Neutropenia

Question 1

neutrophil function

Answer 1

Question 2

general neutropenia meaning

Answer 2

an ANC <1.5x10^9 for caucasians (lower in african or middle eastern descent.

severe is 0.2-0.5

very severe is <0.2

Question 3

absolute neutrophi cound

Answer 3

the number of segmented (mature neutrophils) plus bands in circulation (functioning neutrophils)

Question 4

Isolated neutropenia vs pancytopenia

Answer 4

isolated neutropenia: decreased neutrophils only

pancytopenia: neutropenia + another cell line defincy

Question 5

4 broad reasons for isolated neutropenia

Answer 5

1. decreased bone marrow
2. incrreased consumption

3 idiopathic

4. increased destruction.

Question 6

broad reasonsfor neutropenia with anemia/pancytopenia

Answer 6

1. decreased marrow produciton
2. sequestration

Question 7

what signs on PE and history would indicate neutropenia?

Answer 7

1. significant PMH: medications, autoimmune disease, active cancer, chemo, radiation therapy, infection.
2. obvious sign of infection
3. lymphadenopathy or splenomeagly (may indicate a hemolysis and underline bone marrow issue)
4. congenital abnormalities

Question 8

3 oral complications of neutropenia

Answer 8

1. aphthous ulcer
2. herpes simplex
3. thrush (oral candidiasis)

Question 9

investigations to do with someone with neutropenia

Answer 9

Question 10

what’re congenital disorders that cause either isolated neutropenias aor bone marrow failure syndroms

Answer 10

isolated neutropenia:

• severe congenital neutropenia– can increrase the risk of MAL
• Cyclic neutropenia every three weeks: often severe, associated infections due to excessive apoptosis of myeloid precursors with specific gene mutations

bone marrow failure syndroms with neutropenia:

• fanconi’s anemia
• dyskeratosis congenita

Question 11

4 broad causes of acquired neutropenia (DAIIS)

Answer 11

D: drug induced neutropenia

A: acquired hematologic disorders like bone marrow failuyre syndromes, leukemias, metastatic cancers, vitamin deficiencies

I: immune neutropenia

I: neutropenia with infection (sepsis, viral infection like EBV)

S: neutropenia with splenomegaly (sequestration)

Question 12

In terms of acquired drug-induced neutropenia, what are the main drug classes that cause this? (BIPTS)

Answer 12

antiBiotics

AntiInflammatories

AntiPsychotics

antiThyroid

Antiseizure drugs

Question 13

T/F therapy is needed when someone has chronic benign neutropenia

Answer 13

false. this disease is aka chronic idiopathic neutropenia, which has no obvious cause. Does not have serious recurrent infections adn no therapy is required becuse cone marrow production capactiy is intact.

Question 15

management of febrile neutropenia (this person is immunocompromised and without a properly functioning immune system)

Answer 15

• immediated medical attention

(cultures of blood and infectious sources, chest X ray, START ANTIBIOTICS WITHOUT WAITING FOR CULTURE RESULTS (broad spectrum like piperacillin-tazobactam.

• add vancomycin is septic and suspected line infection.
• antifungal therapy if persistent fever.

Question 16

T/F a person with neutropenia needs to be isolated

Answer 16

false. the most common pathogens are from the patients’ own skin and gut flora– isolation generally is not required. Excellent hand hydigene is essential.

Question 18

most common organisms in neutropenic patients

Answer 18

Staph.aureus– skin

coagulase negative staph in IV sites and lines.

gram negatives in fut and urinary tract

candida and aspergillis.

Question 19

T/F viral infections are a large cause of infection in neutropenic patients

Answer 19

false. bacterial infections are the most common. viral and parasitic infections aren’t really common

Question 20

when would G-CSF injections help a person with neutropenia?

Answer 20

they are generally used with severe/prolonged neutropenia or very seriosu infection.

G-CSF stimulates the BM to produce granulocytes and stem cells and release them into the bloodstream. G-CSF also stimulates the survival, proliferation, differentiation, and function of neutrophil precursors and mature neutrophils via signal transduction pathways.

Question 21

what’s going on

Answer 21

toxic granulation of neutrophils and left shift. BUT this happens before a person is at non-neutropenic levels.

Question 22

Dx?

Answer 22

this patient has ACUTE MYELOID LEUKEMIA

• characterized by clonal proliferation of myeloid precursos with reduced capacity to differentiate into more mature elements
• presence of blasts and auer rods.