Investigating neutropenia

Paediatric autoimmune neutropaenia

Neutropaenia is defined as an absolute neutrophil count (ANC) of less than 1500 cells/µL and is often divided into mild (ANC: 1000 to 1500 cells/µL), moderate (ANC: 500 to 1000 cells/µL) and severe (ANC: >500 cells/µL) neutropaenia. Autoimmune neutropaenia is arguably one of the most clinically relevant forms of neutropaenia and is defined by an ANC of <500 cells/µL alongside the confirmed presence of anti-neutrophil antibodies. It is a rare subset of neutropaenia boasting an incidence of just 1 in 100 000 infants and is thought to be caused as a result of a 'surveillance escape event' of the immune system. This case report identifies key issues in the diagnosis and monitoring of paediatric patients with recurrent neutropaenia and reviews current literature relating to its management in hospital and community settings.

Cyclic neutropenia in a cleft lip and palate patient: a case report

Cleft lip and palate is the most common congenital anomaly. Its association with hematologic disorders is rarely reported. Cyclic neutropenia is a rare blood disorder that may occur spontaneously or has a genetic predisposition. Periodicity/recurrence of cyclic neutropenia has a cyclical pattern reoccurring in multiples of 7 days, usually at 21- or 28-day intervals between attacks, with the patient being fairly asymptomatic. There is no case in the literature that has reported the presence of cyclic neutropenia in cleft patients. We report a case of cleft patient associated with cyclic neutropenia. The clinical features, diagnosis, and course of management are described.

Prolonged acquired neutropenia in children

BACKGROUND

Acquired neutropenia is not uncommon in childhood. This study investigated the risk factors associated with developing prolonged acquired neutropenia.

PROCEDURE

We reviewed 66,062 hospital admission medical records from the 5-year period January 1, 2002 to December 31, 2006 to identify neutropenic patients, with and without follow-up of their neutropenic course until December 31, 2007. After excluding patients with malignancy, collagen disease, bone marrow failure, prematurity, hereditary disease, congenital neutropenia, immunodeficiency, or status post-liver transplantation, 735 admissions with acquired neutropenia were included in our study.

RESULTS

A total of 474 patients with 735 admissions had moderate or severe neutropenia during the 5-year period. Among the 252 acquired neutropenia patients who had follow-up for at least 1 month, 226 patients recovered within 3 months, while 26 patients remained neutropenic after 3 months. Of these 26 patients, 14 recovered after 1 year. An absolute neutrophil count of <500/mm(3) (odds ratio [OR]: 13.66, 95% confidence interval [CI]: 2.90-64.41), thrombocytosis (OR: 5.76, 95% CI: 1.78-18.58), and age <1 year (OR: 4.93, 95% CI: 1.03-23.54) were associated with prolonged acquired neutropenia, as shown by multivariate logistic regression. Kaplan-Meier analysis showed that neutropenia associated with cytomegalovirus (CMV) was more prolonged than neutropenia associated with influenza or Epstein-Barr virus infection.

CONCLUSIONS

Prolonged acquired neutropenia was associated with younger age, thrombocytosis, and CMV infection. Neutropenic infants with CMV infection may require antiviral therapy to prevent prolonged acquired neutropenia.