History

A 33 year-old woman is referred to your outpatient hematology clinic for evaluation of neutropenia. The neutropenia dates back to her childhood but was first formally assessed 11 years ago by a hematologist. Work up at the time included testing for autoimmune disease, which was negative. She had blood drawn three times/week for 6 weeks to rule out cyclic fluctuations in her counts. A bone marrow biopsy was performed and the results were reportedly normal. She never developed a serious infection, nor did she receive G-CSF at any point. Past absolute neutrophil counts have ranged from 0.5-1.0 x 109/L. When you see her, she denies any history of recurrent infections, mouth ulcers, fevers, night sweats, dry mouth, dry eyes, or skin rash. She does complain of hair loss, morning stiffness in her hands, and unintentional weight loss of 10 pounds over the last 12 months. The patient has no other active medical problems. There is no family history of neutropenia or other hematological condition. Her mother has a history of Hashimoto’s thyroiditis. She is a non-smoker and denies any alcohol intake. She works in software. She is not taking any medications and has no known allergies to drugs.

Let’s return to the classification of neutropenia.

  • Chronic vs acute:
    • Chronic or persistent; lasting > 3 months and documented on 3 separate occasions
    • Acute or transient; lasting < 3 months
  • Congenital vs. acquired
  • Severity:
    • Mild 1-1.5 × 109/L
    • Moderate 0.5-1 × 109/L
    • Severe < 0.5 × 109/L
    • Most severe/agranulocytosis ≤ 0.2 × 109/L
  • Isolated neutropenia vs. neutropenia associated with other abnormalities in the complete blood count.

This patient’s past absolute neutrophil counts have ranges from 0.5-1.0 x 109/L. Thus, she has chronic, moderate neutropenia, possibly congenital or acquired in etiology.

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