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Laboratory evaluation of neutropenia and neutrophil dysfunction

INTRODUCTION

The polymorphonuclear neutrophil (PMN) is the primary defense against bacterial and fungal invasion. Although there are some subtle findings that may lead one to suspect either neutropenia or neutrophil dysfunction as a cause of recurrent infection, there is a great deal of overlap in the clinical presentations with those of other immune deficiency states.

The recognition of neutropenia is straightforward (ie, an absolute neutrophil count <1500/microL), while the recognition of neutrophil functional deficiency is more complex. Unless there is strong historical evidence to suggest a primary neutrophil dysfunction syndrome, the humoral and T cell systems should be thoroughly investigated before extensive evaluation of neutrophil function is initiated. (See "Laboratory evaluation of the immune system".)

Although a large number of neutrophil function assays have been described, the low frequency of requests makes them inappropriate for most routine clinical laboratories, and many are used mostly for research purposes. Only the general aspects of each test will be described here. Information concerning specimen requirements, reagents, and the specific procedures to be followed are available elsewhere [1]. Clinical approaches to the patient with neutropenia or neutrophil dysfunction are discussed separately. (See "Overview of neutropenia" and "Primary disorders of phagocytic function: An overview".)

LABORATORY APPROACH TO THE NEUTROPENIC PATIENT

Neutropenia is defined as an absolute neutrophilic granulocyte count (ANC) of less than 1500/microL, although there are age and racial differences. (See "Overview of neutropenia", section on 'Definitions'.) For example, newborn infants have elevated granulocyte counts in the first days of life, and certain populations of blacks and Yemenite Jews normally have lower granulocyte counts.

The ANC is equal to the product of the white blood cell count (WBC) and the fraction of polymorphonuclear cells (PMNs) and band forms noted on the differential analysis; neutrophilic metamyelocytes and younger forms are not included in this calculation:

                  

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Literature review current through: May 2013. | This topic last updated: Jul 31, 2012.
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References
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  1. Coates TD, Beyer LL, Baehner RL. Laboratory evaluation of neutropenia and neutrophil dysfunction. In: Manual of Clinical Laboratory Immunology, 4th ed, Rose NR, de Macario EC, Fahey JL, et al (Eds), American Society for Microbiology, Washington, DC 1992.
  2. Coates TD, Baehner RL. Leukocytosis and leukopenia. In: : Basic Principles and Practice, Hoffman R , Benz EJ Jr, Shattil SJ, et al (Eds), Churchill Livingstone, New York 1991. p.552.
  3. Lalezari P, Pryce SC. Detection of neutrophil and platelet antibodies in immunologically induced neutropenia and thrombocytopenia. In: Manual of Clinical Immunology, 2nd ed, Rose NR, Friedman H (Eds), American Society for Microbiology, Washington, DC 1980. p.744.
  4. Patrick CW, Milson TJ, McFadden PW, et al. Flow cytometry and cell sorting. Lab Med 1984; 15:740.
  5. Nishimura M, Mitsunaga S, Juji T. Frozen-stored granulocytes can be used for an immunofluorescence test to detect granulocyte antibodies. Transfusion 2001; 41:1268.
  6. Curnutte JT. Disorders of phagocyte function. In: Hematology: Basic Principles and Practice, Hoffman R , Benz EJ Jr, Shattil SJ, et al (Eds), Churchill Livingstone, New York 1991. p.571.
  7. Metcalf JA, Gallin JL, Nauseef WM, et al. Laboratory Manual of Neutrophil Function, Raven Press, New York 1986.
  8. Quie PG, White JG, Holmes B, Good RA. In vitro bactericidal capacity of human polymorphonuclear leukocytes: diminished activity in chronic granulomatous disease of childhood. J Clin Invest 1967; 46:668.
  9. Baehner RL, Nathan DG. Quantitative nitroblue tetrazolium test in chronic granulomatous disease. N Engl J Med 1968; 278:971.
  10. Curnutte JT, Babior BM. Chronic granulomatous disease. Adv Hum Genet 1987; 16:229.
  11. Stites DP, Stobo JD, Wells JV. Basic and Clinical Immunology, Lange Medical Publications, Appleton & Lange, Norwalk 1987. p.268.
  12. Coates TD, Harman JT, McGuire WA. A microcomputer-based program for video analysis of chemotaxis under agarose. Comput Methods Programs Biomed 1985; 21:195.
  13. Territo MC. Chemotaxis. In: Leukocyte function, Cline MJ (Ed), Churchill Livingstone, New York 1981. p.46.