Neutrophils

Low neutrophils

• Causes
  • Infection – EBV, HBV, HCV, HIV
  • Ethnic variation – Afro-Carribean, SE Asian
  • Medications – Phenytoin, Carbimazole, Antipsychotics, Clotrimoxazole
  • Endocrine – Thyroid
  • Malignancy – marrow infiltration, myeloma, post chemoradiotherapy
  • Connective tissue disease – RA, Gout
  • Autoimmune disease
  • Deficiency – B12, Folate, Iron
  • Alcohol excess
  • Liver disease – Cirrhosis

• Assess severity
  • 1-1.5 x 109/L
    • Bloods: FBC/blood film, B12, folate, ferritin, ANA
    • Repeat in 4 weeks
    • Refer
      • Persistent
      • Other FBC abnormalities
      • Recurrent infections/ulcers
  • <1 x 109/L
    • Well and afebrile
      • Bloods: FBC/blood film, B12, folate, ferritin, ANA
      • Repeat in 1 week
      • Refer
        • Persistent
    • Unwell, febrile, chemotherapy, lymphadenopathy, splenomegaly, other cytopenia
      • Emergency referral

Raised neutrophils

• Causes
  • Infection – bacterial, some viral (VZV, HSV), fungal, parasitic
  • Medications – steroids
  • Malignancy – carcinoma, lymphoma, leukaemia
  • Connective Tissue Disease – RA, Gout
  • Haemorrhage, Haemolysis, Hypoxia, Infarction, Tissue damage
• Repeat FBC in 4 weeks with inflammatory markers
• Refer
  • >15 x 109/L
  • Splenomegaly
  • Other FBC abnormalities
  • Persistent