• Neutropenia can result from three major mechanisms:
Low neutrophil production/differentiation in bone marrow (eg, drug-associated, infection, nutritional deficiency) Redistribution of circulating neutrophils to the vascular endothelium ("margination") or to the spleen Immune destruction (eg, drug reaction, autoimmunity) Neutropenia can be categorized as
>1,500/mm3 Normal 1,000-1,500 Less chances for infection 500-1,000 Possibility of infection. <500 High chances of infection. Few clinical signs of infection may present . Treatment with IV antibiotics.
<200 The inflammatory process will be absent.
ANC; Absolute Neutrophil Counts Bone marrow study
• The gold standard for diagnosing the ability of bone
marrow to produce neutrophils is by examination of a bone marrow aspirate and marrow biopsy specimen. Bone marrow neutrophil production is considered to be adequate if the cellularity and maturation of the neutrophil series is normal or increased. In contrast, reduced bone marrow cellularity or myeloid arrest at the myelocyte or metamyelocyte stage indicates decreased bone marrow ability. Management Rigorous oral hygiene - Oral antifungal agents, Chlorhexidine mouth wash To prevent infections - Oral trimethoprim- sulfamethoxazole (160/800 mg) BD During fever – Anti pseudomonas / MRSA antibiotic agents – Ceftazidime / Piperacilline - Tazobactum + Vancomycin to cover infection from skin Colony stimulating factors ( CSF ) Colony stimulating factors ( CSF ) Granulocyte CSF ( G-CSF ) - Filgrastim (Grafeel ®, Neupogen ® ) 5 mcg/kg /day SC injection GM-CSF is used to stimulate the production of white blood cells following chemotherapy / drug induced neutropenia. The duration of treatment is usually 14 days, or Continue until absolute neutrophil count is 10,000//mm3 Filgrastim is also indicated for reducing the time to neutrophil recovery and the duration of fever, following induction or consolidation chemotherapy treatment of adults with AML. Cancer Patients Receiving Bone Marrow Transplant - The recommended dose of filgrastim following BMT is 10 mcg/kg/day given as an IV infusion of 4 or 24 hours‚ or as a continuous 24-hour SC infusion. • GM-CSF – Molgramostim(GM-CSF), sargramostim ANC: absolute neutrophil count; C. difficile: Clostridium difficile.