Neutropenia: Causes, Treatment and diagnosis
Neutropenia is characterized by a significant reduction in neutrophils, an essential first line of defense against infections. The main complication of neutropenia is the increased risk of an infection and the lack of resources to fight it off.
There are a variety of reasons for neutropenia including nutrient deficiency and genetic disorders. Most generally, cancer patients develop neutropenia because of chemotherapy the drugs involved destroy the neutrophils alongside the cells of cancer.
In the following paragraphs, we’ll discuss the reasons, signs and symptoms and remedies of neutropenia.
Contents of this article:
- Neutrophils and the causes of neutropenia
- Symptoms and treatments of neutropenia
Fast facts on neutropenia
Here are some key points about neutropenia. More detail and supporting information is in the main article.
- In health, neutrophils are the most abundant type of white blood cell
- Neutropenia describes a condition where neutrophils are dangerously low in number
- Individuals with neutropenia are more likely to pick up serious infections
- One of the most common causes of neutropenia is chemotherapy
- There are a number of types of neutropenia, including cyclic neutropenia and chronic idiopathic neutropenia
- Often, there are no particular symptoms other than a heightened risk of infection
- Febrile neutropenia is regarded as a medical emergency
- Individuals with neutropenia must take extra precautions to avoid infection.
What are neutrophils?
Neutrophils would be the most abundant kind of white-colored bloodstream cell. They’re the first cells from the defense mechanisms to achieve the website of the infection. Neutrophils influence the inflammatory reaction to infection, consume micro-microorganisms and destroy them by delivering enzymes.1
Neutrophils are created in bone marrow, the soft interior from the bigger bones from the body. They’re short-resided cells but highly mobile, having the ability to enter tissue that other cells cannot penetrate.2
Neutrophils would be the primary constituent of pus and have the effect of its whitish-yellow hue.
What is neutropenia?
Neutropenia describes a reduction in neutrophils.
Neutropenia is really a condition where you can find abnormally lower levels of neutrophils within the bloodstream supply. Neutrophils are an essential kind of white-colored bloodstream cell, vital for battling pathogens, particularly microbial infections.
In grown ups, a count of just one,500 neutrophils per μl of bloodstream or fewer is regarded as neutropenia, with any count below 500 per μl of bloodstream considered like a severe situation. In severe cases, even bacteria which are normally contained in the mouth area and stomach may cause infections of the serious nature.3
Neutropenia can result from home loan business neutrophil production, faster use of neutrophils, elevated destruction of neutrophils or a mix of the 3 factors.
Neutropenia could be temporary (acute) or lengthy-lasting (chronic). The problem can also be split up into hereditary (present from birth) and purchased neutropenia (evolves later in existence).
There are a number of types of neutropenia, including:
- Cyclic neutropenia: a rare congenital syndrome causing fluctuations in neutrophil numbers, it affects an estimated 1 in 1,000,000 people4
- Kostmann’s syndrome: a genetic disorder where neutrophils are produced at lower levels – sufferers are prone to infections from an early age5
- Chronic idiopathic neutropenia: a relatively common version of neutropenia, predominantly affecting women
- Myelokathexis: a condition whereby neutrophils fail to move from the bone marrow to the bloodstream
- Autoimmune neutropenia: when an individual’s immune system attacks and destroys neutrophils
- Shwachman’s syndrome: a rare genetic disorder with multiple effects including dwarfism, problems with the pancreas and a low neutrophil count
- Isoimmune neonatal neutropenia: a condition whereby a mother’s antibodies cross the placenta and attack the developing fetus’ neutrophils. This condition generally resolves itself within 2 months of life.
Causes of neutropenia
Neutrophils are created within the bone marrow in the center of bigger bones. Something that disrupts this method may cause neutropenia.
Most generally, neutropenia is because chemotherapy for cancer. Actually, around 1 / 2 of cancer patients going through chemotherapy are experiencing some degree of neutropenia.
Medical News Today requested Dr. Joel Newman, an advisor hematologist, why chemotherapy’s attack on neutrophils is really significant for that defense mechanisms. He stated:
“Chemotherapy affects all cells of the granulocytic lineage, but it is the neutrophils that are most important in acute bacterial infections, and so we are most vigilant when they are low.
When someone is neutropenic, severe infections can develop rapidly and become overwhelming in the space of minutes to hours. In contrast, having too few basophils or eosinophils will not expose you to much harm in the short term.”6
Other potential causes of neutropenia include:
- Leukemia: a group of cancers of the blood
- Barth syndrome: an X-linked genetic disorder affecting multiple systems
- Myelodysplastic syndromes: a group of disorders characterized by dysfunctional blood cells7
- Myelofibrosis: a rare bone marrow cancer, also known as osteomyelofibrosis
- Alcohol use disorder: including alcoholism
- Vitamin deficiencies: most commonly, vitamin B12, folate and copper deficiency8
- Sepsis: an infection of the bloodstream that uses up neutrophils quicker than they can be produced
- Pearson syndrome: a mitochondrial disease
- Some infections: including hepatitis A, B and C, HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome), malaria and Lyme disease
- Rheumatoid arthritis: an autoimmune disorder
- Hypersplenism: an overactive spleen.
Premature babies are more likely to be born with neutropenia than babies born near their due date; the condition affects 6-8% of newborns in neonatal intensive care units. As a general rule, the smaller the baby, the more likely they are to have neutropenia.9
On the next page, we look at the symptoms and treatment of neutropenia.
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Symptoms and diagnosis of neutropenia
Neutropenia itself does not present any symptoms. It is most often spotted during routine blood tests or tests for another condition. For this reason and others, patients undergoing chemotherapy – who are most at risk from the condition – will have regular scheduled blood tests.
The most serious concern with neutropenia is contracting an infection, which can easily spread without adequate neutrophil numbers present to repel it.10
Signs of infection include:
- High fever
- Chills and sweating
- Abdominal pains
- Sore throat, toothache or mouth sores
- Pain near the anus
- Burning sensation when urinating
- Increased urination
- Diarrhea or sores on the anus
- Trouble breathing
- Redness or swelling around wounds
- Unusual vaginal discharge.
If an infection takes hold, there is a risk of febrile neutropenia, also referred to as neutropenic sepsis. This condition is a medical emergency and occurs most commonly in cancer patients undergoing chemotherapy. Mortality rates range from 2% to 21%.11
Infections must be treated as soon as they are recognized.
It is vital that an infection is caught before it develops into febrile neutropenia.
Symptoms of febrile neutropenia include:
- A high temperature, or a perception of high temperature
- A low temperature, or a perception of low temperature
- Flu-like symptoms
- Mucositis – painful inflammation and ulceration of the mucous membranes of the digestive tract
- Diarrhea and vomiting
- Changes in mental state.12
Treatments for neutropenia
The treatment of neutropenia will depend on the underlying reason for the disorder. Medical treatments to help reduce the impact of neutropenia include:
- Granulocyte-colony stimulating factor (G-CSF): a glycoprotein that stimulates the bone marrow to produce neutrophils and other granulocytes and release them into the bloodstream. The most commonly used version of G-CSF is a drug called filgrastim.13
- Granulocyte-macrophage colony-stimulating factor (GM-CSF): naturally produced glycoprotein carrying out a similar role to G-CSF. Both promote neutrophil recovery after chemotherapy.
- Antibiotics: small amounts of antibodies may sometimes be given to reduce the likelihood of infection. They are often given at the point in time when the neutrophil count is likely to be lowest.
Some basic lifestyle precautions are necessary for individuals with neutropenia; they should remove as many risks of infection from their daily routine as possible.
Lifestyle precautions for people with neutropenia include:
- Cleaning hands regularly, especially after using the toilet
- Avoiding crowds and people who are ill
- Not sharing personal items including toothbrushes, drinking cups, cutlery or food
- Bathing or showering daily
- Cooking meat and eggs thoroughly
- Not buying food in damaged packages
- Cleaning the fridge thoroughly and not overfilling – doing so can raise the temperature
- Carefully washing any fruit or vegetables to be eaten raw
- Avoiding direct contact with pet waste and washing hands after handling any animals
- Wearing gloves when gardening
- Using a soft toothbrush
- Using an electric shaver rather than a razor
- Cleaning any wounds with warm water and soap and using antiseptic to clean the site14
- Wearing shoes outdoors
- Not squeezing spots or picking scabs
- Keeping surfaces clean
- Getting the flu shot as soon as it becomes available.15
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