Neutropenia Flashcards
neutrophil function
general neutropenia meaning
an ANC <1.5x10^9 for caucasians (lower in african or middle eastern descent.
severe is 0.2-0.5
very severe is <0.2
absolute neutrophi cound
the number of segmented (mature neutrophils) plus bands in circulation (functioning neutrophils)
Isolated neutropenia vs pancytopenia
isolated neutropenia: decreased neutrophils only
pancytopenia: neutropenia + another cell line defincy
4 broad reasons for isolated neutropenia
- decreased bone marrow
- incrreased consumption
3 idiopathic
- increased destruction.
broad reasonsfor neutropenia with anemia/pancytopenia
- decreased marrow produciton
- sequestration
what signs on PE and history would indicate neutropenia?
- significant PMH: medications, autoimmune disease, active cancer, chemo, radiation therapy, infection.
- obvious sign of infection
- lymphadenopathy or splenomeagly (may indicate a hemolysis and underline bone marrow issue)
- congenital abnormalities
3 oral complications of neutropenia
- aphthous ulcer
- herpes simplex
- thrush (oral candidiasis)
investigations to do with someone with neutropenia
what’re congenital disorders that cause either isolated neutropenias aor bone marrow failure syndroms
isolated neutropenia:
- severe congenital neutropenia– can increrase the risk of MAL
- Cyclic neutropenia every three weeks: often severe, associated infections due to excessive apoptosis of myeloid precursors with specific gene mutations
bone marrow failure syndroms with neutropenia:
- fanconi’s anemia
- dyskeratosis congenita
4 broad causes of acquired neutropenia (DAIIS)
D: drug induced neutropenia
A: acquired hematologic disorders like bone marrow failuyre syndromes, leukemias, metastatic cancers, vitamin deficiencies
I: immune neutropenia
I: neutropenia with infection (sepsis, viral infection like EBV)
S: neutropenia with splenomegaly (sequestration)
In terms of acquired drug-induced neutropenia, what are the main drug classes that cause this? (BIPTS)
antiBiotics
AntiInflammatories
AntiPsychotics
antiThyroid
Antiseizure drugs
T/F therapy is needed when someone has chronic benign neutropenia
false. this disease is aka chronic idiopathic neutropenia, which has no obvious cause. Does not have serious recurrent infections adn no therapy is required becuse cone marrow production capactiy is intact.
management of febrile neutropenia (this person is immunocompromised and without a properly functioning immune system)
- immediated medical attention
(cultures of blood and infectious sources, chest X ray, START ANTIBIOTICS WITHOUT WAITING FOR CULTURE RESULTS (broad spectrum like piperacillin-tazobactam.
- add vancomycin is septic and suspected line infection.
- antifungal therapy if persistent fever.
T/F a person with neutropenia needs to be isolated
false. the most common pathogens are from the patients’ own skin and gut flora– isolation generally is not required. Excellent hand hydigene is essential.
most common organisms in neutropenic patients
Staph.aureus– skin
coagulase negative staph in IV sites and lines.
gram negatives in fut and urinary tract
candida and aspergillis.
T/F viral infections are a large cause of infection in neutropenic patients
false. bacterial infections are the most common. viral and parasitic infections aren’t really common
when would G-CSF injections help a person with neutropenia?
they are generally used with severe/prolonged neutropenia or very seriosu infection.
G-CSF stimulates the BM to produce granulocytes and stem cells and release them into the bloodstream. G-CSF also stimulates the survival, proliferation, differentiation, and function of neutrophil precursors and mature neutrophils via signal transduction pathways.
what’s going on
toxic granulation of neutrophils and left shift. BUT this happens before a person is at non-neutropenic levels.
Dx?
this patient has ACUTE MYELOID LEUKEMIA
- characterized by clonal proliferation of myeloid precursos with reduced capacity to differentiate into more mature elements
- presence of blasts and auer rods.
