Pediatrics in Review
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Clinical Disorders of Neutropenia

Rudolph R. Roskos MD1
Laurence A. Boxer MD2
 1 Assistant Professor of Pediatrics, Pediatric Hematology/Oncology, University of Michigan Hospital, Mott Childrens Hospital, Division of Pediatric Hematology/Oncology, 1500 E Medical Center Dr, F6515, Box 0238, Ann Arbor, MI 48109
2 Director and Professor, Pediatric Hematology/Oncology, University of Michigan Hospital, Mott Childrens Hospital, Division of Pediatric Hematology/Oncology, 1500 E Medical Center Dr, F6515, Box 0238, Ann Arbor, MI 48109

Not uncommonly, during the course of a workup for fever, the pediatrician will find that a patient has neutropenia. Neutropenia is defined as an absolute decrease in the number of circulating neutrophils in the blood. The lower limit for normal neutrophil counts is 1000/mm3 in infants between 2 weeks and 1 year of age; after infancy the corresponding value is 1500/mm3. Blacks have lower neutrophil counts, and the lower limit is 100 to 200/mm3 less than those cited for whites. These lower counts probably reflect a relative decrease in the storage pool of the bone marrow.

CLASSIFICATION OF NEUTROPENIA

Neutropenia can be classified as mild (neutrophil counts of 1000 to 1500/mm3), moderate (neutrophil counts of 500 to 1000/mm3), or severe (neutrophil counts less than 200/mm3). This stratification is useful in predicting risk of infection, but it provides no etiologic information. On the other hand, it is useful to classify patients as having an abnormality either in production or in destruction of neutrophils, because each of these processes is now frequently amenable to distinct therapies if needed.

Susceptibility to bacterial infection, even in the face of severe neutropenia, is variable. Most patients with chronic neutropenia do not experience as many serious infections as those patients receiving cancer chemotherapy or those infected with human immunodeficiency virus who develop comparable degrees of neutropenia.




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J. R. Serwint, M. M. Dias, H. Chang, M. Sharkey, and A. R. Walker
Outcomes of Febrile Children Presumed to be Immunocompetent Who Present with Leukopenia or Neutropenia to an Ambulatory Setting
Clinical Pediatrics, September 1, 2005; 44(7): 593 - 600.
[Abstract] [PDF]


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