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Neutropenia


Neutropenia is a blood disorder where the body has an excessively low number of one type of white blood cells known as neutrophil granulocytes, or neutrophils,. Around 50 to 70% of the white blood cells circulating around the body are made up of neutrophils.

These white blood cells are responsible for attacking and eliminating any bacteria that invade the body, and they function as the first line of defense against infections. People who have Neutopenia are more vulnerable to bacterial infections, and if these infections are not treated immediately, they can cause Neutropenic Sepsis, which is considered serious and life-threatening.

In the United States, one in every 100,000 persons contract Neutropenia. There are many types of the disease, which include the rare Cyclic Neutropenia, which occurs every 21 days, the more common Congenital (inherited) and Idiopathic (no known cause) Neutropenia, and Isoimmune Neonatal Neutropenia, which occurs in newborn infants.

NEUTROPENIA CAUSES

Neutropenia can be caused when the bone marrow has a problem producing neutrophils, such as in cases of cancer, a Vitamin B12 or folic acid deficiency, in hereditary disorders like Congenital Neutropenia, exposure to pesticides, as a result of taking certain medications or undergoing radiation therapy.

It may also be caused by white blood cell destruction in other parts of the body, like in aplastic anemia, Autoimmune Neutropenia, chemotherapy and hemodialysis treatments. In some instances, a mild case of Neutropenia can occur when a person contracts a viral infection.

The measurement of how severe a Neutropenia case is will depend on a person's neutrophil count. Normal neutrophil levels in adults fall between 1,500 to 7,000 neutrophils per mm3. Children under 7 years of age may have a lower neutrophil count.

Patients with mild Neutropenia will have an absolute neutrophil count (ANC) of below 1,500 per mm3, moderate cases have an ANC of between 500 to 1,000 per mm3, while the ANC of severe Neutropenia falls below the 500 per mm3 level.

Females have a higher risk for Neutropenia, as are elderly adults. A person with severe Neutopenia will need immediate medical attention, as there is a greater potential for several types of infection to develop, such as bacterial, fungal or viral, or all three at once combined.
neutropenia
Image: Neutropenia

NEUTROPENIA SYMPTOMS

People who have Acute Neutropenia can develop symptoms over the course of a few days or even hours. Chronic Neutropenia sufferers can develop the disease gradually, but are affected for months, and even years. Chronic Neutropenia will often exhibit no symptoms until an infection sets in. These infections usually manifest themselves in the mouth, throat, sinuses, lungs, and skin. They show up in the form of fever, mouth ulcers, anal sores, ear and gum infections, tonsilitis, sore throats, skin abscesses, and even periodontal disease. In some cases, life-threatening infections or sepsis can set in, requiring hospitalization and intravenous administration of antibiotics.

Other symptoms of Neutropenia include diarrhea, shortness of breath, chills, a burning sensation when urinating, and excessive swelling, pain and redness in wounds.

NEUTROPENIA DIAGNOSIS

To diagnose Neutropenia, the doctor may order a complete blood count to determine the number of neutrophils in the blood. Sometimes, to make a precise diagnosis especially if the doctor suspects other serious illnesses, a bone marrow aspiration or biopsy may be necessary.

In a bone marrow biopsy, the doctor will use a needle to take a sample of the patient's bone marrow and examine it under a microscope. The doctor will be looking for impaired neutrophil production, or if there has been excessive use or destruction of these cells. This test will show if there are any signs of an intrinsic defect in the marrow, Congenital Neutropenia, maturation arrest, a fungal infection, a lack of Vitamin B12 or a folate deficiency in the body. There may be other diseases present, as well, like leukemia, tuberculosis, and other cancers.

When the patient exhibits a form of Neutropenic fever, laboratory tests like blood cultures, urinalysis, Sputum Gram stain and culture, and measuring the serum Vitamin B12 and RBC folate levels may be recommended.

For patients already afflicted with an infection, taking radiograph images of the posterio-anterior and lateral chests may be required to check for any signs of pneumonia.

NEUTROPENIA TREATMENT

Neutropenia is treated depending on its cause and the severity of the case. Patients who have an ongoing infection are administered a round of antibiotics, and if there are any medications which bring about the disease itself, they are immediately stopped.

Patients who have acquired Neutropenia through chemotherapy for cancer treatments are prescribed with sargramostin (Leukine, Prokin), a blood growth factor that acts to stimulate the production of white blood cells. Neutropenia caused by pesticide exposure will be as simple as removing the patient from the environment where pesticide is prevalent.

For patients who have acquired Neutropenia due to a nutritional deficiency or a poor diet, the doctor may recommend B-complex vitamins and folic acid supplements, as well as a diet rich in green leafy vegetables and other foods rich in Vitamin B and folic acid.

Other treatments for Neutropenia include spleen removal for patients who incur repeat infections because of Felty's syndrome (a combination of an abnormally low white blood cell count, an enlarged spleen and rheumatoid arthritis); stool softeners to remedy constipation; medicated ointments and creams for infected wounds and abrasions; colony-stimulating growth factors to induce white blood cell production; corticosteroid treatment for Neutropenia caused by an autoimmune reaction; Antithymocyte globulin to treat symptoms of aplastic anemia, and even bone marrow or stem cell transplant to treat more severe cases of Neutropenia like leukemia or aplastic anemia.

NEUTROPENIA PREVENTION

People diagnosed with Neutropenia should avoid getting an infection by observing proper hygiene, keeping clean surroundings, and avoiding crowded public places where they may be exposed to a whole range of germs, viruses and bacteria. They should also avoid exposing themselves to other people who are sick to prevent any contamination.


Other ways of preventing infection while neutropenic include wearing sunscreen, taking proper care of teeth and gums, avoiding contact sports which may cause cuts or injuries, avoiding the use of rectal suppositories, tampons, and even sexual intercourse.

NEUTROPENIA PROGNOSIS

There is an excellent prognosis for Neutropenia. Patients' recovery will depend on how severe the complications are. Usually, only 21% of patients incur serious complications, and recovery is even faster if the disease is diagnosed and treated immediately. In cancer patients suffering from Neutropenia due to chemotherapy treatments, the mortality rate is 4 to 30%.

Scientists at the Northwest Hepatitis C Resource Center working on Neutropenia Prevention have recently found that using an alternative treatment combination of ribavirin, pegylated interferon, erthropoietin and ganulocyte colony-stimulating factor can control anemia and Neutropenia during anti-hepatitis C therapy.

The use of acupuncture is another alternative therapy undertaken by the NESA Acupuncture Research Collaborative to reduce Neutropenia brought about by chemotherapy treatments in women diagnosed with gynecological disorders like ovarian cancer.

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