorder), Agranulocytosis (finding), Granulocytopenia (disorder), Granulopenia, Agranulocytosis (disorder), Schultz, Granulocytopenic disorder (disorder), Granulocytopenic disorder
French AGRANULOCYTOSE, GRANULOCYTOPENIE, Agranulocytose, Granulocytopénie
Portuguese AGRANULOCITOSE, GRANULOCITOPENIA, Agranulocitose, Granulocitopenia
Spanish AGRANULOCITOSIS, GRANULOCITOPENIA, agranulocitosis (hallazgo), granulocitopenia, agranulocitosis, SAI (trastorno), granulopenia, agranulocitosis, SAI, granulocitopenia (trastorno), agranulocitosis (trastorno), agranulocitosis, trastorno granulocitopénico (trastorno), trastorno granulocitopénico, Agranulocitosis, Granulocitopenia
German AGRANULOZYTOSE, GRANULOZYTOPENIE, Agranulozytose, Granulozytopenie
Swedish Agranulocytos
Japanese カリュウキュウゲンショウショウ, ムカリュウキュウショウ, Schultz症候群, 顆粒球減少症, シュルツ症候群, 無顆粒球症, 顆粒球減少
Czech agranulocytóza, granulocytopenie, Agranulocytóza, Granulocytopenie
Finnish Agranulosytoosi
Italian Granulocitopenia, Agranulocitosi
Korean 무과립세포증
Polish Agranulocytoza, Granulocytopenia
Hungarian granulocytopenia, agranulocytosis
Norwegian Agranulocytose, Granulocytopeni
Dutch agranulocytose, granulocytopenie, Agranulocytose, Cytose, agranulo-, Granulocytopenie

Ontology: Neutropenia (C0027947)

Definition (MSH) A decrease in the number of NEUTROPHILS found in the blood.
Definition (CSP) decrease in the number of neutrophilic leukocytes in the blood.
Concepts Disease or Syndrome (T047)
MSH D009503
ICD9 288.0, 288.00
ICD10 D70 , D70.9
SnomedCT 191336001, 72885007, 142928004, 303011007
English Neutropenias, NEUTROPENIA, neutropenia (diagnosis), neutropenia, Neutropenia, Neutropenia NOS, Neutropenia, unspecified, Neutropenia [Disease/Finding], Neutropenia (disorder), Neutropenia (finding), Disorder characterized by neutropenia, Neutropenic disorder, Neutropenic disorder (disorder), Neutropenia, NOS, Neutropenia (disorder) [Ambiguous]
French NEUTROPENIE, Neutropénie, Neutropénies
Portuguese NEUTROPENIA, Neutropenia, Neutropenias
Spanish NEUTROPENIA, neutropenia (trastorno), neutropenia, neutropenia (concepto no activo), neutropenia - trastorno (trastorno), neutropenia - trastorno, trastorno neutropénico, Neutropenias, Neutropenia
German NEUTROPENIE, Neutropenie, Neutropenien
Italian Neutropenia, Neutropenie
Japanese 好中球減少症, コウチュウキュウゲンショウショウ
Swedish Neutropeni
Czech Snížený počet neutrofilů, Neutropenie
Polish Neutropenia
Hungarian Neutropeniák, neutropenia
Dutch neutropenie, neutropenieën, Neutropenie