Management of the adult with non-chemotherapy-induced neutropenia
- Nancy Berliner, MD
Nancy Berliner, MD
- Professor of Medicine
- Harvard Medical School
- Chief, Division of Hematology
- Brigham and Women's Hospital
The management of adults with neutropenia can be challenging because the number of neutrophils circulating in the peripheral blood (reflected in the absolute neutrophil count [ANC]) is not always predictive of the individual's ability to respond to infection. This topic will discuss the management of the adult patient with non-chemotherapy-induced neutropenia (ie, neutropenia that is not the result of chemotherapy or hematopoietic cell transplant [HCT]).
The diagnostic evaluation of adults with non-chemotherapy-induced neutropenia is presented separately. (See "Approach to the adult with unexplained neutropenia".)
The management of children with neutropenia is also discussed separately. (See "Evaluation and management of fever in children with non-chemotherapy-induced neutropenia" and "Fever in children with chemotherapy-induced neutropenia" and "Congenital neutropenia" and "Cyclic neutropenia" and "Overview of neutropenia in children and adolescents".)
Fever in a patient with neutropenia due to chemotherapy, HCT, or bone marrow suppression from any cause is a medical emergency because such patients are at risk of sepsis and death from overwhelming infection. The management of chemotherapy-induced neutropenia and chemotherapy-induced neutropenia with fever are presented separately. (See "Risk assessment of adults with chemotherapy-induced neutropenia" and "Prophylaxis of infection during chemotherapy-induced neutropenia in high-risk adults" and "Risk of infection in children with fever and non-chemotherapy-induced neutropenia" and "Overview of neutropenic fever syndromes".)
DEFINITION OF NEUTROPENIA
The definition of neutropenia varies from institution to institution. Neutropenia is usually defined (and defined herein) as an absolute neutrophil count (ANC) <1500 cells/microL (<1.5 x 109/L) in an adult. The ANC is equal to the product of the white blood cell (WBC) count and the percentage of neutrophils from the WBC differential (calculator 1). (See "Approach to the adult with unexplained neutropenia", section on 'Terminology and definition of neutropenia'.)
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- DEFINITION OF NEUTROPENIA
- INFECTIOUS RISK STRATIFICATION
- Overview of risk stratification
- Bone marrow evaluation
- Clinical features
- Counseling regarding infectious risk
- PATIENTS WITH INADEQUATE BONE MARROW RESERVE
- Overview of infectious risk
- Preventing infection
- - Overview of infection prevention
- - Myeloid growth factors to reduce infectious risk
- - Hematopoietic cell transplantation
- Treatment of infection
- - Overview of treatment
- - Specific pathogens and sites of infection
- - Antimicrobials
- - Myeloid growth factors to treat infection
- - Granulocyte transfusions
- - Monitoring response to treatment
- PATIENTS WITH ADEQUATE BONE MARROW RESERVE
- Monitoring asymptomatic individuals
- Treatment of infection
- SUMMARY AND RECOMMENDATIONS