Neutropenia: Difference between revisions

Latest revision as of 11:15, 27 February 2024

Background

Low concentration of circulating neutrophils

ANC	Classification
≥1500	Normal
1000-1499	Mild
500-999	Moderate
<500	Severe
0	Agranulocytosis

Etiologies

Congenital

Constitutional neutropenia: mild (ANC>1000), chronic
Benign ethnic neutropenia: mild (ANC>1000), chronic, usually in patients with Mediterranean or African ancestry
Benign familial neutropenia: same as above, but hereditary and not associated with a specific ethnicity
Cyclic neutropenia: hereditary, with severe neutropenia on a 21-day cycle since childhood
Others: severe congenital neutropenia, Schwachman-Diamond syndrome, Fanconi anemia, dyskeratosis congenita, Chediak-Higash syndrome, myelokathesis, Griscelli syndrome II, and cartilage-hair hypoplasia

Acquired

Infectious
- Active infection, particularly viral, but including severe sepsis from any cause; more common in the elderly
- Post-infectious neutropenia, most commonly in children after viral infections (particularly varicella, measles, rubella, influenza, hepatitis, EBV, or HIV)
  - EBV and HIV can sometimes cause prolonged neutropenia; the rest are self-limited
- Bacterial infections, including Brucella, Rickettsiae, and mycobacteria
Drug-induced neutropenia, including agranulocytosis or more mild neutropenia
Autoimmune
- Primary: typically in patients less than 1 year old, can be severe, but usually resolves within 2 years
  - Needs prophylactic antibiotics and GCSF
- Secondary: usually mild, in the context of a systemic autoimmune disease (with lupus being common and tends to reflect disease activity)
- Felty syndrome (triad of rheumatoid arthritis, splenomegaly, and neutropenia)
Malignancy
- Acute leukemia
- Myelodysplastic syndrome
- LGL leukemia: associated with rheumatoid arthritis and can present as a Felty syndrome
- Myeloma
- Lymphoma
- Myelophthisic process
Dietary
- Vitamin B12 deficiency
- Folate deficiency
- Copper deficiency
- Global caloric malnutrition, including anorexia nervosa
Chronic idiopathic neutropenia

@@ Line 36: / Line 36: @@
 * Infectious
-** Active infection, particularly viral, but including severe sepsis from any cause; more common in the elderly
+** Active infection, particularly viral, but including severe [[sepsis]] from any cause; more common in the elderly
-** Post-infectious neutropenia, most commonly in children after viral infections (particularly varicella, measles, rubella, influenza, hepatitis, EBV, or HIV)
+** Post-infectious neutropenia, most commonly in children after viral infections (particularly [[varicella]], [[measles]], [[rubella]], [[influenza]], [[Viral hepatitis|hepatitis]], [[EBV]], or [[HIV]])
-*** EBV and HIV can sometimes cause prolonged neutropenia; the rest are self-limited
+*** [[EBV]] and [[HIV]] can sometimes cause prolonged neutropenia; the rest are self-limited
 ** Bacterial infections, including [[Brucella]], [[Rickettsiae]], and [[mycobacteria]]
 * [[Drug-induced neutropenia]], including [[agranulocytosis]] or more mild neutropenia
@@ Line 47: / Line 47: @@
 ** [[Felty syndrome]] (triad of [[rheumatoid arthritis]], splenomegaly, and neutropenia)
 * Malignancy
-** Acute leukemia
+** [[Acute leukemia]]
 ** [[Myelodysplastic syndrome]]
 ** [[LGL leukemia]]: associated with [[rheumatoid arthritis]] and can present as a [[Felty syndrome]]
@@ Line 58: / Line 58: @@
 ** [[Copper deficiency]]
 ** Global caloric malnutrition, including [[anorexia nervosa]]
-* Chronic idiopathic neutropenia
+* [[Chronic idiopathic neutropenia]]
 == Further Reading ==