Neutropenia is the clinical significance of this indicator. What is neutropenia, how is it defined and how is it treated? What is neutropenia? Why does the disease develop?

Neutropenia is characterized by a significant decrease in neutrophils, a type of white blood cell, which is an important first line of defense against infections. The main complication of neutropenia is an increased risk of infection.

Most often, cancer patients develop neutropenia due to chemotherapy; the drugs used destroy the neutrophils along with the cancer cells they are designed to kill.

This article will discuss the causes, symptoms and treatment of neutropenia.

Facts about neutropenia

1. Neutrophils are the most common type of white blood cells.
2. One of the most common causes of neutropenia is chemotherapy.
3. Often there are no symptoms other than an increased risk of infection.
4. Febrile neutropenia is a medical emergency.
5. A person with neutropenia must take extra precautions to avoid infection.

What are neutrophils?

Neutrophils are the most common type of white blood cell. They participate in the inflammatory response to infection, engulf microorganisms and destroy them by releasing enzymes.

Neutrophils are produced in the bone marrow, the spongy interior of the body's larger bones. These are short-lived cells that are widely distributed throughout the body; they can penetrate tissues that other cells cannot penetrate. Neutrophils are the main component of pus and are responsible for its whitish-yellow color.

What is neutropenia?

Neutropenia is a condition in which there are abnormally low levels of neutrophils in the blood. Neutrophils are an important type of white blood cell vital for fighting pathogens, especially bacterial infections.

In adults, a count of 1,500 neutrophils per microliter of blood or less is considered neutropenia, while a count of less than 500 per microliter of blood is considered a severe condition.

In severe cases, even bacteria that are normally present in the mouth, skin, and intestines can cause serious infections.

Neutropenia can be caused by reduced neutrophil production, accelerated neutrophil utilization, accelerated neutrophil destruction, or a combination of all three.

Neutropenia can be temporary (acute) or prolonged (chronic). The condition is also divided into congenital and acquired neutropenia.

Symptoms and diagnosis of neutropenia

Neutropenia itself is not accompanied by any symptoms. Often the disease is discovered during the receipt of blood test results. For this reason, patients undergoing chemotherapy, who are most at risk of the disease, are regularly scheduled for blood tests.

The most serious problem with neutropenia is infection, which can easily spread throughout the body due to the lack of a normal amount.

Signs of infection include:

1. High or low temperature
2. Chills and sweating
3. Flu-like symptoms
4. Malaise
5. Mucositis - painful inflammation and ulceration of the mucous membranes of the digestive tract
6. Pain in the abdomen
7. Diarrhea and vomiting
8. Changes in mental state
9. Sore throat, toothache
10. Pain in the anus
11. Burning when urinating
12. Frequent urge to urinate
13. Cough
14. Difficulty breathing
15. Redness or swelling around wounds
16. Unusual vaginal discharge

If the infection worsens, there is a risk of developing febrile neutropenia, also called neutropenic fever. This condition is a medical emergency and is most common in cancer patients undergoing chemotherapy. Mortality rates range from 2 to 21 percent.

It is very important that the infection be treated immediately in a neutropenic patient.

Febrile neutropenia is defined as:

1. Fever above 38.3 degrees Celsius or more than 38 for 1 hour or more.
2. Absolute neutrophil count of 1500 cells per microliter or less.

Causes of neutropenia

Neutrophils are produced in the bone marrow. Anything that disrupts this process can cause neutropenia.

Most often, neutropenia is caused by chemotherapy in the treatment of cancer. In fact, half of cancer patients who undergo chemotherapy will have some degree of neutropenia.

Other potential causes of neutropenia:

1. Leukemia - blood cancer.

2. Certain medications - including antibiotics and drugs to treat high blood pressure, psychiatric disorders, and epilepsy.

3. Barth's syndrome is a genetic disease.

4. Myelodysplastic syndromes.

5. Myelofibrosis.

6. Alcoholism.

7. Vitamin deficiency - most often vitamin B12, folic acid and copper deficiency.

8. Sepsis.

9. Pearson's syndrome is a mitochondrial disease.

10. Certain infections - including hepatitis A, B and C, HIV/AIDS, malaria, tuberculosis, dengue fever and Lyme disease.

11. Hypersplenism - an enlarged spleen due to sequestration of blood cells.

Some autoimmune diseases can decrease the number of neutrophils. These conditions include:

1. Crohn's disease
2. Rheumatoid arthritis
3. Lupus

Preterm babies are more likely to be born with neutropenia than babies born near due date. As a general rule, the lighter the baby is, the more likely it is to have neutropenia.

In a person with neutropenia, severe infections develop rapidly.

Treatment of neutropenia

Treatment for neutropenia will depend on the underlying cause of the disease. Medical treatments to help reduce the effects of neutropenia include:

Granulocyte-colony stimulating factor (G-CSF) is a glycoprotein that stimulates the production of neutrophils and other granulocytes in the bone marrow and releases them into the bloodstream. The most commonly used version of G-CSF is filgrastim.

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a naturally occurring glycoprotein that performs a similar role to G-CSF. Both of them contribute to the recovery of neutrophils after chemotherapy.

Antibiotics - Antibiotics are sometimes prescribed to reduce the chance of infection. Most often during a period when the number of neutrophils is extremely low.

Lifestyle precautions are necessary for people with neutropenia; they must minimize the risk of infection in everyday life.

Lifestyle precautions for people with neutropenia include:

1. Wash your hands regularly, especially after using the toilet

2. Avoid crowds and people who are sick

3. Do not use other people's personal items, including toothbrushes, drinking cups, cutlery or food

4. Shower daily

5. Cook Meat and Eggs Thoroughly

6. Do not buy products in damaged packages

7. Thoroughly wash the refrigerator and do not overfill it - this can increase the temperature

8. Thoroughly wash any raw fruits and vegetables or avoid eating them completely

9. Avoid direct contact with pet waste and wash hands after handling any animals

10. Wear gloves when in contact with the ground

11. Use a soft toothbrush

12. Use an electric razor instead of a razor

13. Wash any wounds with warm water and soap, use an antiseptic

14. Always wear shoes when going outdoors

15. Wash surfaces

16. Get vaccinated against the flu

Types of neutropenia

Cyclic neutropenia- a rare congenital syndrome that causes fluctuations in the number of neutrophils, which affects 1 in 1,000,000 people.

Kostman syndrome- a genetic disease in which neutrophils are not produced in sufficient quantities.

Chronic idiopathic neutropenia is a relatively common form of neutropenia, predominantly affecting women.

Myelocathexis A condition in which neutrophils cannot move from the bone marrow into the bloodstream.

autoimmune neutropenia The human immune system attacks and destroys neutrophils.

Shwachman-Diamond Syndrome is a rare genetic disorder with multiple effects, including dwarfism, pancreatic problems, and low neutrophils.

Isoimmune congenital neutropenia is a condition in which maternal antibodies cross the placenta and attack neutrophils in the developing child.

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Neutropenia (NP) is a pathological condition of the body, in which the level of neutrophils (NF) in one microcell sharply becomes less than one and a half thousand neutrophils.

In most cases, neutropenia acts as a complication of the original diseases, but it can progress on its own.

Lowering this indicator leads to a greater chance of infection by bacteria, suppresses the immune system and gives access to infectious diseases in the body. The greater the decline in neutrophils, the greater the risk of infectious and bacterial diseases.

To prescribe an effective treatment, it is always necessary to establish the root cause that contributed to the development of such a condition. The disease is quite rare and occurs in one person per hundred and fifty thousand of the population.

Depending on the severity of the disease, according to statistics, death occurs in ten to sixty percent of registered cases.

Basic concepts of NP

The main cells that saturate the body are leukocytes, one of the functions of which is to identify foreign agents, suppress them and store in the memory of a meeting with each of the individual types of harmful proteins.

Neutrophils are found in granulocytes, which are part of white blood cells containing special granules. Against the background of all other constituents of granulocytes, neutrophils make up the majority of them.

That is why the term agranulocytosis (decrease in the number of granulocytes) is called the identical term neutropenia.

The formation of purulent foci occurs due to the deformation of microbes, their tissue formations and neutrophils, which move at a rapid speed from the blood to the site of inflammation.

Types of neutropenia

The initial classification of neutropenia occurs according to the severity of the disease.

The following three stages are distinguished:

Light degree characterized by the presence of 1000 to 1400 neutrophils per microliter of blood;
Average degree determined by indicators from 500 to 1000 NF;
Severe degree- a decline in the boundaries of NF below five hundred per microliter.

The degree is proportional to the development of weights. The last degree of neutropenia is characterized by the progression of burdens.

The extreme stage is characterized by both strong inflammatory processes and its disappearance, which means that the granulocytes are completely depleted.

What causes NP?

The progression of this pathological condition can be both an independent process and a consequence of various diseases.

Provoking factors include:

Prolonged exposure to radiation on the body;
Congenital diseases and genetic mutations. These include congenital pathologies of immunity, violation of granulocytes of genetic origin, etc.;
Deformation of neutrophils due to exposure to antibodies;
The formation of neutropenia, as one of the symptoms of the initial disease (tuberculosis, bone cancer, HIV, lupus erythematosus);
Taking certain medications (analgesics, diuretics (diuretics), anti-inflammatory drugs).

To fully understand the processes of occurrence of the disease, we will consider each of its types separately.

autoimmune neutropenia

It progresses due to the formation of destructive antibodies to neutrophils by the immune system. Such antibodies can be both emerging counteracting agents to other diseases, and specifically to neutrophils, if a sign of other autoimmune diseases is not detected.

In most cases, this type of neutropenia is diagnosed in children with congenital pathologies of the immune system.

Severe forms of immune diseases contribute to a sudden decline in neutrophils and the rapid acquisition of infectious diseases.

In newborns, neutropenia can be detected as a result of the transfer of antibodies from the mother, when taking certain medications.

And also with a hereditary predisposition, called parodic neutropenia (manifested from the first months, after which each trimester appears).

drug neutropenia

In most cases, this type of neutropenia is recorded in the adult age category. It progresses as a result of allergic reactions, toxic effects of medications. Chemotherapy, in this case, does not affect the performance of neutrophils.

The occurrence of this type of neutropenia can occur after the use of antibiotics with the following containing:

Penicillin;
Cephalosporin;
Chloramphenicol;
Certain types of neuroleptics;
Anticonvulsants;
Sulfonamides.

After the use of the above drugs, neutropenia can be recorded and observed for up to seven days, after which the levels gradually return to normal.

Also, manifestations of neutropenia are possible with the use of drugs directed against the occurrence of seizures. In this case, rashes, an increase in body temperature and possible hepatitis are added to all signs of neutropenia.

Frequent provocateurs of neutropenia are chemotherapy and ion irradiation, since during these processes, young synthesizing bone marrow cells are affected.

Indicators of neutropenia can be recorded up to one month after the procedure. In this month, you need to take special care of the high risk of infection.

infectious neutropenia

This type of pathological decline in neutrophils often accompanies acute viral diseases. During periods of damage to the body by infectious or viral diseases, the immune system is especially weak and the progression of possible burdens is most possible.

In childhood, neutropenia mainly occurs in the form of adhesion of neutrophils to the walls of blood vessels. This species is short-lived and disappears after seven days.

A severe form of the pathological disease of infectious neutropenia is HIV, sepsis and other serious burdens, in which not only the violation of the synthesis of NF progresses, but also the deformation of neutrophils in the body.

Febrile neutropenia

The main reason that provokes the progression of this type of neutropenia is a severe infectious disease that begins with the appointment of the use of cytostatics. In this process, harmful microorganisms multiply at a time when the immune system is weak.

In rare cases, it is caused by chemotherapy and other forms of cancer treatment.

The causative agents of neutropenia of this type can be washed by microbes that are not a threat to many people (streptococci, herpes, etc.), but when they develop, in conditions of a small number of neutrophils, they lead to serious infectious diseases and death.

Basically, it can be determined by an increase in temperature, general weakness, and obvious signs of intoxication.

In this case, inflammatory foci are difficult to diagnose, since the immune system almost does not react. The diagnosis is made by exclusion.

benign neutropenia

This condition belongs to the type of chronic, and is inherent in children. It proceeds for a period of more than two years, without showing symptoms and without requiring therapy. Diagnosis of this type of neutropenia consists in determining low neutrophils, but other normal blood counts.

It does not affect the development and growth of the child. Bone marrow failure is the main version of doctors about the progression of such neutropenia.

How to determine the manifestation of NP?

The manifestation of symptoms when the body is affected by neutropenia is more clearly manifested in more severe stages of the disease. The main symptoms manifested are very similar to a blood disease in which the work of the bone marrow is inhibited.

Signs by which neutropenia can be determined are:

Ulcers with tissue death inside, located on the skin, in the oral cavity, chest and soft tissues;
Swelling of the oral cavity, its redness;
Covering the oral cavity with a white or yellow coating;
Necrotic ulcers in the intestines;
Pneumonia;
Cough;
A sharp increase in temperature;
The appearance of boils;
Acute pain in the abdomen, with a clearly defined pain point;
Nausea and vomiting, regardless of food intake;
constipation;
Fever;
Headache;
Pain in the joints.

With the progression of drug-induced neutropenia, the most pronounced symptoms and a high percentage of death appear. In the acute period of the disease, death occurs in thirty percent of cases.

With the development of neutropenia at the initial stages, symptoms are not traced. In case of suspected neutropenia, it is necessary to carefully examine the oral cavity, skin, anus, the site of insertion of catheters and vascular punctures, and also palpate the abdomen.

For an accurate diagnosis, you need to take laboratory blood tests.

Norms

In the normal state, the quantitative indicator of neutrophils is from forty-five to seventy-five percent (or about 1500 per microliter of blood) of all leukocytes. It is the quantitative indicator of NF in the blood that plays an important role, since the number of other components of leukocytes can fluctuate, while the levels of neutrophils remain normal.

Norm indicators vary slightly depending on the race of the person. So in dark-skinned people, the diagnosis of neutropenia occurs with a decrease in neutrophils less than 1200 per 1 microliter of blood. This is because people with this skin color also have lower neutrophil levels than whites.

The greater the lack of these components in leukocytes, the more clinical manifestations are expressed and the risk of progression of life-threatening burdens increases. Severe forms of this disease are rare.

Normal NF values for childhood are shown in the table below:

	Total leukocytes		Neutrophils			Lymphocytes			Monocytes		Eosinophils
Age	average	range	average	range	%	average	range	%	average	%	average	%
birth	18.1	9--30	11	6--26	61	5.5	2--11	31	1.1	6	0.4	2
12 hours	22.8	13--38	15.5	6--28	68	5.5	2--11	23	1.2	5	0.5	2
24 hours.	18.9	9.4--34	11.5	5--21	61	5.8	2--11.5	31	1.1	6	0.5	2
Week 1	12.2	5--21	5.5	1.5--10	45	5	2--17	41	1.1	9	0.5	4
2 weeks	11.4	5--19.5	4.5	1--9.5	40	5.5	2--17	48	1	9	0.4	3
1 month	10.8	6--17.5	3.8	1--9	35	6	2.5--16.5	56	0.7	7	0.3	3
6 months	11.9	6--17.5	3.8	1--8.5	32	7.3	4--13.5	61	0.6	5	0.3	3
1	11.4	6--17	3.5	1.5--8.5	31	7	4--10.5	61	0.6	5	0.3	3
2	10.6	5.5--15.5	3.5	1.5--8.5	33	6.3	3--9.5	59	0.5	5	0.3	3
4	9.1	5.0--14.5	3.8	1.5--8.5	42	4.5	2--8	50	0.5	5	0.3	3
6	8.5	5--13.5	4.3	1.5--8	51	3.5	1.5--7	42	0.4	5	0.2	3
8	8.3	4.5--13.5	4.4	1.5--8	53	3.3	1.5--6.8	39	0.4	4	0.2	2
10	8.1	4.5--13.5	4.4	1.8--8	54	3.1	1.5--6.5	38	0.4	4	0.2	2
16	7.8	4.5--13	4.4	1.8--8	57	2.8	1.2--5.2	35	0.4	5	0.2	3
21	7.4	4.5-- 11.0	4.4	1.8--7.7	59	2.5	1--4.8	34	0.3	4	0.2	3

How is it diagnosed?

For an accurate diagnosis, if neutropenia is suspected, the doctor directs the patient to laboratory blood tests. The most common blood tests for neutropenia include:

Diagnostic methods depend on the general condition of the patient and the suspicions of the attending physician.

What is the treatment for NP in adults?

There is no single specific treatment regimen for neutropenia, since the symptoms are different for everyone, and are provoked by different diseases. The severity of therapy depends on the age category of the patient, the nature of the bacteria that provoked the inflammation and the general health of the patient.

With the course of the disease in a mild form, treatment is not required, and exacerbations that sometimes occur are treated in the same way as in the rest of the affected.

When diagnosing a severe form of neutropenia, constant supervision of doctors is necessary, twenty-four hours a day, so hospitalization cannot be avoided.

If the body is affected by diseases of an infectious origin, then the following groups of drugs are prescribed:

Antifungal;
Antiviral;
Antibacterial.

The dosage at the stage of treatment is much higher than during the prevention of the disease.

The purpose of this or that drug, mainly depends on the individual reaction of the body to the tolerance of this or that medication.

The main methods of therapy are:

Broad spectrum antibiotics. They are used until the doctor determines what is best perceived by the body. The introduction of such drugs is supposed to be in a vein.

We are talking about the improvement of the condition and an effectively selected drug, in the case of an improvement in the patient's health status, in the first three days, from the moment the treatment was started. If no progress is observed, the dose is increased, or another therapy is used;

With the progression of neutropenia from radiation or chemotherapy, antibiotics are prescribed until the level of NF in the blood reaches at least five hundred neutrophils per microliter of blood:

Fungicides (Amphotericin) are used if fungal infections are added to infectious diseases, but fungicides are not used for preventive actions towards fungal agents;
Colony stimulating drugs (Filgastrim). They are used for severe forms of neutropenia, as well as for children with congenital immunity disorders;
Vitamins (folic acid). Assigned as maintenance therapy;
Glucocorticosteroids. They are prescribed for provoking neutropenia by immune diseases;
Medicines that improve metabolic processes in the body (Methyluracil, Pentoxyl). They are prescribed as maintenance therapy.

In the case of a large number of deformed neutrophils in the cavities of the spleen, its removal is likely, but in severe forms of neutropenia, surgical intervention is contraindicated.

Cardinal treatment consists of a surgical intervention, which consists in bone marrow transplantation.

The method of treatment is the most dangerous, but the most effective.

What is characteristic of NP in childhood?

The manifestation of weak bone marrow function is the main factor in the progression of neutropenia. In newborns, neutrophils in the blood are diagnosed as neutropenia, with a decrease of less than one thousand neutrophils per microliter of blood.

As the child grows, the norm indicator grows, and is set at the level of one and a half thousand.

In the first year of life, the progression of neutropenia is characterized by an acute course, or it proceeds chronically (with an increase in symptoms over several months).

In children, only three types of neutropenia are recorded:

Benign neutropenia of chronic type;
Neutropenia provoked by the immune system;
Hereditary predisposition and genetic mutations.

With mild neutropenia, a slight decline in the quantitative index of neutrophils is recorded in childhood, and obvious symptoms, in many cases, do not appear. In some cases, there are frequent recurrent infectious diseases of an acute form, which tend to proceed for a long time, and are complicated by the presence of bacteria in the body.

In this case, medicines against viruses and medicines aimed at fighting bacteria are effective therapy.

In the moderate stage, there are frequently recurring purulent inflammations, and even the registration of an infectious shock state.

In the extreme stage of NP in children, severe intoxication, fever, and purulent inflammation are always manifested, with localization in the chest, abdomen and oral cavity. If effective treatment is not applied, then death often occurs.

For correct diagnosis, the following points must be observed:

When registering purulent foci with tissue death, it is necessary to conduct a blood culture to determine the microorganisms that provoke this condition;
With symptoms of moderate severity, it is necessary to conduct a study of the myelogram;
Determination of all signs of neutropenia and a careful first examination of the child;
Identification of the factor of hereditary predisposition;
With the viral nature of neutropenia, it is necessary to examine the blood serum;
Every week it is necessary to do a clinical blood test, and control all types of blood cells.

When a child's body is affected by hereditary neutropenia, the general criteria are:

Detection of genetic defects by the method of biological examinations;
The manifestation of obvious deviations, both externally and in the indicators of analyzes in the first three months from the birth of the child;
Heavy heredity.

Serious forms of hereditary neutropenia include the following:

Myelocahexia. With this type of neutropenia, there is a slow release of neutrophils from the bone marrow. This species is characterized by an accelerated breakdown of granulocytes into cells in the bone marrow and a low motor response of microorganisms to a chemical stimulus.

In the first year of life, the newborn has a relative lack of neutrophils and a clear increase in eosinophils, as well as a high level of monocytes in the blood.

When the body is affected by bacteria, a pronounced decline in leukocytes in the blood is recorded.

Kostman syndrome. It is a severe form of hereditary NP, to which the nature of the transmission of a pathological gene. There is also a separate incidence. When a child is affected by such a syndrome, frequent lesions of the child's body with infectious and bacteriological diseases are manifested, which are prone to frequent repetitions.

With this pathological condition, a clear decline in the number of neutrophils in the blood is recorded, sometimes reaching a mark below three hundred NF per microliter of blood. Children affected by this syndrome are at risk for the progression of leukemia.

When diagnosing this disease in childhood, a certain therapy is prescribed, which must be taken throughout life.
For therapeutic purposes, colony-stimulating drugs (Filgrastim) are used.

If this group of medicines does not have the desired effect, then bone marrow transplantation is recommended, which is performed through surgical intervention.

Cyclic neutropenia. It is a rather rare diagnosed form of neutropenia, which is inherited. A characteristic difference from other types of neutropenia is an intermittent course, with the presence of periodic complications. This name bears a clear framework for the recurrence of exacerbations (usually from three to eight days) with intervals between attacks of two to three weeks.

When an exacerbation occurs, abnormalities appear in laboratory tests, due to a sudden decrease in the number of neutrophils, and the concomitant growth of monocytes and eosinophils, as well as the appearance of formed purulent foci in different parts of the body.

During periods of remission, the child's general state of health is restored, and all test deviations return to normal.
A distinctive treatment for this type of neutropenia is the use of colony-stimulating factors, 48 hours before the onset of a possible exacerbation.

The duration of therapy depends on how quickly the granulocyte count in the blood is restored.

Prevention

In order to prevent the progression of neutropenia, it is necessary to follow simple rules that will save not only from this disease, but also from many others.

These include:

Normalize the daily routine, allocating time for a good sleep (at least 8 hours);
Moderate exercise for 30 minutes every day;
It is recommended to engage in non-heavy sports (physical education, swimming, etc.), and also allocate at least one hour a day for walking;
Avoid strenuous exercise;
Eat properly. The diet must be balanced so that the body receives all the necessary nutrients and trace elements;
Maintain body at normal temperature. The body should not be too cool or warm;
Avoid stressful situations. Eliminate strong emotional stress (both positive and negative), constant stress;
Get rid of bad habits. Toxins supplied with alcohol and cigarettes have a detrimental effect on the body.

Video: Neutropenia. How to prevent its consequences?

Expert forecast

With timely admission to the hospital, proper examination and rapid selection of effective complex therapy, the outcome is favorable.

If neutropenia is a symptom of another disease, then the course of treatment is aimed at eliminating the root cause. In severe forms, hospitalization and constant monitoring of health workers are necessary.

As well as a number of laboratory tests aimed at determining the damaging factor. Only during hospitalization, the doctor will be able to choose the most appropriate medications., since each organism reacts to certain types of medicines individually.

If the treatment is ignored or ineffective, serious blood diseases progress, which, after severe stages, will lead to death.

For the prevention of diseases and their timely diagnosis in the early stages, you need to take an annual blood test, undergo examinations and go to the hospital at the first symptoms.

There is a disease in which a reduced content of neutrophils is observed in the blood, that is, blood cells, the maturation of which occurs over two weeks in the bone marrow. It has several forms. For example, it may be called febrile neutropenia. There is also a cyclic form of this disease and autoimmune. Any of them means that some changes have occurred in the blood, which, nevertheless, are reversible if the problem is identified in time.

The fact is that after neutrophils enter the circulatory system, foreign agents become their target, which they destroy. It turns out that neutrophils are responsible for protecting the body from bacteria. If their number is lowered, then the human body becomes more susceptible to various infections.

There are several degrees of neutropenia.

Mild degree, when there are more than 1000 neutrophils per µl.
The average degree, when there are from 500 to 1000 neutrophils per μl.
Severe, when there are less than 500 neutrophils per µl.

It happens that in one person the diagnosis includes both neutropenia and lymphocytosis. They differ from each other. Lymphocytosis is too many lymphocytes in the blood, but they also provide the body's immune defenses.

Causes of a decrease in neutrophils

A reduced number of neutrophils in the blood can be either an independent anomaly or a consequence of various blood diseases. Causes of neutropenia can be as follows:

Sometimes it is difficult for doctors to determine the cause. However, the causes of neutropenia help determine the form of the disease. Consider the three forms that we mentioned at the very beginning of this article.

Febrile neutropenia. It develops as a result of cytostatic chemotherapy, which is carried out mainly for leukemia. Most often, this form is a manifestation of an infection in which it is not possible to identify the focus in time. Such an infection in itself has a severe course and rapid spread throughout the body, which leads to death.
Cyclic neutropenia. Unfortunately, the cause of this form of the disease is not known, but its onset usually occurs in childhood.
autoimmune neutropenia. This form is able to develop as a result of taking certain drugs, for example, analgin and anti-tuberculosis drugs. This disease is observed in rheumatoid arthritis, dermatomyositis, autoimmune diseases, and so on.

Some of these causes are similar to lymphocytosis, which may also be present in the diagnosis next to our ailment. In any case, only a doctor can distinguish these diseases from each other. In many ways, the symptoms that are observed in the patient depend on the listed types. It is very important to pay close attention to them, since the accurate diagnosis largely depends on them.

Main symptoms

The symptoms of neutropenia do not have a special picture, so we have to talk more about the clinical manifestations of this diagnosis associated with the infection that developed against its background. Such manifestations, as well as the severity, completely depend again on the form of the disease.

Febrile neutropenia. It manifests itself in the form of a sudden increase in temperature above 38 degrees. This is accompanied by chills, general weakness, tachycardia, profuse sweat, hypotension. With all this, the number of neutrophils does not exceed 500, so the body reacts very weakly to the infection, which does not allow detecting its focus. The diagnosis of febrile neutropenia is made to patients precisely when it is impossible to quickly establish the cause of the elevated temperature in this disease and it is not possible to find its focus. If the cause is established, the diagnosis changes to a more accurate one. This form can manifest itself in cancer patients, as they are at risk of developing infectious diseases.

Cyclic neutropenia. It usually lasts about five days every three weeks. May be accompanied by fever, arthritis, headache, pharyngitis. There may also be damage to the mouth area, ulceration of the mucous membrane. Ulcers are oval or round in appearance with no signs of healing. If there is no treatment for a long time, then plaque and calculus begin to form, and tooth loss may also begin.
autoimmune form. Its course may be recurrent, progressive or slow. Dangerous complications are bacterial infections, as they can be fatal.

It is worth recalling that patients with oncological diseases are at particular risk. They are much more likely to develop purulent-inflammatory complications, although the risk of infection largely depends on the form of oncology and other factors.

Diagnostics

Diagnostics includes two important points.

Physical exam. The doctor examines an adult or small patient and examines the lymph nodes. He also performs palpation of the abdomen.
Tests and trials. This includes blood tests, urinalysis, bone marrow biopsy, HIV tests.

Treatment of the disease

Treatment of the disease depends entirely on the cause that led to its occurrence. This means that most often you have to treat the infection. The doctor decides in what conditions to carry out treatment, in stationary or at home.

Medications include vitamins, antibiotics, and drugs aimed at strengthening the immune system. If the disease is very difficult, the patient is placed in an isolated room in which sterile conditions are maintained and there is ultraviolet radiation.

After discussion, the conclusion suggests itself: a symptom arose - running to the doctor. Only here, in order to detect a symptom, you need to be more attentive to your health, which does not tolerate connivance towards yourself.

Neutropenia has become one of the symptomatic diseases of our time. This term characterizes such a state of the body in which it remains abnormal. The main causes and consequences of this phenomenon became the subject of research in this material. Here we will consider what neutropenia is in children and adults, what types and forms it has, how to get rid of such an ailment, and other pressing medical issues.

Features of the diagnosis and treatment of neutropenia.

What is neutropenia

In a normal state in healthy adults, children, from 50% to 70% of the number of all circulating white blood cells are neutrophils, acting as the main defender of the body against all kinds of infections, thoroughly looking for, destroying dangerous bacteria in the blood. If, due to certain reasons, such an important proportion is violated, the protective function in the body is significantly weakened or disappears altogether, immediately leading to the appearance of many diseases dangerous to health and life. Such people acquire a high susceptibility to acquiring various bacterial infections. This applies to both adults and children, which occur quite often, although in most cases they occur without dangerous complications. However, at this age, their detection and diagnosis is very important.

Causes of the disease

The realities of life are such that neutropenia can occur and form literally before our eyes - within a few days and even hours, acquiring an acute form. The main reasons for this phenomenon have long been established and studied by official medicine:

congenital pathology.
Genetic failure.
The use of powerful medications (antidepressants, cytostatics, antihistamines, antitumor and anticonvulsant drugs).
Radiation.
Weakened immunity.
Various ailments (malaria, typhoid fever, tuberculosis, helminthiasis, poliomyelitis, diabetes mellitus, viral hepatitis, etc.).
Bone marrow damage.
Oncological diseases.
Lack of vitamin 12, as well as folic acid.

In the chronic form of the disease, which lasts for a long time, it happens - for whole years, everything is explained by a decrease in the volume or an abnormal disproportion in the production of such cells.

Specialists distinguish between the primary form of neutropenia, in which myeloid format cells began to form in the structure of the bone marrow, and the secondary form, when external factors influence the volume of myeloid cells in the bone marrow. Relative and absolute neutropenia is also recorded, which can, with various modifications, take the following forms of the disease:

Soft (initial).
Moderate (average).
heavy (acute)

These forms depend on the absolute number of neutrophils in the patient's body. Infectious transient neutropenia is often associated with recent infectious diseases. Very dangerous is febrile neutropenia, observed most often in cancer patients, or the so-called. "neutropenic fever". This condition in patients occurs suddenly and develops very quickly with the number of neutrophils, representing a real threat to life. There are also other types of pathology - benign childhood neutropenia, in which the number of neutrophils that perform protective functions is sharply reduced in a child. This phenomenon is fixed, as a rule, in one-year-old children, during their first year of life, and lasts from two to three months to several years, passing by itself. Which does not exclude, of course, constant medical supervision of the child.

Symptoms

In medical practice, the symptoms of neutropenia can go unnoticed for a long time, they are clearly manifested only in an acute, already sufficiently developed stage of the disease. Typical symptoms may be:

The appearance of a plaque of pus.
Fever.
Frequently recurring infections leading to mouth sores, diarrhea, uncomfortable burning sensation during urination, and strange reddening of the skin.
Pain and swelling around the wound.
Discomfort in the throat, etc.

Since the range of such symptoms is enormous, any unusual occurrence of abnormality should immediately arouse close adult attention.

Particular attention should be paid in this regard to children. As soon as a child, especially an infant, develops strange symptoms such as those just listed in the previous section, parents should take note of it and consult a pediatrician. We must also constantly remember the specifics of the infantile form of the disease, which has its own differences compared to adults. So, babies are diagnosed with benign chronic neutropenia, which is cyclical. In this form, the number of neutrophils changes, showing low rates and reaching the norm, and vice versa. A benign variety of the disease passes by 2-3 years. Aplastic anemia is one of the most common causes of the disease in children.

Vaccinations for sickness

Vaccinations are a proven method of combating diseases of this kind. Unfortunately, adults often ignore them, considering them something unworthy of use, but this is a deep delusion, often leading to undesirable consequences. There is no need to talk about children. The whole complex of medical vaccinations necessary for them must be carried out in full, in strict accordance with the schedule for their implementation for different age categories.

Diagnostics

Since the development of the disease in practice often leads to various kinds of complications, doctors strongly do not recommend allowing it to exist spontaneously without treatment. As soon as any symptoms of the disease or strange deviations of the body from the norm are detected, it is necessary to undergo a thorough diagnostic study using highly effective equipment in order to accurately identify the causes and stage of the disease and begin its treatment. These diagnostic methods include:

Determination of the level of immunoglobulins in the blood.
Sometimes a bone marrow puncture is needed. To do this, a small sample is taken from the iliac pelvic bone.
Genetic study (in the presence of congenital abnormalities).
Carrying out a general blood test with a leukocyte formula (KLA with a formula).
Additional tests - a test for lupus, determining the level of vitamin B12.
X-ray of ENT organs, chest.

In some cases, it is possible that one will have to resort to genetic studies, bone marrow puncture and other serious laboratory tests.

Treatment

When the causes of the disease are established, treatment begins on the recommendation of the attending physician. There are many proven methods of how to treat neutropenia using a variety of therapeutic agents. Before starting treatment, the doctor puts the form and severity of this disease, since the methods of struggle will depend on this. If the cause of the disease is an infection, it is necessary to get rid of it. This can be carried out in a hospital clinic or at home, the attending physician decides. The main focus is on strengthening the immune system. Medicines used for recovery include:

Vitamins.
Antibiotics.
Immunostimulants.

In the presence of mouth ulcers, hydrogen peroxide, saline, or chlorhexidine solution are used. They are rinsing. And painkillers are suitable for pain relief.

If the disease is severe, the patient is placed in an isolated room where sterility is strictly maintained, and ultraviolet irradiation is also performed.

Treatment of neutropenia in children, in addition, will also require a lot of patience from parents, as is often the case when dealing with older patients with young patients. One must be careful with the use of various antibacterial drugs, basing the treatment solely on the advice of a professional doctor. Features of the treatment of the disease in children:

If the disease appeared against the background of the use of various drugs, its administration is stopped, and neutropenia itself does not require correction.
In a severe form of the child, it is necessary to urgently hospitalize, since various infections spread rapidly during such a course of the disease. In the hospital, the baby will be prescribed strong antibiotics, and in order for the level of neutrophilic leukocytes to stop, drugs are prescribed - growth factors.
If this disorder was caused by an allergic or autoimmune condition, the use of corticosteroids is appropriate.
All cases of illness involve the use of special drugs that increase immunity.
Sometimes a bone marrow transplant is needed. This operation is performed on children from 12 years of age.

There are also traditional medicine recipes that help to cope with this problem:

2 tbsp. l. walnut leaves pour 2.5 tbsp. boiling water, leave overnight, while the container should be well closed. You need to drink a drink for ¼ tbsp. daily. The course of therapy is one month.
250 gr. finely chop the onion, add 1 tbsp. sugar and 500 ml. water. After the mixture is put on a slow fire for 1-1.5 hours. The broth is cooled, 2 tbsp. l. honey, filtered and poured into glassware. Drink 3 times a day for 1 tbsp. l.
0.5 kg. cranberries are softened and mixed with 2-3 pcs. apples, which are pre-cut into cubes, as well as 200 gr. walnut. Next, the drug is poured into 200 ml of water and poured 500 gr. Sahara. All this is put on the stove to bring to a boil, and then poured into a container. The medicine has the consistency of jam, it is eaten with 1 tbsp of tea. per day.
2 cups of honey and 1 cup of dill are poured into 2 liters. hot water, here you should also add 1 tbsp. l. valerian root and leave in a thermos for a day. Before taking the medicine you need to strain. Infusion is recommended to drink 3 times a day for 1 tbsp. l. Be sure to keep it in the refrigerator.
You can also make a balm. To do this, take 500 gr. chopped walnut kernels, 300 gr. honey, 100 gr. aloe juice, 200 ml. vodka and 4 pcs. lemon. The resulting mixture is well shaken and placed in a dark place for a day. You need to drink this balm 3 times a day, 1 tbsp. l.

In addition to drug treatment and traditional medicine, the observance of a special diet will not interfere. Such nutrition implies the exclusion from the diet of perishable foods, as well as poorly processed ones, as they may contain harmful bacteria and microbes. For a quick recovery, you should add the following products to your menu:

Pasteurized milk, yogurt, ice cream, parmesan, mozzarella, cheddar and swiss cheese.
Pork, lamb, boiled or fried fish, beef, poultry.
Hard-boiled eggs.
Freshly prepared first courses.
Oranges, bananas, melons, tangerines, grapefruits.
The use of canned, frozen fruits and pasteurized juices is allowed.
Rice, pasta, potatoes, noodles, and they can be cooked in any form.
Cookies, pastries, bread.
Roasted nuts.

Do not forget about the need to drink 2 liters of liquid throughout the day: fruit drinks, water, juice, tea.

Prevention

The reliability of treatment is also ensured by the preventive side of the matter. When it comes to children, it is necessary to constantly monitor the reliable hygiene of the child's oral cavity, the prevention of stomatitis and other conditions that stimulate the disease of the child's body. Permanent preventive measures are fully necessary, of course, for an adult patient.

(agranulocytosis) occurs when the level of neutrophils (neutrophilic leukocytes) decreases in the blood (becomes less than 1500 in 1 μl). This leads to an increase in susceptibility to a variety of bacteria and fungi, reduces the body's resistance to infections, and reduces immunity.

This condition can act as an independent disease, as well as as a result of other pathologies or external causes that affect the human body. In this case, neutropenia is a complication of a particular disease.

Agranulocytosis is a decrease in granulocytes in the blood in general. Granulocytes are represented by neutrophils, eosinophils and basophils (all of them belong to leukocytes). Neutrophils in this list are the most numerous. Therefore, often a doctor, speaking of agranulocytosis, has in mind precisely neutropenia.

Neutrophils destroy the pathogenic flora that has entered the body, and are also sent to the focus of inflammation and try to neutralize it. Pus is the result of the destruction of microbes, it is represented by their remains and dead neutrophils.

Neutrophils are synthesized in the bone marrow, where they mature, after which they enter the blood and tissues.

The normal level of neutrophils varies from 45 to 70% of all leukocytes. Neutropenia is indicated by a decrease in the level of neutrophils less than 1.5 * 10 9 /l. Black people have fewer neutrophils in their bone marrow than white people. Therefore, their neutropenia is indicated by a drop in the number of neutrophils to 1.2 * 10 9 / l.

Severe neutropenia is extremely rare, but this condition is dangerous not only for health, but also for life. To help a person, it is necessary to clarify the cause of the decrease in the level of neutrophils.

Types and degrees of neutropenia

Depending on the rate of development, the disease can be acute, occurring over a few days, or chronic, developing over many months or years.

Dangerous for human life is only a severe acute form of neutropenia, which can occur due to a violation of the formation of neutrophils.

The norm of neutrophils in the blood is 1500/1 μl. Based on this, three degrees of neutropenia are distinguished by the number of neutrophils:

Mild neutropenia, in which the level of neutrophils drops to 1.0-1.5x10 9 /l.

Moderate neutropenia, in which the level of neutrophils decreases to 0.5-1.0x10 9 /l.

Severe neutropenia, in which the level of neutrophils falls below 500 neutrophils per microliter of blood.

In severe neutropenia, the risk of developing health complications is extremely high.

There are the following types of neutropenia:

Autoimmune. This type of neutropenia develops under the condition that antibodies begin to be produced in the body that destroy neutrophils. Such a reaction can manifest for no apparent reason, or develop with others. Children born with immunodeficiency often suffer from this type of neutropenia.

Medicinal. This type of neutropenia is most often found in adult patients. Its causes may be hidden in the body's allergic reactions to drugs. Penicillins, cephalosporins, chloramphenicol, neuroleptics, sulfonamides and anticonvulsants can provoke a drop in the level of neutrophils. After completion of the course of treatment, neutrophil counts return to normal (after 7 days).

Anticonvulsants are more likely to cause neutropenia. An allergic reaction is indicated by skin rashes and itching, and other symptoms. Be sure to cancel the drug, to which the body reacts with neutropenia. If this is not done, then a person may develop a serious immunodeficiency.

Neutropenia may manifest during chemotherapy or radiation therapy. In this case, the effect is on the bone marrow. After the start of treatment, the level of neutrophils will be markedly reduced already after 7 days. Restoration of the number of neutrophils occurs no earlier than a month later. During this period, the risk of damage to the body by various infections is high.

Infectious. Infectious neutropenia accompanies SARS and other acute infections. Most often, such neutropenia does not last long and resolves on its own after an average of 7 days. Infectious neutropenia due to HIV, sepsis and other serious diseases has a severe course. In this case, there is a failure in the production of neutrophils at the level of the bone marrow, as well as their death in the peripheral vessels.

Febrile. Febrile neutropenia develops during the treatment of tumors of the hematopoietic system with cytostatics, but sometimes it manifests itself during chemotherapy of other cancerous tumors. A severe infection develops in the body, which leads to the active growth of pathogenic flora against the background of insufficient immunity. Moreover, for a healthy person, such pathogens most often do not pose a threat to life (, streptococci, fungi, herpes virus, etc.). However, the lack of neutrophils becomes fatal for the patient. His condition deteriorates sharply, and it is difficult to identify the source of infection, since the inflammatory reaction is very weak. The immune system is simply unable to cause it.

Benign. Benign neutropenia is a chronic condition that is diagnosed in childhood. Treatment is not required. As the child grows older, the level of neutrophils returns to normal. Doctors attribute the development of such neutropenia to the immaturity of the bone marrow in children under 2 years of age.

Hereditary. Congenital neutropenia: Kostman's syndrome, cyclic neutropenia, familial benign neutropenia, lazy leukocyte syndrome.

Causes of neutropenia

Neutropenia can develop as an independent anomaly, or as a result of various blood diseases. The most common cause of neutropenia is a decrease in the formation of neutrophilic leukocytes under the influence of drugs (anticancer and anticonvulsants, penicillin, antimetabolites, etc.). Sometimes the disease is a predictable side effect of taking a number of medications, and sometimes it occurs regardless of the dosage and timing of the use of a particular medication.

In rare cases, neutropenia is a congenital anomaly. Inhibition of neutrophil production may be due to hereditary agranulocytosis, familial or cyclic neutropenia, pancreatic insufficiency, renal failure, or HIV. Also, neutropenia can be caused by bone marrow damage, cancer, or even beriberi (deficiency of vitamin B12 and folic acid).

Symptoms that indicate the development of neutropenia can be very diverse, but they all develop against the backdrop of a failure of the immune system.

Therefore, signs of neutropenia can be considered:

Ulceration in the mouth. It is possible to form plots.

Dermatological diseases.