Neutropenia

Last updated: Friday, 21, January, 2011
CausesAppropriate Tests

Review clinical features, including history of exposure to drugs, toxins, or recent viral illness.

FBC, blood film, differential WCC; bone marrow aspiration if significant and no diagnosis. Infective problems are uncommon unless the neutrophils are <1.0x109/L.

See also Febrile neutropenia, Immunodeficiency, Infection (increased susceptibility), Neutrophil dysfunction

Decreased production

Drug reactions

  • Predictable
    • Cytotoxic drugs
    • Alcohol

Usually pancytopenia, rather than isolated neutropenia.

  • Idiosyncratic
    • Antithyroid drugs
    • Chlorpromizine
    • NSAID
    • Sulphonamides
    • Clozapine
    • Gold

Bone marrow failure 

Bone marrow failure is usually associated with pancytopenia, rather than isolated neutropenia.
See also Pancytopenia


See Myelodysplastic syndromes - classification

Megaloblastic anaemia

Usually pancytopenia, rather than isolated neutropenia.

Chronic idiopathic neutropenia

Hereditary/constitutional

  • Chediak-Higashi syndrome
  • Diamond-Blackfan syndrome
  • Associated with inborn errors of metabolism e.g. organic acidemias.

See under Immunodeficiency

Increased destruction and/or margination

Immune, especially

Check ANA.


Check Rheumatoid factor.

Drug reactions

  • Captopril
  • Penicillins

Drug associated neutrophil antibodies.

Hypersplenism

 

Neutropenia, splenomegaly and rheumatoid arthritis. 30% have LGL leukemia.

Haemodialysis

Idiopathic

Decreased production and increased destruction

Viral infection

 

See Cytomegalovirus infection


See Dengue

Bacterial infections

The neutrophil count is variable in severe bacterial infection, but neutropenia is common, especially in neonates and in patients with Gram-negative septicaemia.

Protozoal infection

Hairy cell leukaemia

Neutropenia with an expansion of LGL's.

Cyclic neutropenia

Follow-up FBC, differential WCC over time, flow cytometry.

Kostmann's Syndrome

Infantile genetic agranulocytosis

Felty Syndrome

Neutropenia, splenomegaly and rheumatoid arthritis. 30% have LGL leukemia.