(Agranulocytosis; Granulocytopenia; Granulopenia)
Neutropenia is a low level of neutrophils in the blood. Neutrophils are a type of white blood cell. They help fight infections.
There are 2 types of neutropenia:
- Acquired—Appears anytime after birth. It can happen quickly or grow slowly over time.
- Congenital—Present at birth.
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The body is always making new neutrophils. They replace old or damaged cells. Neutropenia happens when this system is not balanced. One or more of the following may be present:
- More white blood cells are being destroyed than normal
- The body is using up white blood cells to fight an infection
- The bone marrow is not making enough white blood cells
Acquired neutropenia may be caused by:
- Underlying inflammatory condition
- Certain medicines
- Illegal drug use
- Immune system problems
- Certain toxins
- Poor nutrition—mainly low protein intake
Congenital neutropenia is caused by a problem in the genes.
Risk of neutropenia is higher with:
- Chemotherapy to treat cancer
- Certain medicines such as antidepressants or antihistamines
- An infection
- Exposure to certain chemicals or radiation
- Immune system problems
- Low levels of vitamin B-12 or folate
- Bone marrow diseases
- Family history of certain genetic problems
Most people will not have symptoms. Neutropenia can lead to an infection. This may cause:
- Fever or chills—may come on quickly
- Lack of strength
- Sore throat
- Yellowish skin or whites of the eyes— jaundice
- Mouth sores
- Bleeding gums
- Mild infections of skin, mouth, and nose
- Poor weight gain in children
The doctor will ask about symptoms and past health. A physical exam will be done. Blood tests will show levels of blood cells and possible causes. Other tests may be needed to look for any causes.
The goal of treatment is to bring the level of neutrophils back to a healthy range. How this is done depends on what is causing neutropenia and how bad it is. Treatment may involve:
- Treat infections that are either caused by or due to neutropenia
- Prevent infections in people who are at high risk
- Help the body make more white blood cells
Medicine may need to be changed or avoided. Toxins may also need to be found and removed.
Neutropenia often cannot be prevented. Regular testing to look for changes in neutrophil counts may help people who are higher risk for neutropenia. Medicines can be given early to boost white blood cells.
- Boulton, F., Cooper, C., et al. Neutropenia and agranulocytosis in England and Wales: incidence and risk factors. Am J Hematol, 2003; 72 (4): 248-254.
- Gibson, C. and Berliner, N. How we evaluate and treat neutropenia in adults. Blood, 2014; 124 (8): 1251.
- Neutropenia—approach to the patient. EBSCO DynaMed website. Available at: https://www.dynamed.com/approach-to/neutropenia-approach-to-the-patient-24.
- Neutropenia and risk for infection. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/cancer/preventinfections/neutropenia.htm.
- Michael J. Fucci, DO, FACC
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