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Even though variations of leukopenia can arise, e.g. lymphopenia without neutropenia, these are more rare and the differential is generally less broad than it
would be for leukopenias involving neutropenia.
Dr. Michael Evans developed the One-Pager concept to provide clinicians with useful clinical information on primary care topics.
LEUKOPENIA
II) Neutropenia- Congenital
2
Finding of neutropenia by CBC & Diff Immediate heme referral if 1) Neutrophils < 0.5 x 109/L
(Confirmation by manual repeat of OR
diff and/or blood film.) 2) Neutrophils 0.5 1.0 x 109/L and
patient has Hx repeated infections
If p
ati OR
ent
(fe feb 3) Patient has lymphadenopathy
bri rile
le n
<2-3 months of monitoring
eut
rop
eni
a)
Consider hospital admission.
- Lytes, Cr, LFTs, Blood Cxs x 2 (from
Consider clinical features/characteristics to aid dx, for example: different sites including peripheral vein and
1) Infectious Sxs or diagnoses current, recent, or cyclic indwelling IV, as applicable), coags,
2) Inflammatory Sxs: e.g. lupus, RA ( rheum referral) CRP/ESR
3) Sxs c/w malignancy: e.g. unexplained weight loss, Hx of +/-
fevers, hypercalcemia ( heme referral) - Urine R&M / C&S
4) Patient Hx/general characteristics: e.g. neonatal/pediatric, +/-
vegan, gastrectomy, EtOH consumption, toxin exposure - CXR
5) Medications, Txs: e.g. chemotherapy, hemodialysis +/-
- NP Swab
+/-
If no clinical features / clues present - LP
+/-
- Stool or skin Cxs
- Any Cxs should be taken before rapid
Periodic CBCs (q 3-4 weeks) for 2-3 months for monitoring.
initiation of empiric Abx Tx
- Consider malignancy Dx, specialist referral
CBC and check ESR/CRP +/- serology +/- tests If tests negative, neutropenia
for autoantibodies to r/o autoimmune cause stable and no new clinical features Periodic CBCs q 4-6 months for monitoring.