Neutropenia Quiz: Test Your Medical IQ

Neutropenia occurs when there are low levels of neutrophils, a type of white blood cell, in the blood. Neutrophils help the body fight infections.

Neutropenia may occur when the bone marrow does not produce enough neutrophils, or the neutrophils the body produces are destroyed (such as by the body's own immune system or a medication).

There are numerous causes of neutropenia, including:

• Infections, such as HIV, hepatitis B, tuberculosis, and typhoid fever
• Medications, including cancer medicines, clozapine (Clozaril, FazaClo), and sulfasalazine (Azulfidine)
• Vitamin deficiencies in folic acid, vitamin B12, and copper
• Autoimmune problems, which occur when the body attacks its own healthy cells
• Bone marrow disorders

There are a few types of neutropenia, including:

• Autoimmune Neutropenia – The most common type. The body attacks its own neutrophils and is usually seen associated with other conditions
• Congenital Neutropenia (Kostmann Syndrome) - Usually present at birth (congenital) and very severe
• Idiopathic Neutropenia – cause is unknown
• Cyclic Neutropenia – Congenital, but symptoms may not appear until childhood, adolescence, or early adulthood. Has a cyclical pattern that occurs every 3 weeks and lasts 3-6 days.

Neutropenia may cause no symptoms. But severe neutropenia may result in fevers and frequent infections.

If you have neutropenia, minor infections can quickly become serious. See a doctor if you experience:

• Fever
• Chills or sweating
• Sore throat or mouth sores
• Toothache
• Stomach/abdominal pain
• Pain or sores near the anus
• Pain or burning during urination, or frequent urination
• Diarrhea
• Cough
• Shortness of breath
• Redness, pain, or swelling, (especially around a cut, wound, or catheter)
• Unusual vaginal discharge or itching

A "complete blood count with white blood cell differential" (also called "CBC with diff," for short) is a type of blood test used to diagnose neutropenia. The CBC results may also show other important information about the sizes or numbers of other blood cells.

Other tests may be performed to help determine the cause of the neutropenia, including:

• Blood test for vitamin B12 levels
• Tests for lupus
• Bone marrow biopsy – usually only done if there is a very low neutrophil count or there are other abnormal blood cells

The treatment for neutropenia depends the cause.

If neutropenia is caused by taking a certain medication, a doctor may recommend stopping the medication or switching to another medication. Do not stop taking any prescribed medication without first talking to your doctor.

Injectable medications that can help the bone marrow produce white blood cells such as filgrastim (Neupogen) or sargramostim (Leukine) may be recommended.

If you have an infection you may need antibiotics.

In severe cases, hospitalization may be necessary.

For the most part, neutropenia does not cause cancer. It may occur in people who have cancer and are receiving cancer chemotherapy.

In rare cases, certain congenital forms of severe neutropenia have a very slightly increased risk for a type of blood cancer called acute myeloid leukemia (AML).

When levels of neutrophils are abnormally low and chronic, severe and sometimes fatal infections can occur. Life-threatening complications include febrile neutropenia, characterized by fever and other signs of infection, and neutropenic sepsis, which can lead to organ failure.

There are some lifestyle modifications that may help manage neutropenia and prevent infections, such as:

• Getting regular vaccinations
• Proper oral hygiene
• Wash hands frequently and carefully clean any cuts and scrapes on the skin
• Contact your doctor or go to a hospital promptly if you suspect an infection
• Be careful when traveling abroad – consult your doctor before making travel plans

The prognosis for neutropenia depends on the cause, the severity, and how long the condition has been present.

The overall prognosis for neutropenia patients is generally improved due to broad-spectrum antibiotics and better supportive care.

Severe, prolonged episodes of neutropenia or systemic infections may be life threatening.