Neutropenia

Cross section of blood vessel with normal amounts of red blood cells, platelets, and white blood cells in plasma. Below it is another cross section of blood vessel with neutropenia showing normal amounts of red blood cells, platelets, and too few white bl

Neutropenia is a condition of blood in which the neutrophil cells count is abnormally lowered. Neutrophil cells are type of white blood cells which help to fight against infections particularly those caused by fungi and bacteria.

Neutropenia is a granulocyte disorder characterized by abnormally low number of neutrophils. 50-70% of circulating white blood cells are neutrophils and serves as the primary defense against infections by destroying bacteria present in the blood.

Hence the people with neutropenia are more susceptible to bacterial infections and this condition may become life threatening if prompt medical attention.

Neutropenia in older people is defined as when count of neutrophils is less than 1700 permicrolitre of blood.

The person who suffers from low neutrophil count is more vulnerable to infectious diseases.

Classification of neutropenia

Neutropenia is of two types depending upon the duration of the illness

Acute neutropenia

Chronic neutropenia.

A patient has chronic neutropenia if the condition lasts for longer than three

months.

Severity of neutropenia depends upon the count and it is classified in three forms

•Mild neutropenia (1000< ANC <1500) – minimal risk of infection.

•Moderate neutropenia (500<ANC<1000) – moderate risk of infection.

•Severe neutropenia(ANC<500)-severe risk of infection.
Age and sex predilections of neutropenia

Individuals of higher age group are on higher incidence of suffering from neutropenia than of younger age group.

Neutropenia is more common in females than in males.Races affected by neutropenia

Individuals of black race show low neutrophil counts in their blood.
Causes of neutropenia Causes for neutropenia are grouped in various categories

•First cause is from the origin of its formation that is decreased production in bone marrow due to following causes

Arsenic poisoning.

Cancers especially blood cancers.

Radiation.

Vitamin B12 , copper or folate deficiency.

Aplastic anemia.

Certain medications.

Hereditary disorders example congenital neutropenia, cyclic neutropenia.

•In processes of marginalization and sequestration

Hemodialysis.

•Due to affect of different medications and are as follows

Phenytoin.

Flecainide.

Carbimazole.

Clozapine.

Ticlodipine.

Trimethoprim.

Indomethacin.

Propylthiouracil.

•Conditions or diseases in which destruction of neutrophils are increased are as follows

Autoimmune neutropenia.

Chemotherapy treatments such as in cancer and autoimmune diseases.

Other possible causes of neutropenia are as follows

•Alcoholism.

•Hepatitis A

•Hepatitis B

•Hepatitis C

•HIV/AIDS.

•Leukemia.

•Hyperthyroidism.

•Hypothyroidism.

•Lupus.

•Lyme disease.

•Malaria.

•Myelodysplastic syndromes.

•Myelofibrosis.

•Rheumatoid arthritis.

•Salmonella infection.

•Sepsis.

•Parasitic infections.

•Chemotherapy.
Neutropenia sign and symptoms

Common symptoms of neutropenia are as follows

•Fever of low grade.

•Frequent infections.

•Frequent infections can lead to following symptoms

Mouth ulcers.

Diarrhea.

Burning sensation when urinating.

Unusual redness.

Pain or swelling around the wound.

Sore throat.

•Odynophagia.

•Gingival pain and swelling.

•Recurrent sinusitis and otitis.

•Perirectal pain and irritation.

•Abscesses of skin.

•Symptoms of pneumonia like cough and dyspnea.

Patients with agranulocytosis may present with following symptoms

•Pharyngitis with difficulty in swallowing.

•Stomatitis and periodonitis accompanied by pain.

•Sudden onset of fever, possibly with chills and prostration.

•Sudden onset of malaise.Investigations of neutropenia

Laboratory test which are helpful are as follows

•Complete blood count.

•Differential white blood cell count.

•Peripheral blood smears.

Other tests which are helpful are as follows

•Antinuclear antibody.

•Rheumatoid factor.

•Liver function tests.

•Peripheral blood flow cytometry.

•T-cell rearrangement for T-cell clonality.

•Paroxysmal nocturnal hemoglobinuria testing.

•Antineutrophil antibodies.

CT scan of abdomen is helpful to detect splenomegaly.

Other tests helpful are as follows

•Urinalysis.

•Urine culture and sensitivity.

•Culture of wound or catheter discharge.

•Sputum Gram stains and culture.

•Stool for clostridium difficile.

•Skin biopsy.

Bone marrow aspiration and biopsy is helpful to detect leukemias as a cause of neutropenia.
Differential diagnosis of neutropenia

•Autoimmune diseases.

•Chronic myelomonocytic leukemia.

•Congenital neutropenia.

•Cyclic neutropenia.

•Drug induced neutropenia.

•Large granular lymphocytic leukemia.

•Pseudoneutropenia.

•Large granular lymphocyte leukemia.

•Cytomegalovirus.

•Granulocytopenia.

•Viral hepatitis.

•Infectious mononucleosis.

•Non-Hodgkin lymphoma.

•Systemic lupus erythematosus.

•Wegener granulomatosis.

•Bacterial sepsis.

•Aplastic anemia.

•Acute lymphoblastic leukemia.

•Acute myelogenous leukemia.

•Folic acid deficiency.

•Multiple myeloma.

Treatment of neutropenia

•Antibiotic therapy.

•Colony-stimulating factor therapy for granulocyte colony- stimulating factors (G-CSFs).

•Transfusion of granulocytes.

•Corticosteroid therapy.

•Correction of nutritional deficiency if detected.

•Splenectomy and other surgical procedures.

Complications of neutropenia

•Pneumonia

•Septicemia

•Bacterial infections

•Fungal infections
Diet and management for neutropenia

•Milk and milk products to be used should be pasteurized.

•Avoid raw and undercooked meat or well water.

•Long term preserved cheese and cheese based dressings should not be used.

•Outdated products and all moldy products should not be used.

•Avoid unwashed raw fruits and vegetables.

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