Causes and risk factors
The causes of neutropenia include decreased production of neutrophils such as in congenital defect in the bone marrow, diseases of the bone marrow, e.g. leukemia. Radiation and/or chemotherapy, destruction of neutrophils outside the bone marrow also cause neutropenia. Diseases causing the condition include rheumatoid arthritis, SLE, Crohn’s disease. Neutropenia can occur in infections like dengue, tuberculosis, viral hepatitis, Epstein-Barr virus, HIV, Cytomegalovirus. Certain medications like antihypertensive drugs, antibiotics, antipsychotic drugs, antiepileptic drugs, and diuretics can lead to neutropenia. Nutritional deficiency, alcoholism can cause neutropenia. Hypersplenism can also lead to neutropenia.
Clinical presentation
Neutropenia leads to lowered immunity in a person making him highly susceptible to infections. The following symptoms may be observed in the patient – frequent sore throat, odynophagia. Gingival pain, swelling, mouth ulcers, and gum infection can occur. Otitis media can occur. Recurrent sinusitis can occur. Diarrhea can occur. Patient complains of dysuria. Abnormal swelling, redness, or pain around a wound may occur. Perirectal pain and swelling may occur. There may be frequent presence of fever with chills. Pneumonia may occur.
Investigations
Medical history by the patient and clinical examination by the doctor helps in diagnosis. CBC is done. Bone marrow biopsy in some cases is recommended.
Treatment
Treatment depends upon the underlying cause. All cases of mild neutropenia need not be treated. In cases of drug-induced neutropenia, the offending medication must be stopped or replaced with another drug. In cases of viral infections, the neutropenia caused is usually temporary; removal of the spleen in case of hypersplenism. Corticosteroids or other immune-suppressing drugs in autoimmune diseases are helpful. Bone marrow transplant may be needed in serious causes of neutropenia, such as aplastic anemia, leukemia, etc. In patients with severe congenital neutropenia, the treatment used is granulocyte colony stimulating factors [G-CSFs], which stimulates the bone marrow to produce white blood cells.
Complications
Complications such as frequent and/or persistent infections can occur.
When to Contact a Doctor
One must consult a doctor if patient gets frequent infections.
Systems involved
Immune system, circulatory system
Organs involved
Spleen, bone marrow, digestive tract
