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
A patient has chronic neutropenia if the condition lasts for longer than three
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
Cancers especially blood cancers.
Vitamin B12 , copper or folate deficiency.
Hereditary disorders example congenital neutropenia, cyclic neutropenia.
•In processes of marginalization and sequestration
•Due to affect of different medications and are as follows
•Conditions or diseases in which destruction of neutrophils are increased are as follows
Chemotherapy treatments such as in cancer and autoimmune diseases.
Other possible causes of neutropenia are as follows
Neutropenia sign and symptoms
Common symptoms of neutropenia are as follows
•Fever of low grade.
•Frequent infections can lead to following symptoms
Burning sensation when urinating.
Pain or swelling around the wound.
•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
•Liver function tests.
•Peripheral blood flow cytometry.
•T-cell rearrangement for T-cell clonality.
•Paroxysmal nocturnal hemoglobinuria testing.
CT scan of abdomen is helpful to detect splenomegaly.
Other tests helpful are as follows
•Urine culture and sensitivity.
•Culture of wound or catheter discharge.
•Sputum Gram stains and culture.
•Stool for clostridium difficile.
Bone marrow aspiration and biopsy is helpful to detect leukemias as a cause of neutropenia.
Differential diagnosis of neutropenia
•Chronic myelomonocytic leukemia.
•Drug induced neutropenia.
•Large granular lymphocytic leukemia.
•Large granular lymphocyte leukemia.
•Systemic lupus erythematosus.
•Acute lymphoblastic leukemia.
•Acute myelogenous leukemia.
•Folic acid deficiency.
•Multiple myeloma.Treatment of neutropenia
•Colony-stimulating factor therapy for granulocyte colony- stimulating factors (G-CSFs).
•Transfusion of granulocytes.
•Correction of nutritional deficiency if detected.
•Splenectomy and other surgical procedures.Complications of neutropenia
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.