In general terms, the finding of neutropenia and / or leukopenia is much less common than leukocytosis. Leucopenia is defined as a count Of leukocytes <4000 / mm3 Neutropenia is defined as a count of granulocytes <1500 / mm3. This definition can be applied for all ages and races, although it is known that neonates, for example have Increase in the number of granulocytes during the first few days of life and some populations of blacks and Jews usually have low granulocyte numbers.
The peripheral blood neutrophil has a short life of approximately 10 hours, with a life 1/2 of 6.5 hours. It is distributed in two pools: one circulating, and one marginal at the tissue level. The progenitor cell of the mature neutrophil is the colony-forming unit of granulocytes and macrophages.
The susceptibility to infections in neutropenic patients depends on the RAN (Absolute Neutrophil Count). (% Bands +% mature neutrophils) x 0.01 In turn, the more severe the neutropenia and the longer the duration, the greater the chance of infection.
Which can occur are. Decreased production at the level of the bone marrow. Displacement from the peripheral circulation to the tissues. Destruction at the peripheral level. Combination of any of the above
Causes of neutropenia
In cases of acquired neutropenia, they are generally due to a decrease in peripheral blood survival. Bone marrow is usually normal or hypercellular with maturation disorders. In contrast, in cases of neutropenia due to intrinsic defects the bone marrow is hypocellular.
B- Neutropenia secondary to drugs, physical and chemical agents: 1- By hypoplasia and medullary aplasia: ionizing radiations, benzene, nitrogen mustards, vinblastine, colchicine, anthracyclines, etc. 2- Individual hypersensitivity: phenothiazines, sulfa drugs, antithyroid drugs, anticonvulsants, antihistamines, antimicrobial agents, etc.
C- Neutropenia secondary to metabolic and / or nutritional disorders: Caquexia, ketoacidosis with hyperglycemia , Pernicious anemia due to folate deficiency and vitamin B12. Other less frequent such as Gaucher disease.
What behavior to adopt in front of a patient presenting to the consultation with leucopenia?
It is important as a first step to pay attention to the medical history and physical examination. Duration, frequency and severity of infections, family history, questioning about recent viral infections, medications being taken, symptoms that make us suspect of an autoimmune condition. In the presence of cyclic symptoms, it is suggested to perform a blood count twice a week by In the presence of minimal symptoms, recent viral infection or taking medications that can produce neutropenia, the medication will be discontinued and a weekly blood count will be performed for 8 weeks, and if it persists, Bone (PMO). Finally, in the presence of symptoms, PMO will be performed. Immunological evaluation and ANA will be requested jointly.
Bibliography: 1. Lakshman R, Finn A. Neutrophil disorders and their management. J Clin Pathol 2001 Jan; 54 (1): 7-19 2. Rolston KV. New trends in patient management: risk-based therapy for febrile patients with neutropenia. Clin Infect Dis 1999 Sep; 29 (3): 515-21
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