Neutropenia Flashcards
Reactive casues of neutrophilia
Infection/inflammation - pneumonia common
C.difficile, septic arthritis
Malignancy - cytokine release
Steroids
SMoking
Hyposplenism
Rebound post chemo or GCSF
Full exam - infections/abscesses/malignancy - splenomegaly
First line investigations
inflam markers
Blood film if persistent w no cause
Acute and clear repeat once stimulus over
Common causes of leucocytosis
Lower UTI in adults
Diverticulitis
Sepsis
Infrequent causes of leucocytosis
Acute appendicitis
Acute mesenteric ischameia
Campylobcter infection
Ischaemic colitis
DKA
non-typhoidal salmonella
Subacute/de quervains thyroiditis
HSP
Bladder cancer
AML
HHS
Rare causes of leucocytosis
UC
CML
Familial meditarranean fever
Neuroleptic maliganat syndrome
Stills disease
Iliopsoas abscess
Myelofibrosis
Differntials for eosinophilia
Eosinophilic oesaphagitis
Acute interstitial nephrotis
Addisons disease
Eosinophilc granulomatosis with polyangitis
When investigate neutrophilia further
Persistent
No scondary cause
Splenomegaly
Contact haematologyif above
Key features of neutrophil
Most abundant WC
Front line defence
Express and release cytokines, modify immune response
Life cycle of neutrophil
Promyelocyte -> myelocyte->metamyelocyte-> badn neutrophil
Normal neutrophil count
2-7 x109/L
What is neutropenia
1.5 x 109/L
Mild, moderate and sev neutropenia
Mild - 1-1.5 x 109/l
Moderate 0.5-0.99 x 109/l
Sev <0.5 x 10 9/L
Common causes of neutropenia
Medications - BNF, chemo/immunosupressants
Viral infections/sepsi - transietn
AI disease
B12/folate deficiency
Ethnic variations - part black africans
Less common causes of neutropenia
Hypersplenism
Thyroid dysfunction
Nutritional deficiencies eg anoroexia nervosa
Haematological causes neutropneia
Bone marrow failrue - MDS, aplastic anaemia
Bone marrow infiltration eg acute leukaemia
Congenital syndromes - cyclical neutropenia
INvestiagtions for neutropenai
Historu and exam 0 recurrent infections, mouth ulcers, FH, signs liver disease/AI/lymphadenopathy/splenomegaly
Bloods
Blood tests for neutropneia
FBC
LFTs
HIV, hep B and C
Blood film
TSH
B12 and folate
Ferritin
AI screen
Management neutropenia
Treat cause
Discuss w haem if <1
If fever/sepsis -> admission
Neutropenic spesis features
Non specific symptoms - lack of neutrophils and therefore cytokines - high clincial suspicion
fever >38 degress
What bacteria can be esp dangerous if neutropenic spesis
Gram negative
Treatment neutropenic spesi
ANTIBIOTICS within hour
Fluid resus
GCSF - stimulate neutrophils
