Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

900 Leukocytosis: Neutrophil Leukopenia

management

■Dependent on the cause of the neutrophilia

specific therapy

■No specific therapy required for treatment of white count itself

■Managed by treatment of underlying disease

follow-up

■Determined by the etiology of the leukocytosis

complications and prognosis

■Dependent on the underlying disorder

LEUKOPENIA

NANCY BERLINER, MD

history & physical

■Comprehensive history

➣Inquire about fever, infection, new drugs, potential toxic expo-

sures, previous blood counts

➣Family history of neutropenia, low blood counts

➣History suggestive of collagen vascular disease

■Physical examination

➣Thorough examination for evidence of infection, lymphoma, col-

lagen vascular disease

➣Look for oral mucosal lesions, pharyngeal exudates

➣Evidence of lymphoma: adenopathy, splenomegaly

➣Evidence of collagen vascular disease: joints, skin

tests

CBC,Differential, Platelet Count

■Confirm neutropenia

■In some populations (e.g. Africans and Yemenite Jews), normal ANC

is lower (lower limit of normal of 1.2×106/microliter)

■Urgency of evaluation dependent on degree of neutropenia.

➣ANC 1000–1500 Mild neutropenia, no increased infectious risk

➣ANC 500–1000 Moderate neutropenia, slight increased risk of

infection

➣ANC <500 Severe neutropenia, markedly increased risk of infec-

tion