Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Treatment of neutropenia is based upon the underlying cause, severity, and
the presence of associated infections or symptoms as well as the overall health
status of the patient. Obviously, treatment must also be directed toward any
underlying disease process. Treatments that directly address neutropenia may
include (note that all of these treatments may not be appropriate in a given
setting):
antibiotic and/or antifungal medications to help fight infections;
administration of white blood cells growth factors (such as recombinant
granulocyte colony-stimulating factor (G-CSF, filgrastim) in some cases of
severe neutropenia;
granulocyte transfusions; or
corticosteroid therapy or intravenous immune globulin for some cases of
immune-mediated neutropenia.
Preventive measures may also be implemented in neutropenic patients to limit
risk of infections. These measures might include strict attention to hand
washing, use of private rooms, or in some cases, use of gloves, gowns, and/or
face masks by caregivers.
What is neutropenia?
"Neutropenia" is a condition in which the number of neutrophils in the
bloodstream is decreased. Neutrophils are a type of white blood cell also known
as polymorphonuclear leukocytes or PMNs. Neutropenia affects the body's ability
to fight off infections.
White blood cells are also known as
leukocytes. There are five major types of
white blood cells:
Some white blood cells, called granulocytes, are filled with microscopic
granules that are little sacs containing enzymes (compounds that digest
microorganisms). Neutrophils, eosinophils, and basophils are all granulocytes
and are part of the innate immune system with somewhat nonspecific, broad-based
activity. They do not respond exclusively to specific antigens, as do the
lymphocytes (B-cells and T-cells).
Neutrophils contain enzymes that help the cell kill and digest microorganisms
it has engulfed by a process known as phagocytosis. The mature neutrophil has a
segmented nucleus (it is often called a
'seg' or 'poly'), while the immature
neutrophil has a band-shape nucleus (it is called a band). Neutrophils are made
in the bone marrow and released into the bloodstream. The neutrophil has a
life-span of about three days.
How is neutropenia defined?
The white blood cell count (WBC) is the number of white blood cells in a
volume of blood. The normal range for the WBC varies slightly among laboratories
but is generally between 4,300 and 10,800 cells per microliter or cubic
millimeter (cmm). The WBC can also be referred to as the leukocyte count and can
be expressed in international units as 4.3 x 109to 10.8 x 109 cells per liter.
The percentage of the different types of white blood cells in the WBC is called
the WBC differential.
The absolute neutrophil count (ANC) is determined by the product of the white
blood cell count (WBC) and the fraction of neutrophils among the white blood
cells as determined by the WBC differential analysis. For example, if the WBC is
10,000 per microliter and 70% are neutrophils, the ANC would be 7,000 per
microliter.
An ANC of less than 1500 per microliter (1500/microL) is the generally
accepted definition of neutropenia. Neutropenia is sometimes further classified
as:
mild if the ANC ranges from 1000-1500/microL,
moderate with an ANC of
500-1000/microL, and
severe if the ANC is below 500/microL.
Some medical terms may be used synonymously with neutropenia, even though
their precise definitions are different.
Leukopenia refers to
a reduced number of white blood cells in general, while granulocytopenia refers to a decreased
number of all the granulocyte-type blood cells (neutrophils, eosinophils, and
basophils).
Since neutrophils normally far outnumber the other types of
granulocytes, this term is sometimes used to refer to neutropenia.
Finally, agranulocytosis literally refers to a complete absence of all granulocytes, but
this term is sometimes used to refer to severe neutropenia.
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Fungal nails (onychomycosis) may be caused by many species of fungi but the most common is Trichophyton rubrum. Distal subungal onychomycosis starts as a discolored area at the nail's corner and slowly spread toward the cuticle. In proximal subungal onychomycosis, the infection starts at the cuticle and spreads toward the nail tip. Yeast onychomycosis is caused by Candida and may be the most common cause of fungal fingernail.
Felty's syndrome is a complication of long-term rheumatoid arthritis. Felty's syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen, and an abnormally low white blood count. Treatment of Felty's syndrome is not always required; however, treatment for patients with infections is available.
Felty's syndrome is a complication of long-standing rheumatoid arthritis. Felty's
syndrome is defined by the presence of three conditions: rheumatoid arthritis, an enlarged spleen (splenomegaly),
and an abnormally low white blood count. Felty's syndrome is uncommon. It affects less than 1% of patients with rheumatoid
arthritis.
What are the symptoms of Felty's syndrome?
Some patients with Felty's syndrome have more infections, such as pneumonia or skin
infections, than the average person. This increased susceptibility to infections
is attributed to the low white blood counts that are characteristic of Felty's syndrome. Ulcers in the skin over the legs can complicate
Felty's syndrome.
What causes Felty's syndrome?
The cause of Felty's syndrome is not known. Some patients with rheumatoid arthritis develop Felty's syndrome but most do not. White blood cells are prod...
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