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Neutropenia

Neutropenia, a deficiency of infection-fighting neutrophils, arises from impaired bone marrow production (congenital/acquired), increased destruction (autoimmune), infections, medications, or toxin exposure.

Hematology
Neutropenia is a condition characterized by a lower than normal number of neutrophils in the blood. Neutrophils are a type of white blood cell that plays a crucial role in the immune system, helping the body fight off infections, especially bacterial and fungal infections. Causes: Neutropenia can be caused by various factors, which can be broadly classified into the following categories:
  • Decreased production in the bone marrow:
    • Congenital/Inherited disorders: Some people are born with conditions that affect neutrophil production, such as:
      • Cyclic neutropenia
      • Severe congenital neutropenia (Kostmann syndrome)
      • Shwachman-Diamond syndrome
  • Acquired disorders: Conditions that damage the bone marrow or interfere with its function can lead to neutropenia:
    • Aplastic anemia
    • Myelodysplastic syndromes (MDS)
    • Leukemia and other bone marrow cancers
    • Myelofibrosis
    • Vitamin deficiencies (e.g., B12, folate)
  • Infections: Certain infections can temporarily suppress bone marrow function:
    • Viral infections (e.g., HIV, Epstein-Barr virus)
    • Bacterial infections (e.g., tuberculosis)
  • Medications: Many drugs can cause neutropenia, including:
    • Chemotherapy drugs
    • Antipsychotic medications
    • Anticonvulsants
    • Antibiotics
    • Immunosuppressants
  • Exposure to toxins:
    • Radiation therapy
    • Certain chemicals (e.g., benzene)
  • Increased destruction of neutrophils:
    • Autoimmune disorders: In some conditions, the body's immune system mistakenly attacks and destroys neutrophils:
      • Systemic lupus erythematosus (SLE)
      • Rheumatoid arthritis
      • Felty syndrome (a complication of rheumatoid arthritis)
    • Splenomegaly: An enlarged spleen can trap and destroy neutrophils.
  • Other causes:
    • Severe infections: Overwhelming infections can consume neutrophils faster than they can be produced.
    • Malnutrition: Severe malnutrition can impair bone marrow function.
Symptoms: Neutropenia itself does not usually cause specific symptoms. However, the increased risk of infections due to the low neutrophil count can lead to various symptoms, including:
  • Frequent infections
  • Delayed wound healing
  • Mouth sores (mucositis)
  • Sore throat
  • Fever
  • Chills
  • Pneumonia
  • Sinusitis
  • Skin infections
The severity of symptoms depends on the degree of neutropenia and the underlying cause. Diagnosis: Neutropenia is diagnosed through a blood test:
  • Complete blood count (CBC): This test measures the number of different types of blood cells, including neutrophils.
    • The absolute neutrophil count (ANC) is calculated by multiplying the total white blood cell count by the percentage of neutrophils.
    • An ANC of less than 1,000 cells/microliter is generally considered neutropenia. The lower the ANC, the higher the risk of infection.
Further tests may be needed to determine the cause of neutropenia:
  • Peripheral blood smear: To examine the appearance of blood cells.
  • Bone marrow biopsy: To assess the production of blood cells in the bone marrow.
  • Blood tests: To check for infections, autoimmune disorders, and vitamin deficiencies.
Treatment: Treatment for neutropenia depends on the cause and severity:
  • Treatment of the underlying cause: Addressing the condition causing the neutropenia is crucial.
    • Discontinuing or changing medications that are causing neutropenia.
    • Treating infections with antibiotics, antifungals, or antivirals.
    • Managing autoimmune disorders with immunosuppressive therapy.
    • Treating bone marrow disorders (e.g., chemotherapy for leukemia, bone marrow transplantation for aplastic anemia).
  • Growth factors:
    • Granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CSF) are medications that stimulate the bone marrow to produce more neutrophils.
  • Preventive measures:
    • Good hygiene: Frequent handwashing and careful attention to personal hygiene can help reduce the risk of infection.
    • Avoiding crowds and sick people: Limiting exposure to potential sources of infection.
    • Prophylactic antibiotics or antifungals: In some cases, medications may be given to prevent infections.
    • Dietary precautions: Following food safety guidelines to minimize the risk of foodborne infections.
  • Blood transfusions: In some cases, blood transfusions may be necessary.
  • Stem cell transplantation: For severe cases of neutropenia due to bone marrow failure.
People with neutropenia should be monitored closely for signs of infection, and any infections should be treated promptly.

Related Medications

Commonly prescribed medications for this condition

Palbociclib