Neutropenia
Neutropenia is "a decrease in the number of neutrophilic leukocytes in the blood."[1]
The half-life of a neutrophil is less than one-half of a day. [2]
Diagnosis
Grading
Grading is:[3]
- Grade 1: < 2.0 x 109/L (< 2000/mm3) and > 1.1 x 109/L (> 1500/mm3)
- Grade 2: < 1.5 x 109/L (< 1500/mm3) and > 1.0 x 109/L (> 1000/mm3)
- Grade 3: < 1.0 x 109/L (< 1000/mm3) and > 0.5 x 109/L (> 500/mm3)
- Grade 4: < 0.5 x 109/L (< 500/mm3)
Or the Following
There are three general guidelines used to classify the severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per micro liter of blood:
• Mild neutropenia (1000 < ANC < 1500) — minimal risk of infection • Moderate neutropenia (500 < ANC < 1000) — moderate risk of infection • Severe neutropenia (ANC < 500) — severe risk of infection. • NOTE: These are ranges for Caucasians. Neutropenia in black individuals is defined as ANC < 1200. The following information is from WikiDoc.
For ease of reading the following measurements can be written as:
- Mild neutropenia ranges between 1,000 to 1,500 absolute neutrophil count (ANC) measured in cells per micro liter of blood. There is a minimal risk of infection.
- Moderate neutropenia ranges between 500 to 1,000 absolute neutrophil count (ANC) measured in cells per micro liter of blood. There is a moderate risk of infection.
- Severe neutropenia is less than absolute neutrophil count (ANC) measured in cells per micro liter of blood. There is a severe risk of infection.
Neutropenia is more commonly found in women and the elderly.
Benign ethnic neutropenia has been observed in Africans African-Caribbean persons West Indians Ethiopians, Yemenite Jews and certain Arabs, according to the Annals of Internal Medicine.
Febrile neutropenia
Clinical practice guidelines define febrile neutropenia as "a single oral temperature of >=38.3°C (101°F) or a temperature of >=38.0°C (100.4°F) for >= 1 h. Neutropenia is defined as a neutrophil count of <500 cells/mm3, or a count of <1000 cells/mm3 with a predicted decrease to <500 cells/mm3"[4]
A clinical prediction rule can estimate the risk of morbidity in the febrile patient with neutropenia.[5] A score of >=21 indicates low risk.
Prevention
Hematopoietic colony-stimulating factors for primary prevention of febrile neutropenia may not decrease mortality but do decrease infections in patients undergoing cancer chemotherapy or stem cell transplantation according to a systematic review.[6]
Granulocyte colony-stimulating factor is indicated in selected settings[7][8] if the projected chance of febrile neutropenia is at least 20%.[9]
References
- ↑ Anonymous (2024), Neutropenia (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Carneiro, José; Junqueira, Luiz Carlos Uchôa (2005). Basic histology: text & atlas. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-144091-7.
- ↑ Anonymous (1999). Common Toxicity Criteria (CTC). Cancer Therapy Evaluation Program. Retrieved on 2008-01-06.
- ↑ Hughes WT, Armstrong D, Bodey GP, et al (2002). "2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer". Clin. Infect. Dis. 34 (6): 730–51. DOI:10.1086/339215. PMID 11850858. Research Blogging.
- ↑ Klastersky J, Paesmans M, Rubenstein EB, et al (2000). "The Multinational Association for Supportive Care in Cancer risk index: A multinational scoring system for identifying low-risk febrile neutropenic cancer patients". J. Clin. Oncol. 18 (16): 3038–51. PMID 10944139. [e] (See Table 4 for the prediction rule)
- ↑ Sung L, Nathan PC, Alibhai SM, Tomlinson GA, Beyene J (September 2007). "Meta-analysis: effect of prophylactic hematopoietic colony-stimulating factors on mortality and outcomes of infection". Ann. Intern. Med. 147 (6): 400–11. PMID 17876022. [e]
- ↑ Kuderer NM, Dale DC, Crawford J, Lyman GH (2007). "Impact of primary prophylaxis with granulocyte colony-stimulating factor on febrile neutropenia and mortality in adult cancer patients receiving chemotherapy: a systematic review". J. Clin. Oncol. 25 (21): 3158–67. DOI:10.1200/JCO.2006.08.8823. PMID 17634496. Research Blogging. ACP JC Review
- ↑ Frei, Emil; Kufe, Donald W.; Holland, James F. (2003). Cancer medicine 6: Granulocyte colony-stimulating factor. Hamilton, Ont: BC Decker. ISBN 1-55009-213-8. Full text
- ↑ Smith TJ, Khatcheressian J, Lyman GH, et al (2006). "2006 update of recommendations for the use of white blood cell growth factors: an evidence-based clinical practice guideline". J. Clin. Oncol. 24 (19): 3187–205. DOI:10.1200/JCO.2006.06.4451. PMID 16682719. Research Blogging.