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Neutropenia is a condition in which there is a significant reduction in the blood content of one of the populations of white blood cells, the neutrophils. The symptoms of neutropenia are easy to overlook, and it is serious because it greatly increases the risk of various infections in a patient. What are the causes and symptoms of neutropenia? What is the treatment?

Neutropeniais a reduction in the content of volume-worming granulocytes, or neutrophils, in the blood. There are several different cell populations among white blood cells (leukocytes) - the kind of guardians of the human body's immunity. They are classified as leukocytes, i.a. neutrophils, basophils or different types of lymphocytes. Individual white blood cells not only differ in their percentage share in the total number of leukocytes in the blood, but also have different functions to some extent. For example, B lymphocytes are involved in the production of antibodies, and eosinophils are involved in allergic reactions and fighting parasites. Due to the different types of white blood cells fulfilling different functions, deficiencies of a given type of leukocytes differ in patients. Basically, a deficiency of any white blood cells can lead to serious disorders, but the most dangerous is the deficiency of neutrophils, or neutrophils, a condition known as neutropenia.

Neutropenia: definition and types of neutropenia

Neutropenia can be diagnosed when the amount of neutrophils in the patient's blood is less than 1500 / microliter. There are 3 types of neutropenia:

  • mild neutropenia (where the amount of neutrophils in the blood is less than 1500 / microliter)
  • moderate neutropenia (in this situation, the patient's blood is less than 1000 but more than 500 neutrophils per microliter)
  • severe neutropenia (diagnosed when the amount of neutrophils in the blood is less than 500 / microlitre; according to some studies, this condition is considered agranulocytosis, i.e. essentially no neutrophils in the blood)

Neutropeniaaffects patients of all ages - both children and young adults and the elderly. The existence of such a possibility is due to the fact that there are in fact many different causes of neutropenia.

Neutropenia: causes

Generally for neutropeniapathologies of two types can lead: the first are abnormalities in the production of neutrophils in the marrow, and the second are various disorders in which there is an excessive and premature destruction of these white blood cells in the body.

Neutropenia is sometimes a phenomenon that occurs in a patient due to the existence of some congenital disease entities. Examples of such problems include the Kostmann syndrome, Barth syndrome or Shwachman-Diamond syndrome.

There are many more causes of neutropenia acquired in the course of life. In this case, the following can lead to a drastic reduction in the amount of neutrophils in the patient's blood:

  • various infections (especially in the form of hepatitis B and C, as well as HIV infection)
  • medications taken by the patient (neutropenia may appear as a result of the use of preparations from many different drug groups - it is observed both in people using neuroleptics and antithyroid agents, as well as in patients taking antihypertensive, anticonvulsant or anti-inflammatory drugs)
  • autoimmune diseases (e.g. systemic lupus erythematosus or granulomatosis with polyangiitis - formerly Wegener's granulomatosis)
  • oncological therapies (chemotherapy and radiotherapy)
  • poisoning with various substances (e.g. heavy metals)
  • bone marrow diseases (such as bone marrow aplasia or bone marrow fibrosis)
  • neoplasms (neutropenia may appear in particular in the course of various neoplasms of the white blood cell system, such as e.g. leukemia)
  • hypersplenism

Neutropenia: symptoms

Samneutropeniagenerally shows no symptoms. Their appearance is led by the consequences of an excessive reduction in the amount of neutrophils in the blood. The role of these cells of the immune system is primarily to protect the body against various infections - so when a patient has too little neutrophil, he becomes very susceptible to all kinds of infections. A patient with neutrophilia is at increased risk of developing both bacterial, fungal and viral infections.

Patients with neutropenia develop infections caused by microbes in the body. Under normal conditions, neutrophils do not allow such pathogens to overgrow, so he althy people do not get sick. In the case of neutropenia, the body lacks these defenders against infection. Therefore, for example golden staphylococcus - which is present on the skin of many people - it can be much easier tolead, inter alia, until the appearance of abscesses on the skin.

In the course of neutropenia, skin infections, respiratory and urinary tract infections are the most common.

In the course of neutropenia, skin infections, respiratory infections (e.g. pneumonia), and urinary tract infections are the most frequently observed diseases. The range of possible infections is extremely large, so the symptoms that appear in people with neutropenia vary. Patients with pneumonia may struggle, among others with persistent cough. Conversely, patients who develop urinary tract infections may experience various problems urinating.

Neutropenia is associated with certain symptoms, which may suggest that the patient is suffering from an impaired immune system function. The symptoms of neutropenia in this sense can be treated as:

  • body temperature disturbances (typically in the form of an increase in body temperature, although it is also possible to lower the temperature)
  • feeling of general breakdown
  • redness and swelling in the area of ​​various wounds

It also happens that patients experience pain and swelling of the gums, they may also experience various changes in the mucous membranes (e.g. those located around the anus).

Neutropenia: diagnosis

The diagnosis of neutropenia is made on the basis of blood counts with a smear, which indicate a decrease in the amount of neutrophils in the blood. It is important to find out the cause of the neutropenia so that the patient can be treated appropriately. The choice of tests depends on the suspected causes of neutropenia. Both imaging tests and tests such as bone marrow biopsy (used, for example, when there is a suspicion that neutropenia could have occurred as a result of bone marrow involvement by some neoplastic process) can be used in diagnostics.

Neutropenia: treatment

The therapeutic management of patients with neutropenia is based primarily on the elimination of the cause that led to it. For example, if the medication in a patient may have caused the decrease in neutrophil counts, the drug should be discontinued. If an infection or systemic lupus erythematosus has led to neutropenia, specific treatments are implemented for these individuals.

In neutropenic patients who develop an infection, it is necessary to start treatment as soon as possible - early use of antibiotics (in the case of bacterial infections) or antifungal drugs increases the chance that the infection will be successfulmaster. In a situation where the estimated risk of infections in a patient with neutropenia is high, prophylactic antimicrobial treatment may be used.

With a significant degree of neutropenia, patients are sometimes administered substances that stimulate the production of neutrophils in the bone marrow. They are called neutrophil growth factors (abbreviated as G-CSF and derived from the English term granulocyte-stimulating factor). An example of such a drug is filgrastim and it stimulates the marrow to produce granulocytes and increases their release into the blood.

Sources:

1.C. D. Braden, Neutropenia, Medscape; on-line access: https://emedicine.medscape.com/article/204821-overview2. M. Territo, Neutropenia, Merck Manual; on-line access: http://www.merckmanuals.com/en-pr/home/blood-disorders/white-blood-cell-disorders/neutropenia3.Materials for Centers for Disease Control and Prevention, on-line access: https://www.cdc.gov/cancer/preventinfections/pdf/neutropenia.pdf

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Cardiology