Neutropenia: causes, symptoms and treatment
- What is neutropenia?
- Types and degrees of neutropenia
- Causes of neutropenia
- Symptoms of neutropenia
- Treating neutropenia
What is neutropenia?
Neutropenia (agranulocytosis) occurs when the level of neutrophils (neutrophilic leukocytes) in the blood decreases (becomes less than 1500 in 1 μl). This leads to increased susceptibility to a variety of bacteria and fungi, reduces the body's resistance to infections, lowers immunity.
This condition can act as an independent disease, as well as as a consequence of other pathologies, or external causes that affect the human body. In this case, neutropenia is a complication of a particular disease.
Agranulocytosis is a decrease in granulocytes in the blood in general. Granulocytes are represented by neutrophils, eosinophils and basophils (they all belong to leukocytes). The neutrophils on this list are the most numerous. Therefore, often the doctor, speaking of agranulocytosis, means precisely neutropenia.
Neutrophils destroy the pathogenic flora that has entered the body, and are also sent to the focus of inflammation and try to neutralize it. Pus is the result of the destruction of microbes, it is represented by their remnants and dead neutrophils.
Neutrophils are synthesized in the bone marrow, where they mature, after which they enter the blood and tissues.
Normal neutrophil counts range from 45 to 70% of all leukocytes. Neutropenia is indicated by a decrease in the level of neutrophils less than 1.5 * 10 9 / l. Black people have fewer neutrophils in their bone marrow than white people. Therefore, a drop in the number of neutrophils to 1.2 * 10 9 / l indicates neutropenia.
A severe course of neutropenia is extremely rare, but this condition is dangerous not only for health, but also for life. To help a person, it is necessary to clarify the reason for the decrease in the level of neutrophils.
Types and degrees of neutropenia
Depending on the rate of development, the disease can be acute, occurring in a few days, or chronic, developing over many months or years.
Only a severe acute form of neutropenia is dangerous to human life, which can occur due to a violation of the formation of neutrophils.
The norm of neutrophils in the blood is 1500/1 μl. Based on this, three degrees of neutropenia are distinguished by the number of neutrophils:
Mild neutropenia, in which the level of neutrophils decreases to 1.0-1.5x10 9 / l.
Moderate neutropenia, in which the level of neutrophils decreases to 0.5-1.0x10 9 / l.
- Severe neutropenia, in which the neutrophil count drops to less than 500 neutrophils per microliter of blood.
With a severe course of neutropenia, the risk of developing health complications is extremely high.
There are the following types of neutropenia:
Autoimmune. This type of neutropenia develops when the body begins to produce antibodies that destroy neutrophils. Such a reaction can manifest itself for no apparent reason, or develop in other autoimmune diseases. Children born with immunodeficiency often suffer from this type of neutropenia.
Medicinal. This type of neutropenia is most commonly found in adult patients. Its causes can be hidden in the body's allergic reactions to drugs. Penicillins, cephalosporins, chloramphenicol, neuroleptics, sulfonamides and anticonvulsants can provoke a drop in the level of neutrophils. After the completion of the course of treatment, the neutrophil counts return to normal (after 7 days).
Anticonvulsants are the most likely to cause neutropenia. An allergic reaction is indicated by skin rashes and itching, fever and other symptoms. It is imperative to cancel the drug to which the body reacts with neutropenia. If this is not done, then the person may develop a serious immunodeficiency.
Neutropenia can manifest with chemotherapy or radiation therapy. In this case, the effect is on the bone marrow. After starting treatment, the level of neutrophils will be noticeably reduced after 7 days. The restoration of the number of neutrophils occurs not earlier than in a month. During this period, there is a high risk of damage to the body by various infections.
Infectious. Infectious neutropenia is associated with ARVI and other acute infections. Most often, such neutropenia does not last long and passes on its own after, on average, 7 days. Infectious neutropenia due to HIV, sepsis and other serious diseases has a severe course. In this case, a failure occurs in the production of neutrophils at the level of the bone marrow, as well as their death in peripheral vessels.
Febrile. Febrile neutropenia develops during the treatment of tumors of the hematopoietic system with cytostatics, but sometimes it manifests itself during chemotherapy of other cancerous tumors. A severe infection develops in the body, which leads to the active growth of pathogenic flora against the background of insufficient immunity. Moreover, for a healthy person, such pathogens most often do not pose a threat to life (staphylococci, streptococci, fungi, herpes virus, etc.). However, the lack of neutrophils becomes fatal for the patient. His condition deteriorates sharply, and the focus of infection is difficult to identify, since the inflammatory reaction is very weak. Immunity is simply unable to induce it.
Benign. Benign neutropenia is a chronic condition that is diagnosed during childhood. No treatment required. As the child grows up, the level of neutrophils returns to normal. Doctors associate the development of such neutropenia with bone marrow immaturity in children under 2 years of age.
Hereditary. Congenital neutropenia: Kostman's syndrome, cyclic neutropenia, familial benign neutropenia, lazy leukocyte syndrome.
Causes of neutropenia
Neutropenia can develop as an independent anomaly and as a result of various blood diseases. The most common cause of neutropenia is a decrease in the formation of neutrophilic leukocytes under the influence of drugs (antitumor and anticonvulsants, penicillin, antimetabolites, etc.). Sometimes the disease is a predictable side effect of taking a number of medications, and sometimes it occurs regardless of the dosage and timing of the use of a particular drug.
In rare cases, neutropenia is a congenital anomaly. Suppression of neutrophil production may be due to hereditary agranulocytosis, familial or cyclic neutropenia, pancreatic insufficiency, renal failure, or HIV. Also, the cause of neutropenia can be damage to the bone marrow, cancer, or even vitamin deficiency (vitamin B12 and folic acid deficiency).
Symptoms of neutropenia
Symptoms that indicate the development of neutropenia can be very diverse, but they all develop against the background of a failure of the immune system.
Therefore, signs of neutropenia can be considered:
- Ulceration in the mouth. The formation of areas of necrosis is possible.
- Dermatological diseases.
Inflammation of the lungs, intestines and other organ systems.
- Increased body temperature.
It is stomatitis, gingivitis and tonsillitis that are the basic signs of neutropenia. In this case, the inflammation is always acute, accompanied by painful sensations, tissue edema, bleeding of the gums. Fungal microorganisms cause such damage.
People with neutropenia are susceptible to respiratory problems that are severe. They are accompanied by cough, fever, wheezing, chest pain.
With neutropenia, the intestine becomes covered with ulcers and areas of necrosis. The person develops diarrhea or constipation. He is pursued by stomach pains. This condition is dangerous by perforation of the intestinal wall and the development of peritonitis, which is associated with a high risk of death.
The skin with neutropenia can become covered with purulent rashes. In parallel, the body temperature rises. Skin rashes do not go away for a long time, they can fester and ulcerate.
If neutropenia has a mild course, then it may not manifest itself in anything. A decrease in the number of neutrophils can be suspected by frequent viral infections. As neutropenia progresses, the patient begins to hurt for longer, treatment becomes ineffective. In addition to viral infections, a person will suffer from attacks by fungal and bacterial flora. Severe neutropenia is accompanied by damage to internal organs, febrile conditions, and acute inflammation. Development of sepsis and death is possible.
When the number of neutrophils in the blood drops to less than 500 per 1 μL, a specific dangerous form of neutropenia occurs - febrile neutropenia. Among her symptoms are a sharp increase in body temperature up to 38 ° C, severe weakness, chills, severe sweating, tremors, heart rhythm disturbances, cardiovascular collapse. This condition is also extremely serious due to the difficulties in differentiating it from pneumonia or bacterial sepsis.
Neutropenia cannot be treated with a single regimen. It is important to determine the cause of the development of this condition. The selection of therapeutic measures is influenced by the age of the patient and his state of health.
Mild neutropenia that does not have severe symptoms does not need treatment. If a person develops severe neutropenia, the patient is hospitalized. The development of complications requires the appointment of antibiotics, antifungal and antiviral drugs. The dosage of drugs for people with neutropenia should be higher than that for patients without neutropenia.
The choice of the drug is based on the sensitivity of the pathogenic flora to it. If it is not identified, then the patient is prescribed broad-spectrum antibiotics. They are administered intravenously.
If after 72 hours there is no improvement, then the scheme is considered ineffective and the drugs are changed, or the dose of the antibiotic is increased.
When neutropenia is provoked by tumor neoplasms or chemotherapy, the patient should receive the antibiotic until the time when the neutrophil level reaches 500 cells per microliter of blood.
If, with neutrophilia, a fungal infection is diagnosed in a patient, then in addition to antibiotics, he is prescribed fungicides. They are used only for the treatment of mycotic lesions, and are not used for prophylactic purposes.
For the prevention of bacterial complications in neutropenia, the drug Co-trimoxazole can be used. However, its use is associated with the risk of developing candidiasis of various organs.
Children with congenital neutropenia, as well as those with severe pathology, may be prescribed colony-stimulating factors, for example, Filgrastim. Moreover, this treatment is becoming more and more popular.
To increase the patient's immunity, he is prescribed vitamin complexes with the obligatory content of B vitamins.
When neutropenia is of an autoimmune nature, the administration of glucocorticosteroids is indicated for patients.
The drugs Pentoxil and Methyluracil allow to accelerate tissue regeneration and improve metabolic processes.
If a lot of neutrophils die in the body, then the removal of the spleen may be required. The operation is not performed in patients with sepsis or with the development of severe complications of neutropenia. Another radical treatment for neutropenia is a bone marrow transplant from a donor.
People with neutropenia need to follow certain preventive measures. This will prevent the development of severe complications at the stage of recovery of the neutrophil level. Be sure to wash your hands with soap. It is necessary to limit contact with people who are spreading the infection. It is equally important to avoid various injuries, including minor cuts and scratches. Food must be sufficiently cooked. The implementation of these recommendations will reduce the likelihood of penetration of pathogenic flora into the body at the stage of neutropenia treatment.
Article author: Mochalov Pavel Alexandrovich | d. m. n. therapist
Education: Moscow Medical Institute. IM Sechenov, specialty - "General Medicine" in 1991, in 1993 "Occupational Diseases", in 1996 "Therapy".