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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 Arndt, Pediatric Hematology and Oncology, Mayo Clinic, Rochester, Minnesota
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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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1 Reaction@dsm, you asked about virtual appointments at Mayo Clinic. Mayo Clinic welcomes both new and existing patients for virtual and in-person care in adherence with federal and state executive orders and guidance. Video and phone visits can be great options for appointments before, after or in place of face-to-face care. Appointment coordinators will recommend a virtual visit if it best fits your individual needs. Here is more information and how to get started with submitting an appointment request: http://mayocl.in/1mtmR63
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1 ReactionDear @colleenyoung i need your help about my case my husband before 25 days ago made blood test it seems that his netrophils low and his lym % very high about %82
They made another blood whole test every time say that he had metropenia without any thing else only remain bone marrow test
And am very worry about his case any advise?
Also he had ebv virus and cmvjgg positive
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1 Reaction@sonia85, What does your husbands doctor think might be causing the low neutrophils count? I'm not sure any member is able to provide advice since we are not medical professionals. Is your husband scheduled for a bone marrow test?
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2 Reactionsdear till now no thing appear , he had EBV and CMVJgg positive virus , the doctors said that he should check liver thet tested a sample of his liver but everything normal , so thats why they said that we should make bone marrow test aswell his LYM 4.2 it mean not Hight cuz in range but in percentage high %82
so am worry about everything , what u thing?
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3 ReactionsHello @sonia85,
I can certainly understand your concern for your husband, however, as John (@johnbishop) mentioned in his post to you, on Connect we are not medical professionals, we are patients like yourself and therefore cannot diagnose medical problems nor interpret medical reports. We do offer each other support and encouragement.
I'm wondering how your husband is feeling now? What are his most difficult symptoms?
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2 ReactionsDear @hopeful33250
Thanks for your reply and for your words
SUre i know just i wanted to share my story if there is have same story can help each other
actually before2 weeks had some Night sweats ,Headache sometimes, fatigue
but now everything normal he said that am ok without any symptoms?
in your country EBV AND CMVIgg they focus on it for not?or what do you thing
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2 ReactionsHi @sonia85, You mentioned your husband had night sweats, headaches and fatigue but now everything is normal and he doesn't have those symptoms anymore? From what I have read night sweats, headaches and fatigue can also be symptoms of a condition called Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. There are a lot of different discussions on the condition if you want to read what others have shared. Here is a link to the different discussions and comments on the topic - https://connect.mayoclinic.org/search/discussions/?search=ME%2FCFS
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3 ReactionsHi @sonia85, if you would like to seek the advise of Mayo Clinic specialists, you can submit an appointment request here: http://mayocl.in/1mtmR63
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1 ReactionDear @colleeyoung
Thank you for your reply
Already i made it
But the problem am in iraq
So this not effect on the appointment?