Neutropenia Flashcards
Neutropenia - Causes
Neutropaenia
Causes viral drugs e.g. carbimazole, clozapine haematological malignancy aplastic anemia haemodialysis
Neutropenia - Example Question
A 36-year-old female was referred to the outpatient haematology clinic having been referred by her GP with a falling white cell count. Eight weeks ago she saw her own GP complaining of feeling continuously tired after a viral upper respiratory illness two weeks prior to the onset of her symptoms. She also complained of feeling generally unwell and of having intermittent pains in all her joints and muscles without swelling or stiffness. Her respiratory symptoms had fully resolved and she denied any night sweats or weight loss. Her GP organised a set of screening blood investigations which revealed a white cell count of 2.6 *10^9 g/dl (neutrophil count 2.0 *10^9 g/dl). This was repeated on two further occasions over the next four weeks revealing results of 2.2 and 1.9 respectively (neutrophil counts of 1.5 *10^9 g/dl and 1.2 *10^9 g/dl respectively). Her past medical history included hypothyroidism for which she was treated with levothyroxine 150mcg OD.
Examination at the clinic revealed the presence of a systemically well female. Her blood pressure was 118/74 mmHg, heart rate 82 bpm, respiratory rate 16/min and temperature 36.6ºC. Examination of her cardiovascular system was unremarkable. Similarly, examination of her gastrointestinal system was unremarkable, with no organomegaly identified. No cervical, axillary or inguinal lymph nodes were palpable. Examination of her ENT system was unremarkable.
Initial investigations at the clinic revealed the following results:
Hb 122 g/l WCC 2.0 * 109/l Neutrophils 1.3 * 109/l Lymphocytes 0.6 * 109/l Monocytes 0.1 * 109/l Platelets 224 * 109/l Blood film neutropaenia B12 224 (NR 160-900 ng/l) ESR 15 mm/hr CRP 9 mg/l TSH 0.35 (NR 0.4-3.6mu/ml) FT4 11.6 (NR 4.5-13.6 mcg/dl) Monospot test negative CMV serology negative
What is the single most appropriate management option?
Organise bone marrow aspirate and biopsy Organise peripheral blood flow cytometry analysis > Repeat full blood count in four weeks Organise CT neck, thorax, abdomen and pelvis Organise blood cytogenetic analysis
This is a very common scenario seen in the haematology outpatient clinic. This patient most probably has transient myelosuppression secondary to a viral infection with post viral fatigue and malaise. Although she is symptomatic, she is systemically well and there are no other red flag symptoms or signs including the presence of lymphadenopathy and splenomegaly. Her neutrophil count has been falling but it has remained above 1 and she is not febrile or septic. Her neutrophil count is beginning to improve (albeit very slowly) and therefore a repeat FBC would be justified to ensure that it does return to normal. If it remains low further investigation would be justified.
