How we diagnose neutropenia in the adult and elderly patient

Palmblad, Jan; Dufour, Carlo; Papadaki, Helen Α.

doi:10.3324/haematol.2014.110288

Cited by 47 publications

(63 citation statements)

References 18 publications

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“…are appropriate in children with no associated anomalies to guide testing or when a panel is less expensive than several individual tests. (2-7)…”

Section: Clinical Approach To Neutropeniamentioning

confidence: 99%

How I diagnose and treat neutropenia

Dale

2016

Current Opinion in Hematology

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Purpose Neutropenia (absolute neutrophil count (ANC) > 1.5 × 109L is a common hematological finding, and severe neutropenia, i.e., ANC >0.5 × 109L is a well-known risk factor for susceptibility to bacterial infections. This review provides a succinct clinical approach to the diagnosis and treatment of neutropenia with specific recommendations on the treatment of severe chronic neutropenia with the myeloid growth factor, granulocyte colony-stimulating factor (G-CSF). Recent Findings Experts agree that patients with acute febrile neutropenia should be treated with antibiotics and that patients at high risk of severe neutropenia (>20% risk) after myelosuppressive chemotherapy should be treated prophylactically with a myeloid growth factor, usually granulocyte colony-stimulating factor (G-CSF). The diversity of causes and consequences of chronic neutropenia make the diagnosis and management of these patients more complicated. Summary This review provides a stepwise approach to neutropenia focusing first reaching a provisional diagnosis and treatment plan then steps to a final diagnosis. It also provides specific recommendations on the treatment of severe chronic neutropenia with G-CSF.

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“…are appropriate in children with no associated anomalies to guide testing or when a panel is less expensive than several individual tests. (2-7)…”

Section: Clinical Approach To Neutropeniamentioning

confidence: 99%

How I diagnose and treat neutropenia

Dale

2016

Current Opinion in Hematology

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“…8 In a multi-institutional French study, 108 individuals were observed. They were mostly female (78%) and young adults (median age, 28 years) 9 ; 23 out of 66 patients had neutrophil autoantibodies and 27 patients had severe bacterial infections, but there were no deaths or hematologic malignancies.…”

Section: Neutropenia: Definition Epidemiology and Complicationsmentioning

confidence: 99%

New monogenic disorders identify more pathways to neutropenia: from the clinic to next-generation sequencing

Corey

Oyarbide

2017

Hematology

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Neutrophils are the most common type of leukocyte in human circulating blood and constitute one of the chief mediators for innate immunity. Defined as a reduction from a normal distribution of values, neutropenia results from a number of congenital and acquired conditions. Neutropenia may be insignificant, temporary, or associated with a chronic condition with or without a vulnerability to life-threatening infections. As an inherited bone marrow failure syndrome, neutropenia may be associated with transformation to myeloid malignancy. Recognition of an inherited bone marrow failure syndrome may be delayed into adulthood. The list of monogenic neutropenia disorders is growing, heterogeneous, and bewildering. Furthermore, greater knowledge of immune-mediated and drug-related causes makes the diagnosis and management of neutropenia challenging. Recognition of syndromic presentations and especially the introduction of next-generation sequencing are improving the accuracy and expediency of diagnosis as well as their clinical management. Furthermore, identification of monogenic neutropenia disorders is shedding light on the molecular mechanisms of granulopoiesis and myeloid malignancies.

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“…Severe neutropenia (NP), that is, an absolute neutrophil count (ANC) below 0.5 G/L in the peripheral blood, predisposes individuals to bacterial and fungal infections, particularly if prolonged . In contrast, mild and moderate NPs (ANCs of 1.0‐1.5 G/L and 0.5‐1.0 G/L, respectively) are rarely associated with a remarkable infection propensity regardless if they are transient or chronic.…”

Section: Introductionmentioning

confidence: 99%

“…Yet, they can be of clinical significance as they may be markers of underlying conditions. Examples are autoimmune, viral and hematological disorders where NP often is an associate . The spectrum of underlying conditions appears to vary with degree of NP, presence of other cytopenias and age.…”

Section: Introductionmentioning

confidence: 99%

Age‐related prevalence and clinical significance of neutropenia ‐ isolated or combined with other cytopenias: Real world data from 373 820 primary care individuals

et al. 2020

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Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi-or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi-or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies.Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi-or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.

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How we diagnose neutropenia in the adult and elderly patient

Cited by 47 publications

References 18 publications

How I diagnose and treat neutropenia

How I diagnose and treat neutropenia

New monogenic disorders identify more pathways to neutropenia: from the clinic to next-generation sequencing

Age‐related prevalence and clinical significance of neutropenia ‐ isolated or combined with other cytopenias: Real world data from 373 820 primary care individuals

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