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Classification of Neutropenia
Acquired neutropenia
- Postinfectious: varicella, measles, rubella, hepatitis A and B, mononucleosis, influenza, cytomegalovirus, parvovirus, acquired immunodeficiency syndrome (AIDS), S. aureus, brucellosis, tularemia, rickettsia, Mycobacterium tuberculosis, sepsis.
- Drug induced: Antineoplastic agents, procainamide, antithyroid drugs, sulphasalazine, phenothiazines, semisynthetic penicillins, nonsteroidal anti-inflammatory agents, aminopyrine derivatives, benzodiazepines, barbiturates, gold compounds, sulfonamides, propranolol, dipyridamole, digoxin, acetyldigoxin, sulfamethoxizole, anticonvulsants
- Benign familial neutropenia
- Chronic benign neutropenia of childhood
- Chronic idiopathic neutropenia
- Autoimmune neutropenia
- Isoimmune neutropenia
- Neutropenia associated with immunologic abnormalities
- Neutropenia associated with metabolic diseases
- Neutropenia due to increased margination
- Nutritional deficiency
Intrinsic defects
- Kostmann syndrome (severe infantile agranulocytosis)
- Myelokathexis/neutropenia with tetraploid nuclei
- Cyclic neutropenia
- Shwachman-Diamond-Oski syndrome
- Chediak-Higashi syndrome
- Reticular dysgenesis
- Dyskeratosis congenital
Clinically Significant Neutrophil Counts
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ANC
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Clinical Significance
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>1,500/mm3
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Normal
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1,000-1,500
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No significant propensity to infection. Fevers can be managed on an outpatient basis.
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500-1,000
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Some propensity to infection. Occasionally fever can be managed on an outpatient basis.
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<500
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Significant propensity to infection. Always should be managed as inpatient with parenteral antibiotics. Few clinical signs of infection.
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ANC; Absolute Neutrophil Counts
These rules apply strictly for neutropenia with hypoplastic marrow, early myeloid arrest, and decreased granulocyte reserve pools. There is more latitude for clinical judgment in neutropenias with normocellular marrow. The only regular exception to these rules is documented chronic benign neutropenia of childhood.
Related
Criteria
Classification of Neutrophilia
Serum Levels That Differentiate Anemia of Chronic Disease from Iron-Deficiency Anemia
Diagnostic Criteria for Disseminated Intravascular Coagulation (DIC)
Clinical Conditions Associated with Disseminated Intravascular Coagulation (DIC)
Diagnostic Criteria for Idiopathic Hypereosinophilic Syndrome (HES)
Diagnostic Criteria for Systemic Mastocytosis (SM)
WHO Classification of Mastocytosis
FAB
Classification of Myelodysplastic
Syndromes (MDS)
Diagnostic Criteria for Heparin-Induced Thrombocytopenia (HIT)
More...
References:
- Kyono W, Coates TD. A practical approach to neutrophil disorders. Pediatr Clin North Am. 2002 Oct;49(5):929-71, viii. [Medline]
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Wintrobe's Clinical Hematology11th edition (November 1, 2003)
Hematology: Basic Principles And Practice, by Ronald Hoffman
4th Bk&Cdr edition (December 3, 2004)
Clinical Diagnosis and Management by Laboratory Methods, by John Bernard Henry
20th edition (April, 2001)
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