Internal Medicine

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

Leukocytosis: Neutrophil Leukopenia 903

Increased Peripheral Destruction of Neutrophils

■Overwhelming infection

■Immune destruction

➣Autoimmune neutropenia:

Seen with collagen vascular disorders (SLE, RA), drugs

Also seen with immune thrombocytopenia and autoimmune

hemolytic anemia

Mediated by IgG or IgM antibodies

Marrow: hypercellular with a late myeloid maturation arrest.

Felty’s Syndrome: neutropenia with rheumatoid arthritis and

splenomegaly.

➣Large granular lymphocytosis

May cause profound neutropenia accompanied by severe

infections.

Frequently seen with rheumatoid arthritis

Lymphoproliferative maligancy of T cells

Variable clinical course

■Hypersplenism/Sequestration

➣Mild or moderate neutropenia along with anemia and thrombo-

cytopenia.

➣Normal myeloid maturation in the marrow.

➣Neutropenia is rarely severe.

management

Management of Fever and Neutropenia:

■Depends on degree of neutropenia

■Fever in setting of severe neutropenia (ANC <500× 106 /microliter): a

medical emergency

■Culture blood, bodily fluids

■Empiric broad-spectrum antibiotics to cover gram-negative enteric

pathogens

■Duration of therapy dependent on duration of neutropenia

■Prolonged neutropenia: recurrent/persistent fever requires empiric

anti-fungal therapy

■Granulocyte transfusions for gram-negative sepsis not responsive to

antibiotics

specific therapy

■Therapy directed at cause of neutropenia.

■Kostmann’s syndrome, cyclic hematopoiesis, LGL neutropenia may

respond to G-CSF