Neutropenia

Question 1

What is the appearance of a toxic neutrophil and why does this occur?

Answer 1

Basophilia 
Granulation
Vacuolation
Dohle bodies
Giant, Bands and Metamyelocytes

In response to injury

Question 2

What are the two theoretical causes of neutropenia?

Answer 2

Decreased production

Increased margination or destruction

Question 3

What are the 4 steps to work up a neutropenic patient?

Answer 3

Detailed history- drugs (estrogen, phenobarbital, griseofulvin) and vaccination (parvovirus, panleukopenia)
Physical exam and imaging for septic focus
Testing for FeLV FIV Parvovirus
Bone marrow cytology

Question 4

Bone marrow disease should be considered with what additional finding?

Answer 4

Anaemia and/or thrombocytopenia

Especially if the anaemia is non-regenerative

Question 5

What suggests infection in the neutrophil exam?

Answer 5

Toxic changes

Left shift

Question 6

If there are no toxic changes or a left shift, what are the two likely diagnoses?

Answer 6

Steroid responsive neutropenia

Primary bone marrow disease

Question 7

If infectious and neoplastic causes are ruled out, what should be done?

Answer 7

An IN HOSPITAL therapeutic trial of immunosuppressive corticosteroid

Rapid responses are seen (24-96 hours and doses can be tapered off as for IHA

Question 8

How should a Febrile, Neutropenic patient be treated?

Answer 8

This is a medical emergency and should be treated with aggressive IV antibiotics ie ampicillin 20mg/kg q8