Neutropenia

Trend in WBC

Trend in Neutrophils

Congenital Causes

- Infantile agranulocytosis- Shwachman-Diamond syndrome- Chediak-Higashi syndrome- Reticular dysgenesis.

Acquired causes Post-infectious - bacterial, parasitic, rickettsial,

and viral infections. Drug-induced neutropenia Chronic idiopathic neutropenia Autoimmune neutropenia Collagen/vascular disorders like SLE and RA Deficiencies of dietary vitamins and minerals

(eg, vitamin B12, folate, copper) Myelodysplastic syndromes and hematologic

malignancies Aplastic anemia  Paroxysmal nocturnal hemoglobinuria 

T- Cell LGL Indolent leukemia comprising of 2% to 5% of the chronic

lymphoproliferative diseases. It usually presents around 60 years, equally affecting males

and females. Disorders like rheumatoid arthritis can be associated with

LGL leukemia in 11 to 36% of the cases. There is no standard treatment for patients with LGL

leukemia. Therapy is recommended in patients with ANC < 500 or

those with ANC > 500 and recurrent symptomatic infections. Asymptomatic patients may observed and treated with

supportive measures like G-CSF as needed. Immunosuppressive therapy is the definitive treatment in

the current era, with agents like methotrexate, oral cyclophosphamide, and cyclosporine.

Cocaine induced neutropenia

Occurs due to contamination with levamisole.

Causes immune mediated destruction of the neutrophils .

Improves with cocaine abstinence.

Testing for levamisole, if needed can be done in plasma and urine.

Plasma half-life of levamisole is relatively short (5.6 h), serum testing is likely to be negative if a patient’s last exposure occurred more than 24 h. Urine testing will be positive if done within 2-3 days.

References Buchanan JA, Lavonas EJ. Agranulocytosis and other consequences

due to use of illicit cocaine contaminated with levamisole. Curr Opin Hematol. 2012;19(1):27-31.

Zhang D, Loughran TP Jr. Large granular lymphocytic leukemia: molecular pathogenesis, clinical manifestations, and treatment. Hematology Am Soc Hematol Educ Program. 2012;2012:652-9.