Neutropenia

People with neutropenia have an unusually low number of cells called neutrophils. Neutrophils are cells in your immune system that attack bacteria and other organisms when they invade your body.

Neutrophils are a type of white blood cell. Your bone marrow creates these cells. They then travel in your bloodstream and move to areas of infection where they ingest and then neutralize the offending bacteria.

Symptoms of Neutropenia

Neutropenia itself often doesn't cause symptoms. In some cases, people only learn they have neutropenia when they have a blood test for an unrelated reason. It is most commonly seen--and even expected--as a result of chemotherapy used to treat cancer. But some people may have other symptoms from infection or the underlying problem causing the neutropenia.

Infections can occur as a complication of neutropenia. They occur most often in the mucous membranes, such as the inside of the mouth and the skin.

These infections can appear as:

• Ulcers
• Abscesses (collections of pus)
• Rashes
• Wounds that take a long time to heal

Fever is also a common symptom of infection. In a neutropenic fever, it is common not to identify the exact cause, which is often normal gut bacteria that has made its way into the blood from weakened barriers. Neutropenic fevers are usually treated with antibiotics, even if an infectious source can't be identified. This is important because the weakened immune system means patients can get very sick very quickly.

The risk for serious infection generally increases as:

• Neutrophil count goes down
• Duration of severe neutropenia gets longer

Neutropenia Causes

The causes of neutropenia include:

• Problem in the production of neutrophils in the bone marrow
• Destruction of neutrophils outside the bone marrow
• Infection
• Nutritional deficiency

Causes of decreased production of neutrophils include:

• Being born with a problem with bone marrow production (congenital)
• Leukemia and other conditions that affect the bone marrow or lead to bone marrow failure
• Radiation
• Chemotherapy

Infections that can cause neutropenia include:

• Tuberculosis
• Dengue fever
• Viral infections such as Epstein-Barr virus, cytomegalovirus, HIV, viral hepatitis

Increased destruction of neutrophils can be due to the body's immune system targeting neutrophils for destruction. This may be related to having an autoimmune condition, such as:

• Crohn's disease
• Rheumatoid arthritis
• Lupus

In some people, neutropenia can be caused by certain medications, such as:

• Antibiotics
• Blood pressure drugs
• Psychiatric drugs
• Epilepsy drugs

Neutropenia Treatment

When deciding on treatment, health care providers consider the cause and severity of the neutropenia. Mild cases may not need any treatment.

Approaches for treating neutropenia include:

• Antibiotics for fever. In neutropenic fever, the assumption is made that there is an infection causing the fever even when the source can't be found.
• A treatment called granulocyte colony-stimulating factor (G-CSF). This stimulates the bone marrow to produce more white blood cells. It is used for several types of neutropenia, including low white cell count from chemotherapy. This treatment can be lifesaving in these cases.
• Changing medications, if possible, in cases of drug-induced neutropenia
• Granulocyte (white blood cell) transfusion (very uncommon)
• Stem cell transplants may be useful in treating some types of severe neutropenia, including those caused by bone marrow problems.

People with neutropenia often need to take special steps to prevent infections. These neutropenia precautions include:

• Good hygiene, including frequent hand washing and good dental care, such as regular tooth brushing and flossing
• Avoiding contact with sick people
• Always wearing shoes
• Cleaning cuts and scrapes, then covering them with a bandage
• Using an electric shaver rather than a razor
• Avoiding animal waste and, when possible, not changing infants' diapers
• Avoiding unpasteurized dairy foods; undercooked meat; and raw fruits, vegetables, grains, nuts, and honey
• Staying out of hot tubs, ponds, and rivers

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