Approach to Neutrophilia and Neutropenia

Neutrophilia

The most common causes are:

• Bacterial infection

• Severe stress e.g. trauma, surgery, burns, seizures

• Active inflammation e.g. MI, disseminated malignancy

The less common causes are:

• Corticosteroids

• Myeloproliferative disease (myelofibrosis, polycythaemia vera)

Neutropenia

If isolated, the causes are:

• Viral infections

• Severe sepsis

• Bone marrow failure

• Neutrophil antibodies e.g. SLE, Haemolytic anaemia

It's called agranulocytosis when associated with depleted levels of basophils and eosinophils. This can be caused by Carbamazepine, Carbimazole, Clozapine.

The regimen when treating neutropenic patients is:

• Isolation

• Look for any source of infection

• Avoid IM injections

• Bloods - FBC, U&E, CRP, Platelets, INR, LFT, Cultures