Overview of neutropenia in children and adolescents
- Thomas D Coates, MD
Thomas D Coates, MD
- Professor of Pediatrics and Pathology
- University of Southern California School of Medicine
- Section Editors
- E Richard Stiehm, MD
E Richard Stiehm, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Immunology and Immunodeficiency
- Distinguished Research Professor of Pediatrics
- David Geffen School of Medicine at UCLA
- Laurence A Boxer, MD
Laurence A Boxer, MD
- Section Editor — White Cell Disorders
- Henry and Mala Family Professor of Pediatric Hematology/Oncology
- University of Michigan
This topic review will provide an overview of the causes, clinical manifestations, diagnosis, and management of neutropenia when it occurs as an isolated or predominant feature. Neutropenia is also a common manifestation of bone marrow defects associated with reductions in red cells and platelets, such as aplastic anemia, leukemia, myelodysplasia, megaloblastic anemia due to vitamin B12 or folate deficiency, and the administration of chemotherapy. These disorders are reviewed separately.
Laboratory evaluation of neutropenia and neutrophil function, as well as various disorders associated with neutropenia are discussed separately. (See "Laboratory evaluation of neutrophil disorders" and "Congenital neutropenia" and "Cyclic neutropenia" and "Immune neutropenia" and "Infectious causes of neutropenia" and "Drug-induced neutropenia and agranulocytosis" and "Hematologic manifestations of HIV infection: Neutropenia".)
DEFINITIONS AND NORMAL VALUES
The absolute neutrophil count (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:
ANC = WBC (cells/microL) x percent (PMNs + bands) ÷ 100
Neutrophilic metamyelocytes and younger forms are not included in this calculation (calculator 1). An ANC <1500/microL (<1.5 x 109/L) is the generally accepted definition of neutropenia for adults, as well as the threshold for neutrophil toxicity and infectious risk following chemotherapy (table 1 and table 2).
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- DEFINITIONS AND NORMAL VALUES
- PROPENSITY TO INFECTION AND SIGNIFICANCE OF NEUTROPENIA
- Infection propensity
- Significance of neutropenia
- INCIDENCE OF NEUTROPENIA IN NORMAL SUBJECTS
- Effect of race and ethnic origin
- - Neutropenia in African Americans
- - Benign familial (ethnic) neutropenia
- CLASSIFICATION AND ETIOLOGY OF ISOLATED NEUTROPENIA
- Acquired neutropenias
- - Postinfectious neutropenia
- - Drug-induced neutropenia and agranulocytosis
- - Nutritional neutropenia
- - Primary immune disorders
- - Hypersplenism
- - Bone marrow disorders
- Congenital neutropenias
- Myeloperoxidase deficiency
- CLINICAL PRESENTATION
- Risk of infection
- Specific pathogens associated with neutropenia
- DIAGNOSTIC APPROACH
- Infants and young children
- Older children
- - Neutropenia in the absence of recurrent or protracted infection
- - Moderate to severe neutropenia with recurrent infection
- GENERAL ASPECTS OF TREATMENT
- Patients with bone marrow hypoplasia and/or severe infections
- - Antibiotic therapy
- - Myeloid growth factors
- - Chemotherapy-induced neutropenia
- - Hematopoietic cell transplantation
- Patients with adequate marrow reserves
- INFORMATION FOR PATIENTS