Neutropenia

Question 1

Reactive casues of neutrophilia

Answer 1

Infection/inflammation - pneumonia common
C.difficile, septic arthritis
Malignancy - cytokine release
Steroids
SMoking
Hyposplenism
Rebound post chemo or GCSF
Full exam - infections/abscesses/malignancy - splenomegaly

Question 2

First line investigations

Answer 2

inflam markers
Blood film if persistent w no cause
Acute and clear repeat once stimulus over

Question 3

Common causes of leucocytosis

Answer 3

Lower UTI in adults
Diverticulitis
Sepsis

Question 4

Infrequent causes of leucocytosis

Answer 4

Acute appendicitis
Acute mesenteric ischameia
Campylobcter infection
Ischaemic colitis
DKA
non-typhoidal salmonella
Subacute/de quervains thyroiditis
HSP
Bladder cancer
AML
HHS

Question 5

Rare causes of leucocytosis

Answer 5

UC
CML
Familial meditarranean fever
Neuroleptic maliganat syndrome
Stills disease
Iliopsoas abscess
Myelofibrosis

Question 5

Differntials for eosinophilia

Answer 5

Eosinophilic oesaphagitis
Acute interstitial nephrotis
Addisons disease
Eosinophilc granulomatosis with polyangitis

Question 6

When investigate neutrophilia further

Answer 6

Persistent
No scondary cause
Splenomegaly
Contact haematologyif above

Question 7

Key features of neutrophil

Answer 7

Most abundant WC
Front line defence
Express and release cytokines, modify immune response

Question 8

Life cycle of neutrophil

Answer 8

Promyelocyte -> myelocyte->metamyelocyte-> badn neutrophil

Question 9

Normal neutrophil count

Answer 9

2-7 x109/L

Question 10

What is neutropenia

Answer 10

1.5 x 109/L

Question 11

Mild, moderate and sev neutropenia

Answer 11

Mild - 1-1.5 x 109/l
Moderate 0.5-0.99 x 109/l
Sev <0.5 x 10 9/L

Question 12

Common causes of neutropenia

Answer 12

Medications - BNF, chemo/immunosupressants
Viral infections/sepsi - transietn
AI disease
B12/folate deficiency
Ethnic variations - part black africans

Question 13

Less common causes of neutropenia

Answer 13

Hypersplenism
Thyroid dysfunction
Nutritional deficiencies eg anoroexia nervosa

Question 14

Haematological causes neutropneia

Answer 14

Bone marrow failrue - MDS, aplastic anaemia
Bone marrow infiltration eg acute leukaemia
Congenital syndromes - cyclical neutropenia

Question 15

INvestiagtions for neutropenai

Answer 15

Historu and exam 0 recurrent infections, mouth ulcers, FH, signs liver disease/AI/lymphadenopathy/splenomegaly
Bloods

Question 16

Blood tests for neutropneia

Answer 16

FBC
LFTs
HIV, hep B and C
Blood film
TSH
B12 and folate
Ferritin
AI screen

Question 17

Management neutropenia

Answer 17

Treat cause
Discuss w haem if <1
If fever/sepsis -> admission

Question 18

Neutropenic spesis features

Answer 18

Non specific symptoms - lack of neutrophils and therefore cytokines - high clincial suspicion
fever >38 degress

Question 19

What bacteria can be esp dangerous if neutropenic spesis

Answer 19

Gram negative

Question 20

Treatment neutropenic spesi

Answer 20

ANTIBIOTICS within hour
Fluid resus
GCSF - stimulate neutrophils