107 - Neutropenia: hematologist’s point of view
Autor(s): R. Varaldo, M. Gobbi
Issue: RIMeL - IJLaM, Vol. 3, N. 3-S1, 2007 (MAF Servizi srl ed.)
Page(s): 107-111
Neutropenia is defined by an absolute blood neutrophil count (ANC) that is less than 1,5x109 /l. Decreased number of neutrophils, if sufficiently severe and prolonged , is associated with an increased risk of infections by bacteria or fungi. This risk of infection is also influenced by the clinical context in which neutropenia occurs. A pathophysiological classification of neutropenia comprises disorders of production (including congenital neutropenias, usually recognized in infancy or early childhood, clonal stem cell diseases and aplastic anaemia), disorders of distribution (i.e sequestration and destruction of cells in the splenic circulation during chronic hepatic infection), disorders affecting neutrophil utilization and turnover (usually due to immunologic mechanisms). Unexpected finding of neutropenia should always be verified with repeated blood count and leukocyte differentials determined by direct microscopic evaluation of blood smear. Bone marrow studies are not routinely needed to establish a diagnosis; marrow examination (with morphologic, cytogenetic and immunophenotypic assessment) is always required when the neutropenia is severe or associated with anemia, thrombocytopenia, lymphocytosis, adenopathy, splenomegaly. Initial laboratory evaluation of neutropenic patients may include viral tests (CMV, HIV, HBV, HCV, HBV), serological tests for autoimmune diseases, functional liver evaluation.