Neutropenia in Adults Quiz
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Questions and Answers

What is the most common cause of neutropenia in adults who are ambulatory?

  • Myeloablative therapies
  • Infections
  • Idiosyncratic drug reactions (correct)
  • Neoplasms replacing the bone marrow
  • Which condition does NOT directly reduce bone marrow reserve of neutrophils?

  • Copper deficiency
  • Megaloblastic anemia
  • Myeloablative therapies
  • Infections (correct)
  • Which factor is a rare cause of neutropenia?

  • Copper deficiency (correct)
  • Megaloblastic anemia
  • Myeloablative therapies
  • Secondary autoimmune neutropenia
  • How long do circulating neutrophils typically survive in the bloodstream?

    <p>5-135 hours (C)</p> Signup and view all the answers

    Which of the following is commonly associated with secondary autoimmune neutropenia?

    <p>Collagen vascular disorders (D)</p> Signup and view all the answers

    What classification of neutropenia is indicated by a defect in granulopoiesis?

    <p>Neutropenia with decreased BM reserve (A)</p> Signup and view all the answers

    Which mechanism is involved in the genetic disorder known as Kostmann syndrome?

    <p>Apoptosis of precursors (B)</p> Signup and view all the answers

    Which type of neutropenia is characterized by the ability to accumulate normal bone marrow reserves?

    <p>Neutropenia with normal BM reserve (C)</p> Signup and view all the answers

    What is the inheritance pattern of Kostmann syndrome?

    <p>Autosomal Recessive (A)</p> Signup and view all the answers

    What is a potential severe outcome of primary neutropenia as indicated in the content?

    <p>Myelodysplastic syndromes (MDS) (A)</p> Signup and view all the answers

    What is the normal range for absolute neutrophil count (ANC) in adults?

    <p>1.5 to 7.0×10^9/L (B)</p> Signup and view all the answers

    Which of the following is NOT a primary cause of neutropenia?

    <p>Chronic nutritional deficiency (D)</p> Signup and view all the answers

    In what age group is infection cited as the most common cause of neutropenia?

    <p>Neonates (B)</p> Signup and view all the answers

    What is the lower limit of ANC for infants according to laboratory definitions?

    <p>&lt; 2.5×10^9/L (D)</p> Signup and view all the answers

    Which group has an ANC range that can occasionally be as low as 1.0 to 1.5×10^9/L?

    <p>African American children/adults (C)</p> Signup and view all the answers

    Which of the following is a constitutional disorder associated with neutropenia?

    <p>Cyclic neutropenia (D)</p> Signup and view all the answers

    Which laboratory specialty contributes to the diagnosis of neutropenia?

    <p>Microbiology (A)</p> Signup and view all the answers

    How is neutropenia classified in adults?

    <p>By absolute neutrophil count (D)</p> Signup and view all the answers

    What is a common viral infection that is associated with immune-mediated neutropenia?

    <p>HIV (D)</p> Signup and view all the answers

    Which condition is characterized by a maturation arrest in the myeloid lineage?

    <p>Infection-related neutropenia (A)</p> Signup and view all the answers

    Which of the following congenital conditions is NOT commonly associated with mild neutropenia?

    <p>Adenosine deaminase deficiency (A)</p> Signup and view all the answers

    Which factor is important in the clinical history of a neonate potentially experiencing neutropenia?

    <p>Low birth weight (A)</p> Signup and view all the answers

    What is the possible inheritance mechanism of chronic benign neutropenia?

    <p>Autosomal dominant (D)</p> Signup and view all the answers

    What is the diagnostic frequency of chronic benign neutropenia before bone marrow examination?

    <p>90% (C)</p> Signup and view all the answers

    What is one of the rare causes of neutropenia that involves tetraploid nuclei?

    <p>Myelokathexis (B)</p> Signup and view all the answers

    Which of the following statements accurately describes the nature of neonatal neutropenia related to maternal conditions?

    <p>It is commonly self-limited. (A)</p> Signup and view all the answers

    What mutation is associated with Shwachman-Diamond syndrome?

    <p>SBDS mutation (B)</p> Signup and view all the answers

    What is a common clinical feature of cyclic neutropenia?

    <p>Recurrent fever every 21 days (A)</p> Signup and view all the answers

    What clinical characteristic is associated with Chediak-Higashi syndrome?

    <p>Recurrent pyogenic infections (A)</p> Signup and view all the answers

    What percentage of patients with secondary lymphocytic leukemia show increased apoptosis?

    <p>Up to 80% (D)</p> Signup and view all the answers

    What common factor is noted in drug-induced suppression of myelopoiesis?

    <p>Non-immune reaction (B)</p> Signup and view all the answers

    What is the inheritance pattern of Shwachman-Diamond syndrome?

    <p>Autosomal recessive (A)</p> Signup and view all the answers

    Which factor significantly impacts the severity of neutropenia in drug-induced cases?

    <p>Type of drug (D)</p> Signup and view all the answers

    What laboratory finding can indicate ineffective nutritional marrow suppression?

    <p>Decreased myelopoiesis (B)</p> Signup and view all the answers

    Which disorder is characterized by giant granules in many cells?

    <p>Chediak-Higashi syndrome (B)</p> Signup and view all the answers

    What is a common diagnostic approach for severe congenital neutropenia?

    <p>Bone marrow biopsy (A)</p> Signup and view all the answers

    Flashcards

    Neutropenia

    A condition characterized by an abnormally low neutrophil count.

    Normal ANC range

    The absolute neutrophil count (ANC) for adults ranges from 1.5 to 7.0×10^9/L.

    Neutropenia classification

    Neutropenia is classified based on absolute neutrophil count into three groups.

    Neutropenia in neonates

    In infants, neutropenia is defined as ANC < 2.5×10^9/L.

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    Primary causes of neutropenia

    These include benign conditions, autoimmune disorders, and infections.

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    Secondary causes of neutropenia

    These arise from external factors like medications or infections.

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    Age-related causes of neutropenia

    Causes differ by age: common in neonates and children due to infections, autoimmune issues.

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    Importance of ethnicity

    Ethnicity can affect normal ANC ranges; for example, lower limits for African Americans.

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    Neutropenia causes

    Neutropenia can be caused by various factors including drug reactions and infections.

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    Neutrophil lifespan

    Circulating neutrophils survive around 5-135 hours in the bloodstream.

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    Bone marrow reserves

    95% of neutrophils are stored as maturing granulocytes in the bone marrow.

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    Myeloablative therapies

    Therapies that destroy bone marrow to treat certain conditions, leading to temporary neutropenia.

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    Autoimmune neutropenia

    Neutropenia can arise as a secondary effect of autoimmune disorders or conditions like collagen vascular disorders.

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    Decreased BM Reserve

    A type of neutropenia where the bone marrow has a reduced ability to produce neutrophils.

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    Primary Neutropenia

    Neutropenia caused by intrinsic defects in granulopoiesis.

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    Secondary Neutropenia

    Neutropenia due to suppression of normal granulopoiesis by external factors.

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    Kostmann Syndrome

    A rare genetic disorder causing severe congenital neutropenia.

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    Causes of Neutropenia

    Common causes include viral infections, B12 deficiency, and certain congenital conditions.

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    Viral Infections and Neutropenia

    Certain viral infections (like EBV, CMV, HIV) can cause immune-mediated neutropenia.

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    Clinical History in Neutropenia

    The patient's clinical history is key to determining the cause and degree of neutropenia.

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    Severe Neutropenia Risks

    Severe neutropenia carries significant risks, especially in infants, such as high infection risk.

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    Congenital Neutropenia Conditions

    Includes myelokathexis, reticular dysgenesis, and dyskeratosis congenita, often resulting in mild neutropenia.

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    Importance of Antenatal Care

    Antenatal care can reduce risks of infections in neonates, especially in hypertensive mothers.

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    Diagnosis of Neutropenia

    Diagnosis involves blood tests and possibly bone marrow analysis to assess neutrophil production.

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    Cyclic Neutropenia

    A genetic disorder causing recurrent fever and infections every 21 days due to apoptosis of neutrophil precursors.

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    Chediak-Higashi Syndrome

    A rare genetic disorder marked by recurrent pyogenic infections and giant granules in many cells due to a mutation in the LYST gene.

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    Exocrine Function

    Secretory function involving the release of substances (like sweat) through ducts to external force.

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    Neutropenia in Chemotherapy

    Common side effect of chemotherapy due to direct toxicity to neutrophils, leading to increased infection risk.

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    Drug-Induced Neutropenia

    A non-immune suppression of neutrophils caused by certain drugs, potentially fatal in 25% of cases.

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    Granulocyte Morphology

    Study of the shape and structure of granulocytes in bone marrow, like maturation arrest at the promyelocyte stage.

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    Congenital Neutropenia

    Severe form of neutropenia present from birth, often resulting in frequent bacterial infections and complications.

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    Recurrent Fever

    Symptoms that occur every 21 days in conditions like cyclic neutropenia, indicating immune challenges.

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    FAS Ligand

    Protein involved in apoptosis, its increase in lymphocytes is linked to secondary leukemia.

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    Protein-Calorie Malnutrition

    A form of malnutrition characterized by inadequate protein and calorie intake, causing ineffective hematopoiesis.

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    Study Notes

    Neutropenia Overview

    • Neutropenia is a common laboratory finding in adults and children
    • Underlying causes are heterogeneous, including benign conditions, autoimmune disorders, infections, and malignancies
    • Clinical labs are crucial for diagnosis, using hematology, microbiology, molecular biology/cytogenetics, and clinical chemistry

    Defining Neutropenia

    • Normal adult absolute neutrophil count (ANC) ranges from 1.5 to 7.0 x 109/L
    • Lower limit of ANC varies by patient age and race
    • Neonates/infants lower limit is approximately 2.5 x 109/L
    • Up to 25% of African-American children/adults have ANC ranging from 1.0 to 1.5 x 109/L

    How Neutropenia is classified

    • Most labs classify neutropenia in infants with ANC < 2.5 x 109/L and in adults with ANC < 1.5 x 109/L
    • Stratified into mild, moderate and severe based on ANC values and clinical context
      • Mild: ANC 1.0-1.5 x 109/L, general good health, usually no infection
      • Moderate: ANC 0.5-1.0 x 109/L, associated disease, debilitated/malnourished, usually minimal to moderate infection risk
      • Severe: ANC < 0.5 x 109/L, all clinical settings, moderate to severe infection risk
    • Neonates: Infection (most common), maternal hypertension/drug treatment, maternal antibody production, constitutional disorders (e.g., cyclic neutropenia, Kostmann syndrome, Chediak-Higashi syndrome)

    • Infants/Children: Infections, autoimmune neutropenia, neoplasms replacing bone marrow, idiosyncratic drug reactions, secondary autoimmune neutropenia in collagen vascular disorders, immunodeficiency disorders, megaloblastic anemia, myeloablative therapies, constitutional neutropenia disorders (rare), copper deficiency (rare)

    • Adults: Idiosyncratic drug reactions (most common in outpatients), infections, neoplasms replacing bone marrow, myeloablative therapies, secondary autoimmune neutropenia in collagen vascular disorders, autoimmune disorders (including white blood cell aplasia)

    Classification of Neutropenia by Marrow Reserve

    • Neutropenia with decreased bone marrow reserve (BM)
      • Primary: defect in granulopoiesis.
      • Secondary: suppression of normal granulopoiesis.
    • Neutropenia with normal bone marrow reserve Different disorders responsible for severe congenital neutropenia have distinctive symptoms e.g., Schwachman-Diamond syndrome characterised by steatorrhea, short stature, and exocrine pancreatic deficiency

    Classification of Neutropenias by Marrow Reserve and Clinical Features

    • Table showing primary disorders, clinical traits, and diagnostic tools, distinguishing syndromes through characteristics and diagnostic tests

    Cyclic Neutropenia, Chediak-Higashi Syndrome

    • Cyclic neutropenia: Periodic apoptosis of precursors, often associated with ELA2 mutation; recurrent fever, skin/otolaryngeal infections, and no increased risk of hematological malignancies
    • Chediak-Higashi syndrome: Mutation in the LYST gene, recurrent pyogenic infections, oculocutaneous albinism, decreased microbicidal activity (giant granules in cells)

    Secondary Neutropenias

    • Large granular lymphocytic leukaemia and related disorders
    • Chemotherapy
    • Drug-induced (non-immune)
    • Nutritional deficiencies (protein-calorie malnutrition, folate/copper/B12 deficiency)
    • Infections (viral like EBV,CMV, HIV, Hepatitis)

    Neutropenia with Normal Bone Marrow Reserve

    • Chronic/ benign neutropenia of infancy/childhood: Caused by antineutrophil antibodies
    • Non immune chronic benign neutropenia: High incidence, increased apoptosis.
    • Ethnic or Benign familial neutropenia: Unknown cause (unknown mechanism), incidence AD, findings mostly in family members (similar findings).

    Alloimmune Neutropenia

    • Maternal alloimmunization to HNA antigens (1a/1b/2a/1c/3a/4a)
    • Moderate/severe neutropenia in newborns, cutaneous infections, UTIs, omphalitis

    Drug-Induced Neutropenia

    • Antibody or complement-mediated suppression of myelopoiesis
    • Fever, sepsis, pneumonia, up to 50% mortality, 80% recovery rate
    • Virus-mediated antibody
    • Sequestration, destruction

    Diagnostic Approach to Neutropenia

    • Detailed clinical history and physical examination first.
    • Radiographic findings can be important
    • Blood counts, Peripheral blood smear, Immunological testing, infectious disease testing, bone marrow biopsy
    • Different approaches are used for children vs adults

    Work-up for Pediatric and Adult Patients

    • Flowcharts for evaluation and diagnostic approach, using clinical findings and lab values to guide further investigations (e.g. genetic syndromes, bone marrow biopsy)

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