Neutropenia

What Is Neutropenia?

Neutropenia (noo-treh-PEE-nee-eh) is when the blood doesn't have enough of a type of white blood cell. These cells, called neutrophils, fight bacteria. Bacteria are germs that cause infections. Without enough neutrophils, serious infections can happen.

Most children with neutropenia need medical care right away if they have any signs of an infection. Common signs include fevers, spreading redness around a cut, and shivering or chills. With quick treatment, most infections in children with neutropenia get better.

What Are the Signs & Symptoms of Neutropenia?

Compared with other kids, a child with neutropenia may have infections:

• more often
• that are more severe
• that get worse quickly

The symptoms depend on what kind of infection the child has (for example, ear pain in a child with an ear infection).

What Causes Neutropenia?

Someone with neutropenia has a low number of neutrophils (NOO-treh-filz) in the bloodstream.

Neutropenia can be due to:

• infections
• medicines (such as chemotherapy)
• radiation therapy
• a genetic (inherited) problem
• the bone marrow (the spongy part inside bones that makes blood cells) not working well
• the germ-fighting immune system attacking the neutrophils (called autoimmune neutropenia)

Neutropenia may:

• be present at birth (congenital neutropenia)
• come and go (cyclic neutropenia)

Sometimes doctors don't know what causes a person's neutropenia (called idiopathic neutropenia).

How Is Neutropenia Diagnosed?

Doctors diagnose neutropenia with a blood test called a complete blood count (CBC).

To find out why a child has neutropenia, a hematologist (a doctor who specializes in blood diseases) will:

• look at the child's blood under a microscope
• take a tiny amount of bone marrow to study under a microscope
• do tests for infections
• do genetic tests

How Is Neutropenia Treated?

Treatment for neutropenia depends on its cause and how severe it is. Not all cases need treatment.

Doctors use the ANC (absolute neutrophil count) to help them make decisions about treatment. The ANC is a blood test that measures the number of neutrophils. The lower the number is, the more likely the child is to get serious infections.

Treatment, when needed, can include:

• correcting the neutropenia through:
  • injections of granulocyte colony-stimulating growth factor (G-CSF) to push the bone marrow to make more neutrophils
  • steroid medicines to stop the body's immune system from attacking the neutrophils
  • white blood cell transfusions to give the child more infection-fighting cells
  • stem cell transplant to replace the blood-forming stem cells with healthy donated stem cells
  • surgical removal of the spleen (splenectomy) because the spleen can sometimes destroy neutrophils
  • preventing and treating infections with antibiotics
• for children with very low neutrophil counts who are at very high risk for infection:
  • avoiding public places, including schools
  • avoiding sick people
  • wearing a face mask if they must go out
  • washing hands well and often
  • brushing and flossing teeth every day
  • not using a rectal thermometer to take a temperature
  • cleaning cuts right after injury, then covering with a bandage
  • not using razors
• avoiding certain foods, including:
  • unpasteurized dairy foods
  • raw fruits, vegetables, and nuts
  • raw honey

How Can Parents Help?

To help your child, follow the doctor's instructions on:

• getting scheduled blood tests
• taking any medicines
• preventing infections

When Should I Call the Doctor?

It's important to find care right away if kids with neutropenia have any signs of infection. Quick treatment usually helps them get better.

Call the doctor right away if you see any signs or symptoms of an infection, such as:

• a fever above 100.4°F (38°C)
• chills and/or sweats
• coughing
• shortness of breath
• mouth sores
• sore throat
• pain when peeing
• red area around a break in the skin
• vomiting or diarrhea
• new pain

What Else Should I Know?

Having a child with a serious medical condition can be a challenge for any family. But you're not alone. Talk to anyone on the care team about ways to find support. You also can visit online sites for more information and support, such as:

• National Neutropenia Network