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Neutropenia



 
 
Neutropenia (adjective neutropenic), from Latin prefix
Prefix

A prefix is an affix which is placed before the stem of a word. The word "prefix" is itself made up of the stem fix , and the prefix pre- , both of which are derived from Latin root s....
 neutro- and Greek
Greek language

Greek is an Indo-European languages native to the southern Balkan peninsula, the language of the Greek people. It forms an independent branch within Indo-European....
 suffix
Suffix

In grammar, a suffix is an affix which is placed after the stem of a word. Common examples are case endings, which indicate the grammatical case of nouns or adjectives, and verb endings, which form the grammatical conjugation of verbs....
 -pe??a (deficiency) is a hematological
Hematology

Hematology, American_and_British_English_spelling_differences#Simplification_of_ae_.28.C3.A6.29_and_oe_.28.C5.93.29 haematology, is the branch of biology , pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases....
 disorder characterized by an abnormally low number of a type of white blood cell
White blood cell

White blood cells , or leukocytes , are cell of the immune system defending the body against both infectious disease and foreign materials....
 called a neutrophil. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infection
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
s by destroying bacteria in the blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
. Hence, patients with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening (neutropenic sepsis).

Neutropenia can be acute or chronic
Chronic (medicine)

In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the Course of the disease, or its rate of onset and development....
 depending on the duration of the illness.






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Neutropenia (adjective neutropenic), from Latin prefix
Prefix

A prefix is an affix which is placed before the stem of a word. The word "prefix" is itself made up of the stem fix , and the prefix pre- , both of which are derived from Latin root s....
 neutro- and Greek
Greek language

Greek is an Indo-European languages native to the southern Balkan peninsula, the language of the Greek people. It forms an independent branch within Indo-European....
 suffix
Suffix

In grammar, a suffix is an affix which is placed after the stem of a word. Common examples are case endings, which indicate the grammatical case of nouns or adjectives, and verb endings, which form the grammatical conjugation of verbs....
 -pe??a (deficiency) is a hematological
Hematology

Hematology, American_and_British_English_spelling_differences#Simplification_of_ae_.28.C3.A6.29_and_oe_.28.C5.93.29 haematology, is the branch of biology , pathology, clinical laboratory, internal medicine, and pediatrics that is concerned with the study of blood, the blood-forming organs, and blood diseases....
 disorder characterized by an abnormally low number of a type of white blood cell
White blood cell

White blood cells , or leukocytes , are cell of the immune system defending the body against both infectious disease and foreign materials....
 called a neutrophil. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infection
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
s by destroying bacteria in the blood
Blood

Blood is a specialized bodily fluid that delivers necessary substances to the body's Cell s ? such as nutrients and oxygen ? and transports waste products away from those same cells....
. Hence, patients with neutropenia are more susceptible to bacterial infections and, without prompt medical attention, the condition may become life-threatening (neutropenic sepsis).

Neutropenia can be acute or chronic
Chronic (medicine)

In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the Course of the disease, or its rate of onset and development....
 depending on the duration of the illness. A patient has chronic neutropenia if the condition lasts for longer than 3 months. It is sometimes used interchangeably with the term leukopenia
Leukopenia

Leukopenia is a decrease in the number of circulating white blood cells in the blood. As the principal function of white cells is to combat infection, a decrease in the number of these cells can place patients at increased risk for infection....
 ("deficit in the number of white blood cells"), as neutrophils are the most abundant leukocytes, but neutropenia is more properly considered a subset of leukopenia as a whole.

There are numerous causes of neutropenia that can roughly be divided between either problems in the production of the cells by the bone marrow
Bone marrow

Bone marrow is the flexible biological tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells....
 and destruction of the cells elsewhere in the body. Treatment depends on the nature of the cause, and emphasis is placed on the prevention and treatment of infection.

Classification

There are three general guidelines used to classify the severity of neutropenia based on the absolute neutrophil count
Absolute neutrophil count

Absolute neutrophil count is a measure of the number of neutrophil granulocytes present in the blood. Neutrophils are a type of white blood cell that fights against infection....
 (ANC) measured in cells per microliter of blood:
  • Mild neutropenia (1000 <= ANC < 1500) — minimal risk of infection
  • Moderate neutropenia (500 <= ANC < 1000) — moderate risk of infection
  • Severe neutropenia (ANC < 500) — severe risk of infection.


The above mentioned ranges were developed in Caucasians. In blacks, mild neutropenia is a normal phenomenon, and neutropenia in this population is more properly defined as ANC < 1200. Higher cutoffs may lead to overdiagnosis of neutropenia in the black population.

Signs and symptoms

Neutropenia can go undetected, but is generally discovered when a patient has developed severe infection
Infection

An infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host resources to multiply ....
s or sepsis
Sepsis

Sepsis, is a serious medicine condition characterized by a whole-body Inflammation state and the presence of a known or suspected infection.
. Some common infections can take an unexpected course in neutropenic patients; formation of pus
Pus

Pus is a whitish-yellow, yellow or yellow-brown substance produced during inflammatory pyogenic bacteriuml infection. An accumulation of pus in an enclosed tissue space is known as an abscess....
, for example, can be notably absent, as this requires circulating neutrophil granulocytes.

Some common symptoms of neutropenia include fever
Fever

Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1?2 ?C ....
s and frequent infections. These infections can result in conditions such as mouth ulcers, diarrhea
Diarrhea

In medicine, diarrhea, also spelled diarrhoea , is characterized by frequent loose or liquid bowel movements. The spelling of "diarrhea" is an appropriation of the Greek "diarrhoia" meaning "a flowing through." ....
, a burning sensation when urinating, unusual redness, pain, or swelling
Swelling

Swelling can mean:* In medicine:** Swelling is the enlargement of organs caused by accumulation of excess fluid in tissues, called edema.* In engineering:...
 around a wound, or a sore throat
Sore Throat

Sore Throat were a United Kingdom crust punk / grindcore band, formed in Yorkshire in 1987. They are known for being one of the earliest exponents of the grindcore subgenre known as "noisecore", as well launching the careers of several prominent members of the British heavy metal music community....
.

Diagnosis

Low neutrophil counts are detected on a full blood count. Generally, some other investigations are required to arrive at the right diagnosis. When the diagnosis is uncertain, or serious causes are suspected, bone marrow biopsy
Bone marrow biopsy

Bone marrow examination refers to the pathology analysis of samples of bone marrow obtained by bone marrow biopsy and bone marrow aspiration....
 is often necessary.

Other investigations commonly performed: serial neutrophil counts for suspected cyclic neutropenia
Cyclic neutropenia

Cyclic neutropenia is a form of neutropenia which tends to occur every three weeks and lasting three to six days at a time due to changing rates of cell production by the bone marrow....
, tests for antineutrophil antibodies, autoantibody
Autoantibody

An autoantibody is an antibody manufactured by the immune system that is directed against one or more of the individual's own proteins.It is derived from the Greek "auto" which means "self", "anti" which means "against" and "body"....
 screen and investigations for systemic lupus erythematosus
Systemic lupus erythematosus

Systemic lupus erythematosus is a chronic Autoimmunity connective tissue disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body?s cells and tissue, resulting in inflammation and tissue damage....
, vitamin B12
Vitamin B12

Vitamin B12 is a water soluble vitamin with a key role in the normal functioning of the brain and nervous system, and for the formation of blood....
 and folate assays and acidified serum (Ham's) test.

Causes

Causes can be divided into the following groups:
  • Decreased production in the bone marrow
    Bone marrow

    Bone marrow is the flexible biological tissue found in the hollow interior of bones. In adults, marrow in large bones produces new blood cells....
    :
    • aplastic anemia
      Aplastic anemia

      Aplastic anemia is a condition where bone marrow does not produce sufficient new cell s to replenish blood cells.The term 'aplastic' means the marrow suffers from an aplasia that renders it unable to function properly....
    • cancer
      Cancer

      Cancer is a class of diseases in which a group of cell display uncontrolled growth , invasion , and sometimes metastasis . These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize....
      , particularly blood cancers
    • certain medications
    • hereditary disorders (e.g. congenital neutropenia, cyclic neutropenia
      Cyclic neutropenia

      Cyclic neutropenia is a form of neutropenia which tends to occur every three weeks and lasting three to six days at a time due to changing rates of cell production by the bone marrow....
      )
    • radiation
      Radiation

      In physics, radiation describes any process in which energy emitted by one body travels through a medium or through space, ultimately to be absorbed by another body....
    • Vitamin B12
      Cobalamin

      Cobalamin may refer to several substances depending on the upper axial ligand of the cobalt ion. These are:*Cyanocobalamin , which is not found in nature....
       or folate deficiency.
  • Increased destruction:
    • autoimmune neutropenia.
    • chemotherapy
      Chemotherapy

      Chemotherapy, in its most general sense, refers to treatment of disease by chemicals that kill cells, specifically those of micro-organisms or cancer....
       treatments, such as for cancer and autoimmune diseases
  • Marginalisation and sequestration:
    • Hemodialysis
      Dialysis

      In medicine, dialysis is primarily used to provide an artificial replacement for lost kidney function due to renal failure. Dialysis may be used for very sick patients who have suddenly but temporarily, lost their kidney function or for quite stable patients who have permanently lost their kidney function ....


There is often a mild neutropenia in viral infections.

Therapy

There is no ideal therapy for neutropenia, but recombinant G-CSF (granulocyte-colony stimulating factor) can be effective in chemotherapy patients, in patients with congenital forms of neutropenia including severe congenital neutropenia, autosomal recessive Kostmann's syndrome, cyclic neutropenia, and myelokathexis.

History


The relationship between a low neutrophil count and increased risk of infection was first demonstrated in patients with leukemia
Leukemia

Leukemia is a cancer of the blood or bone marrow and is characterized by an abnormal proliferation of blood Cell , usually white blood cells ....
.

See also

  • Aplastic anemia
    Aplastic anemia

    Aplastic anemia is a condition where bone marrow does not produce sufficient new cell s to replenish blood cells.The term 'aplastic' means the marrow suffers from an aplasia that renders it unable to function properly....
  • Pancytopenia
    Pancytopenia

    Pancytopenia is a medicine condition in which there is a reduction in the number of red blood cell and white blood cells, as well as platelets....
  • Thrombocytopenia
    Thrombocytopenia

    Thrombocytopenia is the presence of relatively few platelets in blood.Generally speaking, in humans, a normal platelet count ranges from 150,000 and 450,000 per mm3....


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