0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15
902 Leukocytosis: Neutrophil Leukopenia■Acquired syndromes
➣Postinfectious
Commonly seen following viral infections (Varicella, measles,
EBV, CMV, influenza, hepatitis, parvovirus, HIV)
Also seen with bacterial infections (rickettsial infections,
typhoid fever, brucellosis, and tularemia), or sepsis with any
bacteria
Occurs several days after onset of infection, may last several
weeks
Resolves spontaneously
➣Nutritional deficiency
Megaloblastic hematopoiesis 2o B
12 , folate deficiency
Copper deficiency: rare nutritional cause of neutropenia in
severe malnutrition
Mild neutropenia may also occur with anorexia nervosa
➣Drug-induced
Multiple mechanisms of drug-induced neutropenia
direct marrow suppression
immune destruction with antibody or complement medi-
ated damage of myeloid precursors
peripheral destruction of neutrophils.
Direct marrow suppression usually dose dependent.
Common offending drugs include cancer chemotherapeu-
tic agents, phenothiazines, anticonvulsants, and ganciclovir.
Alcohol can also cause neutropenia by marrow suppres-
sion.
Indose-dependentneutropenia, if not possible to stop the drug,
drug may be continued with careful monitoring in face of mild
neutropenia
Drugs that cause immune neutropenia usually cause profound
agranulocytosis,
Common offending drugs: anti-thyroid medications, sul-
fonamides, and semi-synthetic penicillins.
Bone marrow shows a maturation arrest of myeloid lineage
Drugmustbe stopped.
Recovery of the neutrophil count can be accelerated by the
administration of G-CSF.
➣Primary marrow failure
Aplastic anemia
Myelodysplasia
Acute leukemia