Mayo Clinic Q and A: Understanding neutropenia

May 31, 2018 | Mayo Clinic Hematology Staff | @mayoclinichematologystaff | Comments (11)

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DEAR MAYO CLINIC: My 1-year-old has neutropenia, and his neutrophil count is very low (310). He often gets infections, and his neutrophil count goes even lower when he’s on antibiotics. What are our options at this point to get him healthy?

ANSWER: Neutropenia is a condition in which a person has too few neutrophils. Neutrophils are a type of white blood cell that helps the body fight infections, particularly infections caused by bacteria. People who have neutropenia are at high risk for multiple infections. In infants and toddlers with neutropenia, those infections often affect the ears, mouth, lungs, sinuses, throat and urinary tract.

To manage neutropenia appropriately, it’s important to know the cause. Various diseases and conditions can lead to neutropenia. Make an appointment for your child to have further evaluation by a pediatric hematologist — a health care provider who specializes in blood disorders in children — to find the reason for his neutropenia. He or she will be able to help you decide on the most appropriate treatment.

Neutrophils are made in bone marrow — the spongy tissue inside some larger bones. The normal level of neutrophils in children varies depending on the child’s age. A 1-year-old is considered to have neutropenia when the neutrophil count goes below 1,500. A count below 500, as in your son’s case, puts him at a significantly higher than normal risk for infection.

To determine the cause of your son’s neutropenia, it is important to first determine whether it is due to increased destruction of neutrophils (e.g., as a result of an immune disorder) or because of decreased production of neutrophils. A decrease in the production of neutrophils can be the result of a congenital problem in the bone marrow, a nutritional deficiency or another condition that prevents the bone marrow from making a sufficient amount of neutrophils.

Neutropenia also can be a result of taking certain medications, especially antibiotics and other drugs used to fight infection.

In some cases, particularly when neutropenia occurs in young children, the problem may be caused by a genetic mutation. This form of the disorder is called severe chronic neutropenia. There are several categories of genetic neutropenia, including congenital neutropenia, also called Kostmann syndrome; cyclic neutropenia; and autoimmune neutropenia.

To find out what’s causing his neutropenia, your son likely will need to undergo several tests, including additional blood tests and evaluation of his bone marrow. If his health care provider suspects a genetic component to the disorder, genetic testing also may be appropriate. There are instances where no clear cause can be found for neutropenia — even after thorough testing. In those cases, the disorder is labeled as idiopathic neutropenia.

If evaluation finds an underlying disorder that’s causing neutropenia, treatment for that problem could help restore the neutrophils and decrease the risk of infection. Sometimes, treatment with a medication called granulocyte colony-stimulating factor, or GCSF, also may be used to help the body rebuild its supply of neutrophils.

If your son is diagnosed with severe chronic neutropenia, there is an international registry available for people with the disorder. If he’s accepted to and enrolled on the registry, he may be able to receive granulocyte colony-stimulating factor treatment free of charge. Find more information visit The Severe Chronic Neutropenia International Registry.

Talk to a pediatric hematologist about assessing your loved one's neutropenia. By gathering more information about his or her condition — especially the cause — you’ll be better equipped to make an informed decision about the best way to move forward. — Dr. Carola ArndtPediatric Hematology and Oncology, Mayo Clinic, Rochester, Minnesota


Have you been diagnosed with neutropenia? Join or start a discussion on the Blood Cancers & Disorders Group to meet real members like you who understand.

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I have history of neutropenia. Back in 2001 my white blood cell count dipped to high 900 with absolute neutrophil count over 500. Battled pulmonary infection for over 3 weeks no response to antibiotics till one physician treated me course of prednisone.

A second bout 2016 with absolute neutrophil count around 800. Over the years have had 3 bone marrow biopsies, first one a dry tap then two more, after second biopsy showed hypocellular sample and last one during 2016 with monocyte count higher than normal. All other tests normal except Anti-neutrophil cytoplasmic antibody that came back positive. My cell count remained stable with low normal neutrophil count when my hematologist suggested no longer follow up necessary. Several weeks ago following dog bite infection and 5 days course of Augmentin stopped treatment due to significant diarrhea and past history of C. Diff colitis. Repeat CBC showed absolute neutrophil count of 200. Visited a hematologist where I was seen last 2017 with the original specialist no longer there. He told me there is no need for me to repeat my cell count or be seen there again. I have been having temperatures fluctuating from 95.7 to as high as 99.8 and fatigue. Being in my mid 60s if you were in my situation would get a second opinion. Bring on an HMO plan, will have to pay on my own. Any reputable hematologist who offer second opinion via telemedicine.
Appreciate your input.

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dsm (@dsm) Did you ever get a second opinion? Please let us know if you have any updates.

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