|
|
| Line 4: |
Line 4: |
|
| |
|
| ==Overview== | | ==Overview== |
| Various mechanisms and factors come to play with respect to the causes of neutropenia which could arise from decreased production of [[neutrophils]] in the bone marrow; commonly from drugs, cancer, radiation and [[vitamin B12 deficiency]] or [[folate deficiency]] or could be caused by increased destruction (for example from [[aplastic anemia]] and [[chemotherapy]]. Marginalisation and sequestration of neutrophils also cause neutropenia following procedures such as [[hemodialysis]].
| | 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. | | The most common etiologies are constitutional or benign ethnic neutropenia (BEN) and drug-induced neutropenia. |
|
| |
|
| BEN is more often seen in blacks, Yemenites, West Indians, and Arab Jordanians with up to 4.5% prevalence in these populations <ref name="pmid17404350">{{cite journal |author=Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP |title=Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences |journal=Ann. Intern. Med. |volume=146 |issue=7 |pages=486-92 |year=2007 |pmid=17404350 |doi=|url=http://www.annals.org/cgi/content/abstract/146/7/486}}</ref>. In these individuals, a mutation in the Duffy antigen gene - a gene which encodes a red blood cell receptor used by [[malaria]] to enter these cells - both confers a protective effect against this parasite and, for unclear reasons, lowers the circulating neutrophil count. While quite common, the neutropenia is typically mild (ANC 1,000-1500 cells/microliter) and does not predispose to increased risk of infection or increased risk of febrile neutropenia in the setting of chemotherapy as these individuals have normal bone marrow neutrophil reserves
| | 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. |
| <ref name="PMID3181399">{{cite journal |author=Shoenfeld Y, Alkan ML, Asaly A, Carmeli Y, Katz M |title=Benign familial leukopenia and neutropenia in different ethnic groups |journal=Eur J Haematol. |volume=41 |issue=3 |pages=273-7 |year=1988 |pmid=3181399 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/3181399}}</ref>
| |
| <ref name="PMID4027348">{{cite journal |author=Shoenfeld Y, Ben-Tal O, Berliner S, Pinkhas J |title=The outcome of bacterial infection in subjects with benign familial leukopenia (BFL) |journal=Biomed Pharmacother. |volume=39 |issue=1 |pages=23-6 |year=1985 |pmid=4027348 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/4027348}}</ref>
| |
| <ref name="PMID20194862">{{cite journal |author=Hsieh MM, Tisdale JF, Rodgers GP, Young NS, Trimble EL, Little RF |title=Neutrophil count in African Americans: lowering the target cutoff to initiate or resume chemotherapy? |journal=J Clin Oncol. |volume=28 |issue=10 |pages=1633-7 |year=2009 |pmid=20194862 |doi=|url=https://www.ncbi.nlm.nih.gov/pubmed/20194862}}</ref>.
| |
|
| |
|
| 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]] and [[shigella enteritis]], [[brucellosis]], [[tularemia]], [[tuberculosis]], and [[rickettsial disease]]s, such as [[Rocky Mountain spotted fever]] can present with neutropenia. Parasitic diseases with neutropenia include [[leishmaniasis]] with [[hemolysis]] and splenic sequestration and [[malaria]] due to hyperreactive malarial splenomegaly (HMS). Viral etiologies include [[HIV]], [[EBV]], [[CMV]], HHV-6, viral [[hepatitis]], [[dengue fever]], [[yellow fever]], [[measles]], [[varicella]], and [[rubella]]. |
|
| |
|
| Alternative etiologies include post-infectious neutropenia resulting from bacterial, fungal, or viral infections. While bacterial infections typically cause leukocytosis, Salmonella and Shigella enteritis, brucellosis, tularemia, tuberculosis, and rickettsial diseases such as Rocky Mountain Spotted Fever (RMSF) can present with neutropenia. Parasitic diseases with neutropenia include Leishmaniasis with hemolysis and splenic sequestration and malaria due to hyper-reactive malarial splenomegaly (HMS). Viral etiologies include HIV, EBV, CMV, HHV-6, viral hepatitis, dengue, yellow fever, and common childhood exanthematous viruses including measles, varicella, and rubella where ANC nadirs around the time of the onset of rash.
| | 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 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>. |
| | |
| 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 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. | | 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. |
| Line 597: |
Line 592: |
| {{Reflist|2}} | | {{Reflist|2}} |
|
| |
|
| [[Category:Disease]]
| |
| [[Category:Hematology]]
| |
| [[Category:Crowdiagnosis]] | | [[Category:Crowdiagnosis]] |
|
| |
|
| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
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 and shigella enteritis, brucellosis, tularemia, tuberculosis, and rickettsial diseases, such as Rocky Mountain spotted fever can present with neutropenia. Parasitic diseases with neutropenia include leishmaniasis with hemolysis and splenic sequestration and malaria due to hyperreactive malarial splenomegaly (HMS). Viral etiologies include HIV, EBV, CMV, HHV-6, viral hepatitis, dengue fever, yellow fever, measles, varicella, and rubella.
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 syndrome [1].
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
Causes by Organ System
| Cardiovascular
|
No underlying causes
|
| Chemical / poisoning
|
Arsenic trioxide, gold salts, strontium-89
|
| Dermatologic
|
Chediak-Higashi disease, dyskeratosis congenita, x-linked, Elejalde syndrome , reticular dysgenesis, reticular dysplasia
|
| Drug Side Effect
|
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, Diethylpropiondiflunisal, 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
|
| Ear Nose Throat
|
No underlying causes
|
| Endocrine
|
Hyperthyroidism
|
| Environmental
|
No underlying causes
|
| Gastroenterologic
|
Glycogen storage disorder, hypersplenism, Shwachman-Diamond syndrome
|
| Genetic
|
Barth syndrome, cartilage-hair hypoplasia, Chediak-Higashi disease, Cohen syndrome, Dubowitz syndrome, Elejalde syndrome , familial histiocytic reticulosis, Fanconi syndrome, fumarate hydratase deficiency, Griscelli syndrome type 1, methylmalonic aciduria, myelokathexis, propionic acidemia, propionyl-CoA carboxylase deficiency PCCA type, Shwachman-Diamond syndrome, WHIM syndrome
|
| Hematologic
|
Alloimmune neonatal neutropenia, alloimmune neutropenia in infancy, aplastic anemia, autoimmune neutropenia, chronic lymphocytic leukemia, cyclical neutropenia, familial histiocytic reticulosis, Hermansky-Pudlak syndrome, histiocytosis X, hypersplenism, Kostmann disease, myelodysplastic syndrome, myelofibrosis, pancytopenia, paroxysmal nocturnal haemoglobinuria, Shwachman-Diamond syndrome, x-linked agammaglobulinemia
|
| Iatrogenic
|
Hemodialysis, radiation therapy
|
| Infectious Disease
|
Brucellosis, cytomegalovirus, dengue, Epstein-Barr virus, hepatitis A, hepatitis B, hepatitis C, hepatitis, human granulocytic ehrlichiosis, human immunodeficiency virus, human monocytotropic ehrlichiosis, kala azar, Kostmann disease, lassa fever, Lyme disease, malaria, measles, rickettsiae, rickettsial infections, rocky mountain spotted fever, rubella, salmonella infection, sepsis, severe acute respiratory syndrome, shigellosis, tuberculosis, tularemia, varicella, visceral leishmaniasis, WHIM syndrome
|
| Musculoskeletal / Ortho
|
Cartilage-hair hypoplasia, metaphyseal chondrodysplasia, Mckusick type
|
| Neurologic
|
Fumarate hydratase deficiency
|
| Nutritional / Metabolic
|
Copper deficiency, glutathione synthase deficiency, glycogen storage disorder, glycogenosis type 1b, hereditary orotic aciduria, isovaleric acidemia, methylmalonic aciduria, propionic acidemia, propionyl-CoA carboxylase deficiency PCCA type, vitamin deficiencies
|
| Obstetric/Gynecologic
|
No underlying causes
|
| Oncologic
|
Chronic lymphocytic leukemia, hairy cell leukemia, histiocytosis X, leukemia, myelodysplastic syndrome, myelofibrosis
|
| Opthalmologic
|
No underlying causes
|
| Overdose / Toxicity
|
Alcoholism
|
| Psychiatric
|
No underlying causes
|
| Pulmonary
|
Severe acute respiratory syndrome
|
| Renal / Electrolyte
|
Fanconi syndrome
|
| Rheum / Immune / Allergy
|
Alloimmune neonatal neutropenia, alloimmune neutropenia in infancy, autoimmune lymphoproliferative syndrome type 1, autoimmune lymphoproliferative syndrome type 2, autoimmune neutropenia, common variable immune deficiency, Felty's syndrome, histiocytosis X, hyper-immunoglobulin M syndrome, lupus, rheumatoid arthritis, secondary autoimmune neutropenia, WHIM syndrome, x-linked agammaglobulinemia, x-linked hyperimmunoglobulin M syndrome
|
| Sexual
|
No underlying causes
|
| Trauma
|
No underlying causes
|
| Urologic
|
No underlying causes
|
| Dental
|
No underlying causes
|
| Miscellaneous
|
No underlying causes
|
Causes in Alphabetical Order
The unnamed parameter 2= is no longer supported. Please see the documentation for {{
columns-list}}.
3
References
Template:WH
Template:WS