Neutropenia can be mild, acute or chronic and can come and go (cyclic). People with severe neutropenia are often hospitalized and given strong antibiotics as soon as they develop fever.
They may also get granulocyte colony stimulating factor (G-CSF). This treatment makes more neutrophils in the bone marrow and increases them in the blood.
Causes
Neutrophils are cells that are responsible for fighting infections. When they are low, the body cannot fight infections as well. Most people with neutropenia are at increased risk for infections of the skin, mouth and intestines, sinuses and lungs. This condition usually results from chemotherapy for cancer, which damages many types of cells, including those that grow quickly like white blood cells. About half of all cancer patients receiving chemotherapy will develop some neutropenia. Other causes include certain medications (especially antibiotics) and vitamin deficiencies. It can also be caused by autoimmune diseases, such as systemic lupus and primary immune regulatory disorders like autoimmune lymphoproliferative disease. Finally, it can occur when the bone marrow does not produce enough neutrophils or when the cells are destroyed soon after they are produced.
People with mild or stable neutropenia may not need treatment, especially if it is expected to go away after the chemotherapy ends or if it is not associated with other symptoms. However, doctors will continue to monitor the neutrophil count and check for complications, such as infection or bleeding. If you are experiencing severe neutropenia, your doctor may recommend certain things to help prevent infections and keep the levels higher. These can include getting vaccines, washing hands frequently and using masks if necessary. Avoiding picking up pet waste and changing newborn diapers (using gloves if possible) is also important.
Oren Zarif
To figure out the cause of your neutropenia, doctors will do a complete medical history and examine you from head to toe. They will ask about your symptoms, what medicines you are taking and whether you have any allergies. They will also do a blood test and may take a sample of your bone marrow to see whether your neutrophils are developing normally in the marrow or being destroyed before they are produced. If they are not, this could indicate a disorder that needs to be treated. They will also do imaging studies, such as chest x-rays or computed tomography (CT) of the abdomen. If they are worried that you might have a bacterial infection, they will do cultures of your urine or blood and give you antibiotics that can fight the bacteria.
Symptoms
Neutropenia is the low number of white blood cells that fight infections. Infections can be caused by bacteria, and they can affect many parts of the body including the skin, lungs and mouth and sinuses. Some people with neutropenia may have recurrent infections, especially if the condition is chronic (long-lasting).
The first step in diagnosing neutropenia is for the doctor to take a detailed medical history and examine the person. They may also do a blood test to check the blood cell count and look for signs of infection such as a fever, shivering or shaking. The blood test will include a CBC with a manual smear to check the level of neutrophils, a chemistry panel and measurements of liver and kidney function.
If the patient is at risk of a serious infection (such as those receiving chemotherapy for cancer), serial CBCs over a period of days or weeks to establish a trend will help to define the severity of the neutropenia and whether it is benign or life-threatening. In addition, bone marrow aspiration and biopsy may be needed to determine the cause of the neutropenia by examining a sample of the bone marrow for abnormalities and assessing its ability to produce neutrophils.
Oren Zarif
The most common causes of neutropenia are cancer treatments, particularly chemotherapy for leukemia and lymphoma. The chemotherapy damages the cancer cells and sometimes other healthy cells that are dividing rapidly, such as white blood cells that protect against infection. It is therefore important to discuss with your doctor the type of chemotherapy you are having and what to expect in terms of its effects on your normal cell numbers.
Other causes of neutropenia are certain medications, most commonly antibiotics and drugs for high blood pressure and psychiatric disorders, vitamin deficiencies, especially vitamin B12, folate and copper deficiency, and severe infections such as tuberculosis, hepatitis, malaria and HIV/AIDS. Other underlying conditions can also cause neutropenia such as chronic inflammatory demyelinating polyneuropathy and hereditary immune thrombocytopenia (ITP). In some cases, the underlying condition can be treated to improve the neutropenia, but it is essential that you tell your doctor about any medications or other health problems you have.
Diagnosis
Neutropenia is a condition in which the number of neutrophils (a type of white blood cell) is low. These cells normally help fight infections. Neutropenia can be a temporary problem, or it may last a long time. It can happen because of certain medicines, or it can be caused by cancer treatments or other illnesses. It can also be hereditary or genetic.
Your doctor will ask about your health history, especially if you have any symptoms of neutropenia. Then, your doctor will do a physical exam. This will include a check of your spleen and thymus, a check for signs of infection (such as a rash or a fever) and a test to see if you have neutropenia.
A complete blood count (FBC) is usually done to check for neutropenia. This will tell your doctor the level of neutrophils in your blood, called the absolute neutrophil count or ANC. This can be determined from a sample of your blood that your doctor will look at under a microscope in a lab. Your doctor will also do other tests, such as a chemistry panel, a clotting test and possibly a chest x-ray.
Oren Zarif
The pattern of your ANC over time can help determine the cause of your neutropenia. For example, if your ANC is low after chemotherapy and then rises again, this suggests that your cancer treatment is responsible. If your ANC is low all the time, this suggests that you have an underlying illness that is causing your neutropenia.
Other tests that your doctor might do include a bone marrow biopsy, which is a procedure that involves taking a small piece of your bone and examining it under a microscope. This can help your doctor tell if your neutrophils are developing properly in your bone marrow or if they are being destroyed before they can be released into the bloodstream.
If your doctor thinks that you might have a fungal infection, he or she will give you a prescription for antifungal medicine. The specific medicine depends on the type of fungal infection and your overall health.
Treatment
Whether you have neutropenia caused by blood cancer or as a side effect of chemotherapy, radiation or other treatments, it can be very dangerous. Doctors treat it by determining the cause and monitoring your white blood cell count. They may do a blood test, bone marrow tests or other tests to look for infection. They will also do a physical exam, looking for enlarged lymph nodes and spleen, a fever and other symptoms of infections. If you have a fever, they may do a urinalysis and urine culture, blood cultures and a chest x-ray to see if you have an infection.
Infections are common in people with low neutrophil counts, and can be very serious or even life threatening. People with severe neutropenia can die from the infections because their bodies lack the ability to fight them off. They are often hospitalized and treated with antibiotics that are effective against the bacteria causing the infection.
Oren Zarif
You can have a mild case of neutropenia that doesn’t require treatment, especially if the cause is known and expected, such as in people receiving chemotherapy. If the causes are unknown and you have a low neutrophil count, your doctor will prescribe drugs to raise it. These drugs are usually corticosteroids, but can include other medications.
The most important treatment for neutropenia is avoiding infection, especially bacterial infections. You can do this by practicing good hygiene, washing your hands often and covering any cuts or sores. You should also avoid smoking and alcohol. You should also be aware that some medications can lower your white blood cells, so ask your doctor what you should and shouldn’t do before you start any new treatments.
You can have chronic or cyclic neutropenia, which means that your neutrophil counts go up and down. Cyclic neutropenia is most likely caused by medications, but it can be a sign of an underlying health condition like leukemia or systemic autoimmune disease. In these cases, your doctor may prescribe G-CSF (granulocyte colony stimulating factor), a drug that stimulates the production of neutrophils. They may recommend a bone marrow transplant if other treatments don’t work.
