Neutropenia is a disease characterized by an abnormally low number of neutrophils. Neutrophils usually constitute 50-70% of circulating white blood cells and serve as the main defense against infection, destroying bacteria in the blood. Thus, patients with neutropenia are more susceptible to bacterial infection.
In early childhood, neutropenia occurs quite often, and although in most cases it is easy and not treatable, they still require timely detection, differential diagnosis and optimal tactics for patients.
Neutropenia - Causes of occurrence
Acute neutropenia (formed within a few hours or days) can develop as a result of rapid consumption, destruction or disruption of production of neutrophils. Chronic neutropenia (duration of months and years), as a rule, is due to a decrease in the production of cells or their excessive sequestration in the spleen. Neutropenia can be classified as primary in the presence of internal deficiency of myeloid cells in the bone marrow or as a secondary one (due to the influence of external factors on the bone marrow myeloid cells).
Neutropenia - Symptoms
Neutropenia can go unnoticed, but with the development of severe infection or sepsis in the patient, they manifest. Some common infections can take an unexpected course in patients with neutropenia (pus formation).
Some common symptoms of neutropenia include fever and frequent infections. These infections can lead to mouth sores, diarrhea, burning sensation when urinating, unusual redness, pain or swelling around the wound, sore throat.
Neutropenia - Diagnosis
Diagnostic tactics in detecting neutropenia in a young child can be as follows:
- exclusion of the transient nature of neutropenia (association with a recently transferred viral infection, re-examination through 1-2 weeks)
- search for signs that exclude the possibility of HDDV:
- severe course of the disease (frequent bacterial infections, febrile conditions, physical development disorders, etc.)
- presence of life-threatening infections in the anamnesis
- the level of neutrophils is less than 200 / μl. since birth
- hepato- or splenomegaly
- hemorrhagic syndrome.
If none of these signs is present, then the most probable diagnosis is HDVD. If there is at least one, you should look for other causes of neutropenia.
The nature and volume of laboratory examinations of a patient with neutropenia depends not so much on the severity of neutropenia as on the frequency and severity of the infections associated with it.
For patients with HDI, an important point is the documentation of the duration of neutropenia for more than 6 months, the absence of other changes in the hemogram, and an increase in the level of neutrophils during intercurrent infections.
The minimum diagnostic program for isolated neutropenia also includes the determination of the level of immunoglobulins in the blood.
Bone marrow puncture may be required to exclude other diseases.
It is routine to determine the level of antinea-trophic antibodies in patients with HDVD in the blood, since it is not possible to identify them all. On the other hand, when suspected of secondary autoimmune neutropenia, these tests, like the determination of other autoantibodies, should be carried out. Determination of the titer of antibodies to NA1 and NA2 in the blood serum of the child and mother can be useful for confirming the diagnosis of isoimmune neutropenia.
Congenital neutropenia may require genetic testing.
The management of patients with early childhood with CDDV provides, first of all, an explanation of the problem to parents, in order to avoid unnecessary anxiety on their part. Recommend to pay more attention to oral hygiene of the child for the prevention of stomatitis, gingivitis. Prophylactic vaccinations are carried out according to the calendar, it is recommended also to vaccinate children in addition to influenza, pneumococcal and meningococcal infections. In the overwhelming majority of cases, HDI does not require any other measures.
Neutropenia - Types of the disease
There are three degrees of severity of neutropenia based on the absolute number of neutrophils (ANC) measured in cells per microliter of blood:
- mild neutropenia (1000 ≤ ANC <1500) - minimal risk of infection
- moderate neutropenia (500 ≤ ANC <1000) - moderate risk of infection
- Severe neutropenia (ANC <500) is a serious risk of infection.
Neutropenia - Treatment
Treatment of the disease depends on the reason for which it arose. Therefore, treat the infection, which led to the development of neutropenia. Depending on the severity and form of the disease, the doctor decides whether to treat neutropenia in the hospital or at home. The main emphasis is on strengthening the immune system. From drugs used antibiotics, vitamins, medicines to strengthen immunity. In very severe form, the patient is placed in an isolated room where sterility is maintained and ultraviolet irradiation is carried out.
Neutropenia - Complications
There are many ways, based on common sense, in order to reduce the risk of complications when undergoing treatment, for example:
- Avoid crowded places, especially patients
- vaccinate against influenza and other diseases
- carefully observe the rules of hygiene - wash your hands as often as possible
- do not eat raw eggs and seafood. Remember that the side effects of antiviral therapy are best treated with the help of medical specialists and that the treatment of neutropenia is a complex process requiring the participation of a physician.
Neutropenia - Prevention
Antibacterial drugs are prescribed only if a child has a hotbed of bacterial infection, and if there is neutropenia and fever without a clear foci of infection.
With frequent recurrences of bacterial infection, prophylaxis with trimethoprim / sulfometaxazole is suggested, but the dose, course duration, efficacy and safety of this method have not been studied.
Frequent repeated infections, resistant to antibiotic therapy, and certain forms of congenital neutropenia are indications for the use of G-CSF and intravenous immunoglobulins.
Glucocorticoids can increase the level of neutrophils. However, their use in neutropenia can be justified only in the case of ineffectiveness of all other methods, and as a whole is the exception rather than the rule. It is strictly recommended not to prescribe glucocorticoids to children with uncomplicated HDDN in order to correct the level of neutrophils.