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They are an important type of white blood cell, vital for fighting pathogens, particularly bacterial infections.
The neutropenia describes a reduction in neutrophils.
Neutropenia is a condition in which there are abnormally low levels of neutrophils in the blood supply .
In adults, a count of 1,500 neutrophils per microliter of blood or less is considered neutropenia, and any count less than 500 per microliter of blood is considered severe.
In severe cases, even bacteria that are normally present in the mouth, skin, and intestine can cause serious infections.
Neutropenia may be due to decreased neutrophil production, accelerated neutrophil use, increased neutrophil destruction, or a combination of all three factors.
Neutropenia can be temporary (acute) or long-lasting (chronic). The condition is also divided into congenital (present from birth) and acquired (develops later in life) neutropenia.
Types
There are a variety of neutropenias, including:
- Cyclic Neutropenia : This is a rare congenital syndrome that causes fluctuations in the number of neutrophils, affecting approximately 1 in 1,000,000 people.
- Kostmann syndrome : This is a genetic disorder in which neutrophils are produced at lower levels. People with Kostmann syndrome are prone to infections from a young age.
- Chronic idiopathic neutropenia : This is a relatively common version of neutropenia, predominantly affecting women.
- Myelocatexis : This is a condition in which neutrophils cannot move from the bone marrow (where they are created) into the bloodstream.
- Autoimmune Neutropenia : This occurs when an individual’s immune system attacks and destroys neutrophils.
- Shwachman-Diamond syndrome: This is a rare genetic disorder with multiple effects including dwarfism, problems with the pancreas, and a low neutrophil count.
- Isoimmune Neonatal Neutropenia : This is a condition where the mother’s antibodies cross the placenta and attack the neutrophils of the developing fetus. This condition usually resolves within 2 months of life. It can be asymptomatic or cause sepsis.
Causes of low neutrophils
Neutrophils are produced in the bone marrow in the center of the largest bones. Anything that interrupts this process can cause neutropenia.
Most commonly, neutropenia is caused by cancer chemotherapy. In fact, about half of cancer patients who receive chemotherapy will experience some level of neutropenia.
Other possible causes of neutropenia include:
- Leukemia.
- Certain medications, including antibiotics and medications for high blood pressure, psychiatric disorders, and epilepsy.
- Barth syndrome, a genetic disorder that affects multiple systems.
- Myelodysplastic syndromes, which are a group of disorders characterized by dysfunctional blood cells due to problems with bone marrow production.
- Myelofibrosis, a rare bone marrow problem, also known as osteomyelofibrosis.
- Alcohol dependence.
- Vitamin deficiencies, most commonly vitamin B12, folic acid, and copper deficiencies.
- Sepsis, a bloodstream infection that uses neutrophils faster than they can be produced.
- Pearson syndrome.
- Certain infections, including hepatitis A, B, and C, HIV / AIDS, malaria, tuberculosis, dengue fever, and Lyme disease.
- Hypersplenism or an enlarged spleen.
Some autoimmune conditions can affect neutrophils, reducing their number. These conditions include:
- Crohn’s disease .
- Rheumatoid arthritis.
- Lupus.
Premature babies are more likely to be born with neutropenia than babies born close to their due date. The condition affects 6 to 8 percent of newborns in neonatal intensive care units.
As a general rule of thumb, the smaller the baby, the more likely they are to have neutropenia.
Symptoms of low neutrophils
Neutropenia itself does not have any symptoms. It is often found during routine blood tests or exams for another condition. For this and other reasons, patients undergoing chemotherapy, who are at the highest risk of contracting the disease, will undergo regular blood tests.
The most serious concern with neutropenia is getting an infection, which can easily spread throughout the body without an adequate number of neutrophils to control it.
Signs of infection include:
- High fever or low temperature.
- Chills and sweating
- Flu-like symptoms
- Discomfort.
- Mucositis, a painful inflammation and ulceration of the mucous membranes of the digestive tract.
- Abdominal pain
- Diarrhea and vomiting
- Changes in mental state.
- Sore throat, toothache, or mouth sores.
- Pain near the anus.
- Burning sensation when urinating.
- Increased urination
- Tos.
- Difficulty breathing.
- Redness or swelling around the wounds.
- Unusual vaginal discharge
If an infection sets in, there is a risk of febrile neutropenia, also known as neutropenic sepsis.
This condition is a medical emergency and occurs most often in cancer patients undergoing chemotherapy. Mortality rates range from 2 to 21 percent.
Febrile neutropenia is defined as:
- Fever greater than 101 Fahrenheit or greater than 100.4 Fahrenheit for 1 hour or more.
- An absolute neutrophil count of 1,500 cells per microliter or less.
It is vital that an infection is treated immediately in a patient with neutropenia.
Treatment of low neutrophils
Treatment of neutropenia will depend on the underlying reason for the disorder. Medical treatments to help reduce the impact of neutropenia include:
- Granulocyte Colony Stimulating Factor (G-CSF): is a glycoprotein that stimulates the bone marrow to produce neutrophils and other granulocytes and releases them into the bloodstream. The most commonly used version of G-CSF is a drug called filgrastim.
- Granulocyte Macrophage Colony Stimulating Factor (GM-CSF): Naturally produced glycoprotein plays a role similar to G-CSF. Both promote neutrophil recovery after chemotherapy.
- Antibiotics : Prophylactic antibiotics are sometimes given to reduce the chance of infection. They are often given at the time when the neutrophil count is lowest.
