what is Neutropenia?
This is a count of neutrophils that is atypically low. Neutrophils are white blood cells that aid the immune system fighting off infections, especially fungi as well as bacteria. The body has several kinds of white cells, and approximately 45% to 70% of all white cells are neutrophils.
The edge for the defining of neutropenia varies somewhat between medical practices. Neutropenia for adults is normally defined as any count of 1700 or fewer neutrophils per micro-liter of blood. The count of cells representing neutropenia in children does vary with age.
The lower the neutrophil count, the more susceptible an individual is to diseases which are infectious. If the individual has severe neutropenia – for example fewer than approximately 500 cells per micro-liter of blood – bacteria which is normally living in your digestive system or mouth may cause infections.
Neutropenia Symptoms
Neutropenia often goes overlooked because of the absence of any symptoms which are specific. Many times, the illness is detected only after the affected individual has developed severe infections. Neutrophils at low levels normally make the individual very vulnerable to having infections frequently. Any bacteria normally present in the body may quickly cause infections, when the number of neutrophils significantly drops. Usually only very few symptoms can be observed in individuals with neutropenia, and some symptoms may be caused by some other health problem as well. The symptoms of neutropenia include:
- Frequent infections
- Chills
- Unexplained fever
- Anal and mouth ulcers
- Sore throat
- Lymph node enlargement
- Diarrhea
- Infections of the skin
- Burning sensation upon urinating
- Redness and swelling that is unusual around any wound or injury site
Some individuals have cyclic neutropenia that exhibits all or just a few of the symptoms mentioned above, but only when there is a period of neutrophil being low. The symptoms will only occur during these periods when the neutrophil drops to a level that is significantly low.
Neutropenia Causes
Neutropenia can be caused by:
- Disorders that are congenital and characterized by bone marrow functions which are poor
- Cancer or other problems that can damage the bone marrow
- Disorders that are autoimmune problems and destroy bone marrow cells as well as neutrophils
- Viral infections that disrupt the function of bone marrow
- Infections that overwhelm and quickly use up neutrophils faster than they are produced
- Drugs that damage marrow of the bone and destroy neutrophils
Some probable causes of neutropenia may include:
- Alcoholism
- Bone marrow transplant
- Aplastic anemia
- Chronic idiopathic neutropenia in adults
- Chemotherapy
- Drugs such as diuretic and antibiotics
- Hepatitis A, B, C
- HIV/AIDS
- Histoplasmosis
- Leukemia
- Malaria
- Lupus
- Mononucleosis
- Myelofibrosis
- Rheumatoid arthritis
- Myelodysplastic syndromes
- Radiation therapy
- Syndrome-associated neutropenia
- Sepsis
- Sjogren’s syndrome
- Tuberculosis
- Vitamin deficiencies
Neutropenia Diagnosis
The diagnosis of neutropenia is made by a blood test where the blood cells are counted on a sample of that blood. In order to define the precise cause of neutropenia in a given case, other tests are usually required.
Some other tests that can also be performed include:
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- Test for antineutrophil antibodies
- Autoantibody screening
- Vitamin B12
- Folate assays
- Acidified serum test
- Test for systemic lupus erythematous
Often bone marrow biopsy is done especially if the neutropenia is believed to be caused by serious underlying conditions. If cyclic neutropenia is suspected, serial neutrophil counts are done.
Neutropenia Treatment
The management of neutropenia will be centered on the causal disease or illness, the existence of accompanying infections or symptoms, the severity and the overall status of the health for the individual. Often treatment also must be directed toward any underlying process of disease. Treatments that address direct to the neutropenia may consist of:
- Antifungal and/or antibiotic drugs to fight infections
- Administration and management of growth factor for white cells – for instance “recombinant granulocyte colony stimulating factor” also referred to as G-CSF or filgrastim. This is for cases of very severe neutropenia
- Transfusion of granulocyte
- Corticosteroid therapy
- IV immune globulin for cases of immune suppressed neutropenia
Precautions or Preventive Measures
Measures which are preventive usually should be implemented in those patients with this condition in order to limit any risk of infections.
Personal Hygiene
- Hands need to be washed often with a soap that is antibacterial particularly before meals, after the restroom and after shaking hands.
- Daily baths or showers followed by patting dry lightly the skin
- To prevent problems developing from dry skin use a moisturizer
- Thoroughly cleaning rectum after bowel activities. Women need to remember to clean perianal region front to back.
- Care in grooming for instance cutting nails. Do not cut or tear cuticles, use cuticle cream as well as remover
- No scratching or squeezing of blemishes
- Use a electric razor which is clean in place of a safety or disposable razor
- Women need to use sanitary pads instead of tampons in order to reduce risk of infection.
Safety Care
- People with flu, colds, any sores that are open or other infection should be avoided
- Avoid sunburn
- Avoid enclosed, crowded public areas
- Shoes need to be worn in order to avoid cuts
- Avoid rectal suppositories or thermometers
- Guard hands from burns or cuts
- The status of vaccinations needs to be discussed with your physician. Individuals who are receiving chemotherapy need to avoid any contact with others who have recently gotten a live vaccine.
Home
- No shoes from the outside should be worn in the home
- Avoid any contact with stools or urine of animals
- Avoid stagnant water, for instances vases, denture cups, humidifiers
- Keep furnace and ducts cleaned
- Have filters to air or heater replaced monthly
- Outerwear needs to be dry cleaned frequently
Dental and Oral hygiene
- Use a tooth brush with soft brushes to stop cuts in the mouth
- Don’t use dental floss
- Clean dentures with water that is fresh
- Rinse mouth well and often
- Any scheduled or required dental work needs to first be discuss with physician
- Antibiotic therapy is needed after any oral teeth cleaning or other work
Lifestyle
- Regular exercise
- Plenty of rest
- Learn to deal with stress
- Learn about this disease. Knowledge is power.
Neutropenia Diet
A so called Neutropenic diet seeks to lessen the food amount introduced into the body that might have levels of bacteria which are high. There are usually good bacteria in our food but there are also bad bacteria. Those individuals who are healthy can usually eat bad bacteria but that is not the case for others who have reduced immune functions.
Raw Fruits and Vegetables
Fruits which are fresh and vegetables normally carry bacteria even after thorough washing. Individuals with neutropenia need to avoid raw vegetables, herbs, fresh salsas, salad bars and the majority of fruits that are fresh. Bananas and oranges are safe. Unpasteurized fruit or vegetable juices need to be avoided.
Uncooked Grains
Most starches and grains are ok, but any cereals or breads that have raw nuts or oats should be avoided. Raw nuts as well as oats do not have any exposure to heating so bacteria flourish. Also avoid any pasta that is uncooked and should not bake any bread with active yeast.
Rare-cooked Meat and Unpasteurized Dairy
Avoid any rare-cooked or raw fish, meat or poultry. All meat must be cooked well done. This diet prohibits sashimi and sushi and any freshly sliced deli meat as well as lox/smoked salmon. Eggs that are undercooked could be a hazard. Avoid any unpasteurized cheese, yogurt or milk.
Beverages Untreated
Pasteurization kills any harmful living microbes so any fruit or vegetable juices need to have undergone that process. Avoid cold brewed teas. Well water must be boiled for at least 1 minute.
