Neutropenia | CMAJ
Neutropenia is seen in 5%–10% of wholesome folks
Based mostly on absolute neutrophil depend, neutropenia is often outlined as gentle (1.0–1.5 × 109/L), average (0.5–0.9 × 109/L) or extreme (< 0.5 × 109/L).1 Nevertheless, the reference interval is restricted to the inhabitants. Gentle asymptomatic neutropenia per the above definition is widespread in folks of sub-Saharan African, Arab or West Indian ancestry,2 and is strongly related to the Duffy-null phenotype of pink blood cells that protects towards Plasmodium vivax malaria.
Widespread causes embrace medicines, an infection, dietary deficiency, malignant illness and autoimmune illness
Causes embrace underproduction (e.g., myelodysplastic syndrome), immune-mediated destruction or redistribution of neutrophils to the endothelium and reticuloendothelial system. Antithyroid, anti-infective and psychotropic medication, in addition to chemotherapy, are causes of drug-induced neutropenia.3,4 Transient neutropenia could happen after acute viral an infection and usually resolves inside 2 weeks. Joint swelling, rash, bony ache, splenomegaly or lymphadenopathy could recommend malignant or autoimmune illness.
Investigation ought to start with a repeat full blood depend and peripheral blood movie
Neutropenia is usually recognized by the way. Persistent and unexplained neutropenia requires additional work-up for a variety of causes, together with continual viral an infection (e.g., hepatitis, HIV) and dietary deficiency (e.g., vitamin B12) (Appendix 1, out there at www.cmaj.ca/lookup/doi/10.1503/cmaj.220499/tab-related-content).
Remedy of gentle neutropenia must be directed on the underlying trigger
Sufferers with gentle neutropenia should not at considerably elevated danger of an infection.5 The neutrophil depend must be checked each 3–6 months for not less than 1 12 months to rule out development to extra extreme neutropenia.
Sufferers with moderate-to-severe neutropenia for greater than 6 months must be referred to a specialist
Sufferers with recurrent or extreme bacterial infections (e.g., requiring hospital admission or intravenous antibiotics), abnormalities on peripheral blood movies (e.g., circulating blasts, bushy cells, massive granular lymphocytes, dysplastic granulocytes) or pancytopenia additionally warrant referral to a specialist (e.g., hematologist, internist, pediatrician).1 Febrile neutropenia (absolute neutrophil depend < 0.5 × 109/L and an oral temperature > 38.0°C sustained over 1 h) requires quick therapy with broad-spectrum antibiotics.
Footnotes
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Competing pursuits: Siraj Mithoowani has acquired private charges from Leo Pharma. Mark Crowther has served on advisory boards for Precision Biologicals, Hemostasis Reference Laboratories and Syneos Well being. He has developed academic packages or acquired talking charges from Bayer, Pfizer, CSL Behring and Diagnostica Stago. He’s additionally the Leo Pharma Chair in Thromboembolism Analysis at McMaster College. No different competing pursuits had been declared.
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This text has been peer reviewed.
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