Neutropenia causes: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Neutropenia}} | {{Neutropenia}} | ||
{{CMG}} | {{CMG}}; {{AE}} {{Ochuko}}, {{DG}} | ||
==Overview== | ==Overview== | ||
[[Neutropenia]] may be caused by [[drugs]], [[cancer]], [[radiation]], [[vitamin B12 deficiency]] or [[folate deficiency]]. Marginalization and sequestration of neutrophils also can cause neutropenia following procedures such as [[hemodialysis]]. | |||
==Causes== | ==Causes== | ||
The most common etiologies are constitutional or benign ethnic neutropenia (BEN) and drug-induced [[neutropenia]]. | |||
[[Malignancy]] is often associated with neutropenia, due to impaired production from [[myelodysplastic syndromes]] and hematological malignancies with [[bone marrow]] infiltration, [[hemolysis]] and impaired production from [[cytotoxic]] [[chemotherapy]], and [[antibody]]-mediated destruction of neutrophils. | |||
Alternative etiologies include post-infectious neutropenia resulting from [[bacterial]], [[fungal]], or [[viral]] [[infections]]. While bacterial infections typically cause [[leukocytosis]], [[Salmonella enterica|salmonella]], [[shigella enteritis]], [[brucellosis]], [[tularemia]], [[tuberculosis]], and [[rickettsial disease]]s, such as [[Rocky Mountain spotted fever]] can present with neutropenia.<ref name="PMID9311642">{{cite journal |author=James J, Dutta TK, Jayanthi S.|title=Correlation of clinical and hematologic profiles with bone marrow responses in typhoid fever. |journal=Am J Trop Med Hyg. |volume=57|issue=3 |pages=313-6 |year=1997|pmid 9311642|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=9311642}}</ref> <ref name="PMID7068229">{{cite journal |author=Fried D, Maytal J, Hanukoglu A.|title=The differential leukocyte count in shigellosis. |journal=Infection. |volume=10|issue=1 |pages=13-4 |year=1982|pmid 7068229|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=7068229}}</ref> <ref name="PMID8449576">{{cite journal |author=al-Eissa Y, al-Nasser M.|title=Haematological manifestations of childhood brucellosis. |journal=Infection. |volume=21|issue=1 |pages=23-6 |year=1993|pmid 8449576|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=8449576}}</ref> <ref name="PMID3710592">{{cite journal |author=Syrjälä H.|title=Peripheral blood leukocyte counts, erythrocyte sedimentation rate and C-reactive protein in tularemia caused by the type B strain of Francisella tularensis. |journal=Infection. |volume=14|issue=2 |pages=51-4 |year=1986|pmid 3710592|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=3710592}}</ref> <ref name="PMID286884">{{cite journal |author=Hall GW, Schwartz RP. |title=White blood cell count and differential in Rocky Mountain spotted fever. |journal=N C Med J. |volume=40|issue=4 |pages=212-4 |year=1979|pmid 286884|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=286884}}</ref> | |||
[[Parasitic]] diseases with neutropenia include [[leishmaniasis]] with [[hemolysis]] and splenic sequestration and [[malaria]] due to hyperreactive [[malarial]] [[splenomegaly]] (HMS).<ref name="PMID4575057">{{cite journal |author=Dale DC, Wolff SM. |title=Studies of the neutropenia of acute malaria. |journal=Blood. |volume=41|issue=2 |pages=197-206 |year=1973|pmid 4575057|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=4575057}}</ref> [[Viral]] etiologies include [[HIV]], [[EBV]], [[CMV]], HHV-6, viral [[hepatitis]], [[dengue fever]], [[yellow fever]], [[measles]], [[varicella]], and [[rubella]].<ref name="PMID6318560">{{cite journal |author=Schooley RT, Densen P, Harmon D, Felsenstein D, Hirsch MS, Henle W, Weitzman S. |title=Antineutrophil antibodies in infectious mononucleosis. |journal=Am J Med. |volume=76|issue=1 |pages=85-90 |year=1984 |pmid 6318560|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=6318560}}</ref> | |||
[[Immunodeficiencies]] are frequently associated with neutropenia (38% in [[Hyper IgM syndrome]], 12% in [[CVID]], and 7% in [[X-linked agammaglobulinemia]]) as are [[autoimmune disorders]] including up to 50% of patients with systemic [[lupus erythematosus]], yet with lower overall prevalence. While [[rheumatoid arthritis]] infrequently presents with neutropenia, severe neutropenia can develop in the setting of [[large granular lymphocyte]] (LGL) leukemia or [[Felty's syndrome]].<ref name="PMID6979979">{{cite journal |author=Bucknall RC, Davis P, Bacon PA, Jones JV |title=Neutropenia in rheumatoid arthritis: studies on possible contributing factors |journal=Ann Rheum Dis. |volume=41 |issue=3 |pages=242-7 |year=2009 |pmid=6979979 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed?term=6979979}}</ref> | |||
Finally, nutritional deficiencies resulting in neutropenia are typically attributed to [[vitamin B12]], [[folate]], and [[copper]] and are related to inadequate dietary intake, [[pernicious anemia]], [[bariatric surgery]], and malabsorptive syndromes. | |||
===Life Threatening Causes=== | ===Life Threatening Causes=== | ||
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. | ||
=== Common Causes === | === Common Causes === | ||
* [[Aplastic anemia]] | |||
* [[Cancer]] | |||
* [[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]] | * [[List of chemotherapeutic agents#Cytotoxic Chemotherapy|Cytotoxic chemotherapy]] | ||
* [[Hemodialysis]] | |||
* [[Medications]]<ref name="PMID17142169">{{cite journal |author=Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. |title=Idiosyncratic drug-induced agranulocytosis: Update of an old disorder. |journal=Eur J Intern Med. |volume=17|issue=8 |pages=529-35 |year=2006|pmid 17142169|doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/17142169}}</ref> | |||
* [[Radiation therapy]] | |||
* [[avitaminosis|Vitamin deficiencies e.g. folate, Vitamin B12]] | |||
=== Causes by Organ System === | === Causes by Organ System === | ||
{|style="width:80%; height:100px" border="1" | {|style="width:80%; height:100px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular''' | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Chemical / poisoning''' | | '''Chemical / poisoning''' | ||
|bgcolor="Beige"|[[Arsenic trioxide]], [[gold salts]], [[strontium-89]] | |bgcolor="Beige"|[[Arsenic trioxide]], [[gold salts]], [[strontium|strontium-89]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Drug Side Effect''' | | '''Drug Side Effect''' | ||
|bgcolor="Beige"| [[5-azacytidine]], [[acetophenazine]], [[aclarubicin]], [[actinomycin D]], [[aflibercept]] | |bgcolor="Beige"| [[5-azacytidine]], [[acetophenazine]], [[aclarubicin]], [[actinomycin D]], [[acyclovir]], [[aflibercept]], [[albendazole]], [[alemtuzumab]], [[allopurinol]], [[amantadine]], [[amiloride]], [[aminoglutethimide]], [[aminoglutethimide]], [[aminopyrine]], [[amiodarone]],[[amodiaquine]], [[ampicillin]], [[amsacrine]], [[anakinra]], [[anidulafungin]], [[anti-thymocyte globulin]], [[antibiotics]], [[antipyrine]], [[aprepitant]], [[aripiprazole]], [[arsenic trioxide]], [[asenapine]], [[atazanavir]], [[atovaquone]], [[auranofin]], [[azacitidine]], [[azathioprine]], [[aztreonam]], [[barbiturates]], [[belinostat]], [[benazepril]], [[bendamustine]], [[bevacizumab]], [[blinatumomab]], [[boceprevir]], [[bortezomib]], [[bosutinib]], [[brentuximab]], [[busulfan]], [[cabazitaxel]], [[cabozantinib]], [[canakinumab]], [[candesartan]], [[capecitabine]], [[captopril]], [[carbimazole]], [[carboplatin]], [[carfilzomib]], [[carmustine]], [[cefaclor]], [[cefadroxil]], [[cefazolin]], [[cefepime]], [[cefixime]], [[cefoperazone]], [[cefotetan]], [[cefotiam]], [[cefoxitin]], [[ceftaroline]], [[ceftriaxone]], [[cefuroxime]], [[cephalexin]], [[cephapirin]], [[cephradine]], [[cetuximab]], [[chemotherapy]], [[chlorambucil]], [[chloramphenicol]], [[chloroquine]], [[chlorpromazine]], [[chlorthalidone]], [[cidofovir]], [[cilazapril]], [[cimetidine]], [[cisplatin]], [[cladribine]], [[clarithromycin]], [[clindamycin]], [[clofarabine]], [[clopidogrel]], [[clozapine]], [[colchicine]], [[crizotinib]], [[cromolyn]], [[cyclophosphamide]], [[cytarabine]], [[cytosine arabinoside]], [[dabrafenib]],[[dacarbazine]], [[daclatasvir]], [[dactinomycin]], [[dasatinib]], [[daunorubicin]], [[decitabine]], [[deferasirox]], [[deferiprone]], [[delavirdine]], [[desipramine]], [[dexrazoxane]], [[diatrizoate]], [[diazepam]], [[diazoxide]], [[dicloxacillin]], [[Diethylpropion]][[diflunisal]], [[dipyrone]], [[docetaxel]], [[dolutegravir]], [[doripenem]], [[dothiepin]], [[doxorubicin]], [[doxycycline]], [[efavirenz]], [[eflornithine]], [[elvitegravir]], [[enalapril]], [[enalaprilat]], [[enfuvirtide]], [[enzalutamide]], [[epirubicin]], [[eprosartan]], [[eribulin]], [[etanercept]], [[ethacrynic acid]], [[ethambutol]], [[ethosuximide]], [[ethotoin]], [[etodolac]], [[etoposide]], [[everolimus]], [[felbamate]], [[fentanyl]], [[fidaxomicin]], [[flucytosine]], [[fludarabine]], [[fluorouracil]], [[fluoxetine]], [[fosamprenavir]], [[foscarnet]], [[fosinopril]], [[ganciclovir]], [[gefitinib]], [[gemcitabine]], [[gemifloxacin mesylate]], [[glyburide]], [[golimumab]], [[griseofulvin]], [[guanidinium]], [[haloperidol]], [[hydroxycarbamide]], [[hydroxyurea]], [[ibuprofen lysine]], [[ibritumomab tiuxetan]], [[ibrutinib]], [[ibuprofen]], [[idarubicin]], [[idelalisib]], [[iloperidone]], [[imatinib]], [[imipenem cilastatin]], [[indinavir]], [[indomethacin]], [[infliximab]], [[interferon alfa-2a]], [[interferon alfa-2b]], [[interferon alfacon-1]], [[interferon beta-1b]], [[irinotecan]], [[isoniazid]], [[isotretinoin]], [[itraconazole]], [[ixabepilone]], [[lamivudine]], [[lamotrigine]], [[lansoprazole]], [[lenalidomide]], [[levamisole]], [[levetiracetam]], [[levomepromazine]], [[lincomycin]], [[linezolid]], [[lisinopril]], [[loxapine]], [[lurasidone]], [[maprotiline]], [[maraviroc]], [[meclofenamate]], [[mercaptopurine]], [[meropenem]], [[mesalamine]], [[methazolamide]], [[methimazole]], [[methotrexate]], [[methyldopa]], [[metolazone]], [[mexiletine]], [[mianserin]], [[micafungin]], [[mifamurtide]], [[milnacipran]], [[minocycline]], [[mirtazapine]], [[mitotane]], [[mitoxantrone]], [[moexipril]], [[moxalactam]], [[mycophenolate]], [[mycophenolic acid]], [[nafcillin]], [[naproxen]], [[nefazodone]], [[nelarabine]], [[nelfinavir]], [[nevirapine]], [[nilotinib]], [[nilutamide]], [[norfloxacin]], [[nortriptyline]], [[obinutuzumab]], [[ofatumumab]], [[ofloxacin]], [[olanzapine]], [[olaparib]], [[olsalazine]],[[omacetaxine]], [[omeprazole]], [[oprelvekin]], [[oxacillin]], [[oxaliplatin]], [[paclitaxel]], [[palbociclib]], [[paliperidone]], [[panobinostat]], [[pantoprazole]], [[pazopanib]], [[peginterferon alfa-2a]], [[peginterferon alfa-2b]], [[pemetrexed]], [[penicillamine]], [[penicillin]], [[penicillin G]], [[pentamidine]], [[pentostatin]], [[peramivir]], [[perazine]], [[perindopril]], [[pertuzumab]], [[phenylbutazone]], [[phenytoin]], [[piperacillin]], [[piperaquine]], [[pipothiazine]], [[piroxicam]], [[pixantrone]], [[pomalidomide]], [[ponatinib]], [[posaconazole]], [[pralatrexate]], [[prednisone]], [[probenecid]], [[procainamide]], [[procarbazine]], [[prochlorperazine]], [[proguanil]], [[propylthiouracil]], [[pyrimethamine]], [[quetiapine]], [[quinapril]], [[quinidine]], [[quinine]], [[radium chloride]], [[raltitrexed]], [[ramipril]], [[ramucirumab]], [[ranitidine]], [[rasagiline]], [[rasburicase]], [[regorafenib]], [[remoxipride]], [[ribavirin]], [[rifabutin]], [[rifapentine]], [[rifaximin]], [[rilonacept]], [[riluzole]], [[risperidone]], [[ritodrine]], [[ritonavir]], [[rituximab]], [[romidepsin]], [[ruxolitinib]], [[saquinavir]], [[satraplatin]], [[secukinumab]], [[sirolimus]], [[sodium aurothiomalate]], [[sofosbuvir]], [[sorafenib]], [[stavudine]], [[stiripentol]], [[succimer]], [[Sulfacetamide]], [[Sulfamethoxazole/Trimethoprim (oral)]], | ||
[[sulfasalazine]], [[sulfonamide]], [[sulindac]], [[sunitinib]], [[suramin]], [[tacrolimus]], [[tedizolid]], [[teicoplanin]], [[temozolomide]], [[temsirolimus]], [[teniposide]], [[tenofovir]], [[terbinafine]], [[teriflunomide]], [[thalidomide]], [[thiothixene]], [[ticarcillin]], [[ticlopidine]], [[tipranavir]], [[tocilizumab]], [[tofacitinib]], [[tolazamide]], [[tolmetin]], [[topotecan]], [[tositumomab]], [[trabectedin]], [[trametinib]], [[trandolapril]], [[trastuzumab]], [[trimethadione]], [[trimethoprim]], [[trimetrexate]], [[valganciclovir]], [[valproic acid]], [[valrubicin]], [[valsartan]], [[vancomycin]], [[vandetanib]], [[vesnarinone]], [[vincristine]], [[vindesine]], [[vinflunine]], [[vinorelbine]], [[zidovudine]], [[zileuton]], [[ziprasidone]], [[ziv-aflibercept]], [[zoledronic acid]] | |||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
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|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Musculoskeletal / Ortho''' | | '''Musculoskeletal / Ortho''' | ||
|bgcolor="Beige"|[[Cartilage-hair hypoplasia]], metaphyseal chondrodysplasia, Mckusick type | |bgcolor="Beige"|[[Cartilage-hair hypoplasia]], [[metaphyseal chondrodysplasia, Mckusick type]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| Line 117: | Line 123: | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| '''Rheum / Immune / Allergy''' | | '''Rheum / Immune / Allergy''' | ||
|bgcolor="Beige"| Alloimmune neonatal neutropenia, alloimmune neutropenia in infancy, [[autoimmune lymphoproliferative syndrome type 1]], [[ | |bgcolor="Beige"| Alloimmune neonatal neutropenia, alloimmune neutropenia in infancy, [[autoimmune lymphoproliferative syndrome type 1]], [[autoimmune lymphoproliferative syndrome type 2]], [[neutropenia|autoimmune neutropenia]], [[common variable immune deficiency]], [[Felty's syndrome]], [[histiocytosis X]], [[hyper-immunoglobulin M syndrome]], [[lupus]], [[rheumatoid arthritis]], [[neutropenia|secondary autoimmune neutropenia]], [[WHIM syndrome]], [[x-linked agammaglobulinemia]], [[x-linked hyperimmunoglobulin M syndrome]] | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |-bgcolor="LightSteelBlue" | ||
| Line 142: | Line 148: | ||
=== Causes in Alphabetical Order === | === Causes in Alphabetical Order === | ||
{{columns-list | {{columns-list| | ||
* [[5-azacytidine]] | * [[5-azacytidine]] | ||
* [[Acetophenazine]] | * [[Acetophenazine]] | ||
| Line 168: | Line 174: | ||
* [[Antibiotics]] | * [[Antibiotics]] | ||
* [[Antipyrine]] | * [[Antipyrine]] | ||
* [[ | * [[Anti-thymocyte globulin]] | ||
* [[Aplastic anemia]] | * [[Aplastic anemia]] | ||
* [[Aprepitant]] | * [[Aprepitant]] | ||
| Line 179: | Line 185: | ||
* [[Autoimmune lymphoproliferative syndrome type 1]] | * [[Autoimmune lymphoproliferative syndrome type 1]] | ||
* [[Autoimmune lymphoproliferative syndrome type 2]] | * [[Autoimmune lymphoproliferative syndrome type 2]] | ||
* [[Autoimmune neutropenia]] | * [[neutropenia|Autoimmune neutropenia]] | ||
* [[Azacitidine]] | * [[Azacitidine]] | ||
* [[Azathioprine]] | * [[Azathioprine]] | ||
| Line 301: | Line 307: | ||
* [[Familial histiocytic reticulosis]] | * [[Familial histiocytic reticulosis]] | ||
* [[Fanconi syndrome]] | * [[Fanconi syndrome]] | ||
* [[Felty syndrome]] | * [[Felty's syndrome]] | ||
* [[Fentanyl]] | * [[Fentanyl]] | ||
* [[Fidaxomicin]] | * [[Fidaxomicin]] | ||
| Line 319: | Line 325: | ||
* [[Glyburide]] | * [[Glyburide]] | ||
* [[Glycogen storage disorder]] | * [[Glycogen storage disorder]] | ||
* [[Glycogenosis type 1b]] | * [[glycogen storage disease type I|Glycogenosis type 1b]] | ||
* [[Gold salts]] | * [[Gold salts]] | ||
* [[Golimumab]] | * [[Golimumab]] | ||
| Line 327: | Line 333: | ||
* [[Hairy cell leukemia]] | * [[Hairy cell leukemia]] | ||
* [[Haloperidol]] | * [[Haloperidol]] | ||
* [[Hemodialysis]] | |||
* [[Hepatitis]] | * [[Hepatitis]] | ||
* [[Hepatitis A]] | * [[Hepatitis A]] | ||
* [[Hepatitis B]] | * [[Hepatitis B]] | ||
* [[Hepatitis C]] | * [[Hepatitis C]] | ||
* [[Hereditary orotic aciduria]] | * [[orotic aciduria|Hereditary orotic aciduria]] | ||
* [[Hermansky-Pudlak syndrome]] | * [[Hermansky-Pudlak syndrome]] | ||
* [[Histiocytosis X]] | * [[Histiocytosis X]] | ||
| Line 345: | Line 352: | ||
* [[Ibrutinib]] | * [[Ibrutinib]] | ||
* [[Ibuprofen]] | * [[Ibuprofen]] | ||
* [[Ibuprofen lysine]] | |||
* [[Idarubicin]] | * [[Idarubicin]] | ||
* [[Idelalisib]] | * [[Idelalisib]] | ||
| Line 389: | Line 397: | ||
* [[Meropenem]] | * [[Meropenem]] | ||
* [[Mesalamine]] | * [[Mesalamine]] | ||
*Metaphyseal chondrodysplasia, Mckusick type | * [[Metaphyseal chondrodysplasia, Mckusick type]] | ||
* [[Methazolamide]] | * [[Methazolamide]] | ||
* [[Methimazole]] | * [[Methimazole]] | ||
| Line 427: | Line 435: | ||
* [[Olanzapine]] | * [[Olanzapine]] | ||
* [[Olaparib]] | * [[Olaparib]] | ||
* [[Olsalazine]] | |||
* [[Omacetaxine]] | * [[Omacetaxine]] | ||
* [[Omeprazole]] | * [[Omeprazole]] | ||
| Line 497: | Line 506: | ||
* [[Rifaximin]] | * [[Rifaximin]] | ||
* [[Rilonacept]] | * [[Rilonacept]] | ||
* [[Riluzole]] | |||
* [[Risperidone]] | * [[Risperidone]] | ||
* [[Ritodrine]] | * [[Ritodrine]] | ||
| Line 508: | Line 518: | ||
* [[Saquinavir]] | * [[Saquinavir]] | ||
* [[Satraplatin]] | * [[Satraplatin]] | ||
* [[Secondary autoimmune neutropenia]] | * [[neutropenia|Secondary autoimmune neutropenia]] | ||
* [[Secukinumab]] | * [[Secukinumab]] | ||
* [[Sepsis]] | * [[Sepsis]] | ||
| Line 515: | Line 525: | ||
* [[Shwachman-Diamond syndrome]] | * [[Shwachman-Diamond syndrome]] | ||
* [[Sirolimus]] | * [[Sirolimus]] | ||
* [[Sodium aurothiomalate]] | |||
* [[Sofosbuvir]] | * [[Sofosbuvir]] | ||
* [[Sorafenib]] | * [[Sorafenib]] | ||
| Line 542: | Line 553: | ||
* [[Tocilizumab]] | * [[Tocilizumab]] | ||
* [[Tofacitinib]] | * [[Tofacitinib]] | ||
* [[Tolazamide]] | |||
* [[Tolmetin]] | |||
* [[Topotecan]] | * [[Topotecan]] | ||
* [[Tositumomab]] | * [[Tositumomab]] | ||
| Line 548: | Line 561: | ||
* [[Trandolapril]] | * [[Trandolapril]] | ||
* [[Trastuzumab]] | * [[Trastuzumab]] | ||
* [[Trimethadione]] | |||
* [[Trimethoprim]] | * [[Trimethoprim]] | ||
* [[Trimetrexate]] | * [[Trimetrexate]] | ||
| Line 579: | Line 593: | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Crowdiagnosis]] | [[Category:Crowdiagnosis]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 22:08, 10 January 2020
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Neutropenia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Neutropenia causes On the Web |
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American Roentgen Ray Society Images of Neutropenia causes |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2], Daniel A. Gerber, M.D. [3]
Overview
Neutropenia may be caused by drugs, cancer, radiation, vitamin B12 deficiency or folate deficiency. Marginalization and sequestration of neutrophils also can cause neutropenia following procedures such as hemodialysis.
Causes
The most common etiologies are constitutional or benign ethnic neutropenia (BEN) and drug-induced neutropenia.
Malignancy is often associated with neutropenia, due to impaired production from myelodysplastic syndromes and hematological malignancies with bone marrow infiltration, hemolysis and impaired production from cytotoxic chemotherapy, and antibody-mediated destruction of neutrophils.
Alternative etiologies include post-infectious neutropenia resulting from bacterial, fungal, or viral infections. While bacterial infections typically cause leukocytosis, salmonella, shigella enteritis, brucellosis, tularemia, tuberculosis, and rickettsial diseases, such as Rocky Mountain spotted fever can present with neutropenia.[1] [2] [3] [4] [5]
Parasitic diseases with neutropenia include leishmaniasis with hemolysis and splenic sequestration and malaria due to hyperreactive malarial splenomegaly (HMS).[6] Viral etiologies include HIV, EBV, CMV, HHV-6, viral hepatitis, dengue fever, yellow fever, measles, varicella, and rubella.[7]
Immunodeficiencies are frequently associated with neutropenia (38% in Hyper IgM syndrome, 12% in CVID, and 7% in X-linked agammaglobulinemia) as are autoimmune disorders including up to 50% of patients with systemic lupus erythematosus, yet with lower overall prevalence. While rheumatoid arthritis infrequently presents with neutropenia, severe neutropenia can develop in the setting of large granular lymphocyte (LGL) leukemia or Felty's syndrome.[8]
Finally, nutritional deficiencies resulting in neutropenia are typically attributed to vitamin B12, folate, and copper and are related to inadequate dietary intake, pernicious anemia, bariatric surgery, and malabsorptive syndromes.
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Common Causes
- Aplastic anemia
- Cancer
- Cytotoxic chemotherapy
- Hemodialysis
- Medications[9]
- Radiation therapy
- Vitamin deficiencies e.g. folate, Vitamin B12
Causes by Organ System
Causes in Alphabetical Order
- 5-azacytidine
- Acetophenazine
- Aclarubicin
- Actinomycin D
- Acyclovir
- Aflibercept
- Albendazole
- Alcoholism
- Alemtuzumab
- Alloimmune neonatal neutropenia
- Alloimmune neutropenia in infancy
- Allopurinol
- Amantadine
- Amiloride
- Aminoglutethimide
- Aminopyrine
- Amiodarone
- Amitriptyline
- Amodiaquine
- Ampicillin
- Amsacrine
- Anakinra
- Anidulafungin
- Antibiotics
- Antipyrine
- Anti-thymocyte globulin
- Aplastic anemia
- Aprepitant
- Aripiprazole
- Arsenic trioxide
- Asenapine
- Atazanavir
- Atovaquone
- Auranofin
- Autoimmune lymphoproliferative syndrome type 1
- Autoimmune lymphoproliferative syndrome type 2
- Autoimmune neutropenia
- Azacitidine
- Azathioprine
- Aztreonam
- Barbiturates
- Barth syndrome
- Belinostat
- Benazepril
- Bendamustine
- Bevacizumab
- Blinatumomab
- Boceprevir
- Bortezomib
- Bosutinib
- Brentuximab vedotin
- Brucellosis
- Busulfan
- Cabazitaxel
- Cabozantinib
- Canakinumab
- Candesartan
- Capecitabine
- Captopril
- Carbimazole
- Carboplatin
- Carfilzomib
- Carmustine
- Cartilage-hair hypoplasia
- Caspofungin
- Cefaclor
- Cefadroxil
- Cefazolin
- Cefepime
- Cefixime
- Cefoperazone
- Cefotetan
- Cefotiam
- Cefoxitin
- Ceftaroline
- Ceftriaxone
- Cefuroxime
- Cephalexin
- Cephapirin
- Cephradine
- Cetuximab
- Chediak-Higashi disease
- Chemotherapy
- Chlorambucil
- Chloroquine
- Chlorpromazine
- Chlorthalidone
- Chronic lymphocytic leukemia
- Cidofovir
- Cilazapril
- Cimetidine
- Cisplatin
- Cladribine
- Clarithromycin
- Clindamycin
- Clofarabine
- Clofarabine
- Clopidogrel
- Clozapine
- Cohen syndrome
- Colchicine
- Common variable immune deficiency
- Copper deficiency
- Crizotinib
- Cyclical neutropenia
- Cyclophosphamide
- Cytarabine
- Cytomegalovirus
- Cytosine arabinoside
- Dabrafenib
- Dacarbazine
- Daclatasvir
- Dactinomycin
- Dasatinib
- Daunorubicin
- Decitabine
- Deferasirox
- Deferiprone
- Delavirdine
- Dengue
- Desipramine
- Dexrazoxane
- Diatrizoate
- Diazepam
- Diazoxide
- Dicloxacillin
- Diflunisal
- Dipyrone
- Docetaxel
- Dolutegravir
- Doripenem
- Dothiepin
- Doxorubicin
- Doxycycline
- Dubowitz syndrome
- Dyskeratosis congenita, X-linked
- Efavirenz
- Eflornithine
- Elejalde syndrome
- Elvitegravir
- Enalapril
- Enalaprilat
- Enfuvirtide
- Enzalutamide
- Epirubicin
- Eprosartan
- Epstein-Barr virus
- Eribulin
- Etanercept
- Ethacrynic acid
- Ethambutol
- Ethosuximide
- Ethotoin
- Etodolac
- Etoposide
- Everolimus
- Familial histiocytic reticulosis
- Fanconi syndrome
- Felty's syndrome
- Fentanyl
- Fidaxomicin
- Flucytosine
- Fludarabine
- Fluorouracil
- Fluoxetine
- Fosamprenavir
- Foscarnet
- Fosinopril
- Fumarate hydratase deficiency
- Ganciclovir
- Gefitinib
- Gemcitabine
- Gemtuzumab ozogamicin
- Glutathione synthase deficiency
- Glyburide
- Glycogen storage disorder
- Glycogenosis type 1b
- Gold salts
- Golimumab
- Griscelli syndrome type 1
- Griseofulvin
- Guanidinium
- Hairy cell leukemia
- Haloperidol
- Hemodialysis
- Hepatitis
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hereditary orotic aciduria
- Hermansky-Pudlak syndrome
- Histiocytosis X
- Human granulocytic ehrlichiosis
- Human immunodeficiency virus
- Human monocytotropic ehrlichiosis
- Hydroxycarbamide
- Hydroxyurea
- Hyper-immunoglobulin M syndrome
- Hypersplenism
- Hyperthyroidism
- Ibritumomab
- Ibrutinib
- Ibuprofen
- Ibuprofen lysine
- Idarubicin
- Idelalisib
- Iloperidone
- Imatinib
- Imipenem cilastatin
- Indinavir
- Indomethacin
- Infliximab
- Interferon alfa-2a
- Interferon alfa-2b
- Interferon alfacon-1
- Interferon beta-1b
- Irinotecan
- Isoniazid
- Isotretinoin
- Isovaleric acidemia
- Itraconazole
- Ixabepilone
- Kala azar
- Kostmann disease
- Lamivudine
- Lamotrigine
- Lansoprazole
- Lassa fever
- Lenalidomide
- Leukemia
- Levamisole
- Levetiracetam
- Levomepromazine
- Lincomycin
- Linezolid
- Lisinopril
- Loxapine
- Lupus
- Lurasidone
- Lyme disease
- Malaria
- Maprotiline
- Maraviroc
- Measles
- Meclofenamate
- Mercaptopurine
- Meropenem
- Mesalamine
- Metaphyseal chondrodysplasia, Mckusick type
- Methazolamide
- Methimazole
- Methotrexate
- Methyldopa
- Methylmalonic aciduria
- Metolazone
- Mexiletine
- Mianserin
- Micafungin
- Mifamurtide
- Milnacipran
- Minocycline
- Mirtazapine
- Mitotane
- Mitoxantrone
- Moexipril
- Moxalactam
- Mycophenolate
- Mycophenolic acid
- Myelodysplastic syndrome
- Myelofibrosis
- Myelokathexis
- Nafcillin
- Naproxen
- Nefazodone
- Nelarabine
- Nelfinavir
- Nevirapine
- Nilotinib
- Nilutamide
- Norfloxacin
- Nortriptyline
- Obinutuzumab
- Ofatumumab
- Ofloxacin
- Olanzapine
- Olaparib
- Olsalazine
- Omacetaxine
- Omeprazole
- Oprelvekin
- Oxacillin
- Oxaliplatin
- Paclitaxel
- Palbociclib
- Paliperidone
- Pancytopenia
- Panobinostat
- Pantoprazole
- Paroxysmal nocturnal haemoglobinuria
- Pazopanib
- Peginterferon alfa-2a
- Peginterferon alfa-2b
- Pemetrexed
- Penicillamine
- Penicillin
- Penicillin G
- Pentamidine
- Pentostatin
- Peramivir
- Perazine
- Perindopril
- Pertuzumab
- Phenylbutazone
- Phenytoin
- Piperacillin
- Piperaquine
- Pipothiazine
- Piroxicam
- Pixantrone
- Pomalidomide
- Ponatinib
- Posaconazole
- Pralatrexate
- Prednisone
- Probenecid
- Procainamide
- Procarbazine
- Prochlorperazine
- Proguanil
- Propionic acidemia
- Propionyl-CoA carboxylase deficiency PCCA type
- Propylthiouracil
- Pyrimethamine
- Quetiapine
- Quinapril
- Quinidine
- Quinine
- Radiation therapy
- Radium chloride
- Raltitrexed
- Ramipril
- Ramucirumab
- Ranitidine
- Rasagiline
- Rasburicase
- Regorafenib
- Remoxipride
- Reticular dysgenesis
- Reticular dysplasia
- Rheumatoid arthritis
- Ribavirin
- Rickettsiae
- Rickettsial infections
- Rifabutin
- Rifapentine
- Rifaximin
- Rilonacept
- Riluzole
- Risperidone
- Ritodrine
- Ritonavir
- Rituximab
- Rocky mountain spotted fever
- Romidepsin
- Rubella
- Ruxolitinib
- Salmonella infection
- Saquinavir
- Satraplatin
- Secondary autoimmune neutropenia
- Secukinumab
- Sepsis
- Severe acute respiratory syndrome
- Shigellosis
- Shwachman-Diamond syndrome
- Sirolimus
- Sodium aurothiomalate
- Sofosbuvir
- Sorafenib
- Stavudine
- Stiripentol
- Strontium-89
- Succimer
- Sulfasalazine
- Sulfonamide
- Sulindac
- Sunitinib
- Suramin
- Tacrolimus
- Tedizolid
- Teicoplanin
- Temozolomide
- Temsirolimus
- Teniposide
- Tenofovir
- Terbinafine
- Teriflunomide
- Thalidomide
- Thiothixene
- Ticarcillin
- Ticlopidine
- Tipranavir
- Tocilizumab
- Tofacitinib
- Tolazamide
- Tolmetin
- Topotecan
- Tositumomab
- Trabectedin
- Trametinib
- Trandolapril
- Trastuzumab
- Trimethadione
- Trimethoprim
- Trimetrexate
- Tuberculosis
- Tularemia
- Valganciclovir
- Valproic acid
- Valrubicin
- Valsartan
- Vancomycin
- Vandetanib
- Varicella
- Vesnarinone
- Vincristine
- Vindesine
- Vinflunine
- Vinorelbine
- Visceral leishmaniasis
- Vitamin deficiencies
- WHIM syndrome
- X-linked agammaglobulinemia
- X-linked hyperimmunoglobulin M syndrome
- Zidovudine
- Zileuton
- Ziprasidone
- ziv-aflibercept
- Zoledronic acid
References
- ↑ James J, Dutta TK, Jayanthi S. (1997). "Correlation of clinical and hematologic profiles with bone marrow responses in typhoid fever". Am J Trop Med Hyg. 57 (3): 313–6. Text "pmid 9311642" ignored (help)
- ↑ Fried D, Maytal J, Hanukoglu A. (1982). "The differential leukocyte count in shigellosis". Infection. 10 (1): 13–4. Text "pmid 7068229" ignored (help)
- ↑ al-Eissa Y, al-Nasser M. (1993). "Haematological manifestations of childhood brucellosis". Infection. 21 (1): 23–6. Text "pmid 8449576" ignored (help)
- ↑ Syrjälä H. (1986). "Peripheral blood leukocyte counts, erythrocyte sedimentation rate and C-reactive protein in tularemia caused by the type B strain of Francisella tularensis". Infection. 14 (2): 51–4. Text "pmid 3710592" ignored (help)
- ↑ Hall GW, Schwartz RP. (1979). "White blood cell count and differential in Rocky Mountain spotted fever". N C Med J. 40 (4): 212–4. Text "pmid 286884" ignored (help)
- ↑ Dale DC, Wolff SM. (1973). "Studies of the neutropenia of acute malaria". Blood. 41 (2): 197–206. Text "pmid 4575057" ignored (help)
- ↑ Schooley RT, Densen P, Harmon D, Felsenstein D, Hirsch MS, Henle W, Weitzman S. (1984). "Antineutrophil antibodies in infectious mononucleosis". Am J Med. 76 (1): 85–90. Text "pmid 6318560" ignored (help)
- ↑ Bucknall RC, Davis P, Bacon PA, Jones JV (2009). "Neutropenia in rheumatoid arthritis: studies on possible contributing factors". Ann Rheum Dis. 41 (3): 242–7. PMID 6979979.
- ↑ Andrès E, Zimmer J, Affenberger S, Federici L, Alt M, Maloisel F. (2006). "Idiosyncratic drug-induced agranulocytosis: Update of an old disorder". Eur J Intern Med. 17 (8): 529–35. Text "pmid 17142169" ignored (help)