Yıl: 2021 Cilt: 8 Sayı: 3 Sayfa Aralığı: 236 - 242 Metin Dili: İngilizce DOI: 10.14744/nci.2020.65624 İndeks Tarihi: 27-05-2022

Etiological causes and prognosis in children with neutropenia

Öz:
OBJECTIVE: Neutropenia is defined as an absolute neutrophil count (ANC) below 1500/mm3 in the peripheral blood and is a common condition in childhood. In this study, underlying etiological causes and prognoses in children in follow-up due to neutropenia were analyzed to form a guide for physicians working in primary health care institutions. METHODS: The medical records of pediatric patients who were followed up as an inpatients or outpatients due to neutropenia between October 2014 and October 2017 were reviewed retrospectively. RESULTS: A total of 94 patients were included in the study with a median age of 24 (8–77) months. The median ANC at the time of admission was 600 (300–970)/mm3. The ANC was 0–500/mm3 in 34 patients (36.2%), 500–1000/mm3 in 36 patients (38.3%), and 1000–1500/mm3 in 24 patients (25.5%). Of the total, 43 patients (45.7%) were followed up as inpatients and 51 (54.3%) were followed as outpatients. Fifty-five patients (58.5%) were diagnosed with post-infectious neutropenia. The most common focus of infection was the upper respiratory airway (38.4%). The etiological cause could not be identified in 23 (24.6%) patients, neutropenia developed during drug use in 6 patients (6.3%), 5 patients (5.3%) were diagnosed with Vitamin B12 deficiency (Vitamin B12 level: 168 [129–174] pg/ml, the levels were studied in 48 patients), 2 patients (2%) were diagnosed with chronic benign neutropenia, 1 patient (1.1%) was diagnosed with immune deficiency, 1 patient (1.1%) was diagnosed with autoimmune lymphoproliferative syndrome, and 1 patient (1.1%) was diagnosed with hemophagocytic lymphohistiocytosis secondary to a previous infection. No patient was diagnosed with congenital neutropenia. A total of 91 patients (96.8%) recovered from the neutropenia. Neutropenia did not improve in 3 patients (3.2%). One patient was lost due to infection. CONCLUSION: Etiological cause can be shown in approximately 75% of neutropenic children. The most common etiological cause is infection. Drug use, nutritional deficiencies, and chronic benign neutropenia are less common causes of neutropenia. The clinical course is largely benign and the mortality rate is very low.
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Bouma G, Ancliff PJ, Thrasher AJ, Burns SO. Recent advances in the understanding of genetic defects of neutrophil number and function. Br J Haematol 2010;151:312–26.
  • 2. Dinauer MC, Newburger PE. The phagocyte system and disorders of granulopoiesis and granulocyte function. In: Nathan DG, Orkin SH, Ginsburg D, Look AT, Fisher D, Lux SE, editors. Nathan and Oski’s hematology of infancy and childhood. 7th ed. Philadelphia, PA: WB Saunders Company; 2008. p.1109–217.
  • 3. Segel GB, Halterman JS. Neutropenia in pediatric practice. Pediatr Rev 2008;29:12–23.
  • 4. Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP. Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences. Ann Intern Med 2007;146:486–92.
  • 5. Bonilla MA, Menell JS. Disorders of white blood cell. In: Fish J, Lipton J, Lanzkowsky P, editor. Manual of pediatric hematology and oncology. 6th ed. New York: Churchill Livingstone; 2016. p. 209–39.
  • 6. Lyall EG, Lucas GF, Eden OB. Autoimmune neutropenia of infancy. J Clin Pathol 1992;45:431–4.
  • 7. Jonsson OG, Buchanan GR. Chronic neutropenia during childhood. A 13-year experience in a single institution. Am J Dis Child 1991;145:232–5.
  • 8. Bux J, Behrens G, Jaeger G, Welte K. Diagnosis and clinical course of autoimmune neutropenia in infancy: analysis of 240 cases. Blood 1998;91:181–6.
  • 9. Lalezari P, Khorshidi M, Petrosova M. Autoimmune neutropenia of infancy. J Pediatr 1986;109:764–9.
  • 10. Wang LY, Wang CL, Chu CC, Lee HL, Ho HT, Liang DC, et al. Primary autoimmune neutropenia in children in Taiwan. Transfusion 2009;49:1003–6.
  • 11. Husain EH, Mullah-Ali A, Al-Sharidah S, Azab AF, Adekile A. Infectious etiologies of transient neutropenia in previously healthy children. Pediatr Infect Dis J 2012;31:575–7.
  • 12. Coates TD. Overview of neutropenia in children and adolescents. Available at: https://www.uptodate.com/contents/overview-of-neutropenia- in-children-and adolescents. Accessed Feb 17, 2021.
  • 13. Pascutti MF, Erkelens MN, Nolte MA. Impact of viral infections on hematopoiesis: from beneficial to detrimental effects on bone marrow output. Front Immunol 2016;7:364.
  • 14. Avcı Z, Alioğlu B, Kale Çekinmez E, Malbora B, Özyürek E, Özbek N. The frequency and the causes of leukopenia with hospitalized pediatric patients in Başkent University Adana Hospital. Türk Çocuk Hematoloji Derg 2007;1:37–42.
  • 15. Sheen JM, Kuo HC, Yu HR, Huang EY, Wu CC, Yang KD. Prolonged acquired neutropenia in children. Pediatr Blood Cancer 2009;53:1284– 8.
  • 16. Gaudichon J, Cornet E, Minckes O, Bodet D. Fortuitously discovered neutropenia in children: diagnosis and follow-up. [Article in French]. Arch Pediatr 2015;22:822–9.
  • 17. Husain EH, Mullah-Ali A, Al-Sharidah S, Azab AF, Adekile A. Infectious etiologies of transient neutropenia in previously healthy children. Pediatr Infect Dis J 2012;31:575–7.
  • 18. Curtis BR. Non-chemotherapy drug-induced neutropenia: key points to manage the challenges. Hematology Am Soc Hematol Educ Program 2017;2017:187–93.
  • 19. Pick AM, Nystrom KK. Nonchemotherapy drug-induced neutropenia and agranulocytosis: could medications be the culprit? J Pharm Pract 2014;27:447–52.
  • 20. Medrano-Casique N, Tong HY, Borobia AM, Carcas AJ, Frías J, Ramírez E. Nonchemotherapy drug-induced agranulocytosis in children detected by a prospective pharmacovigilance program. Pediatr Hematol Oncol 2016;33:441–56.
  • 21. Ibáñez L, Vidal X, Ballarín E, Laporte JR. Population-based drug-induced agranulocytosis. Arch Intern Med 2005;165:869–74.
  • 22. Andrès E, Mourot-Cottet R, Maloisel F, Séverac F, Keller O, Vogel T, et al. Idiosyncratic drug-induced neutropenia & agranulocytosis. QJM 2017;110:299–305.
  • 23. Pisciotta AV. Drug-induced agranulocytosis. Peripheral destruction of polymorphonuclear leukocytes and their marrow precursors. Blood Rev 1990;4:226–37.
  • 24. Salama A, Schütz B, Kiefel V, Breithaupt H, Mueller-Eckhardt C. Immune- mediated agranulocytosis related to drugs and their metabolites: mode of sensitization and heterogeneity of antibodies. Br J Haematol 1989;72:127–32.
  • 25. Kiatboonsri P, Richter J. Dipyrone trials in Thailand. Lancet 1989;2:107.
  • 26. Akyay A, Deveci U. Metamizole related granulocytopenia and agranulocytosis: An analysis of 13 children. Turgut Ozal Med Cent 2015;22:86–9.
  • 27. Farruggia P. Immune neutropenias of infancy and childhood. World J Pediatr 2016;12:142–8.
  • 28. Bux J, Mueller-Eckhardt C. Autoimmune neutropenia. Semin Hematol 1992;29:45–53.
  • 29. Fioredda F, Calvillo M, Burlando O, Riccardi F, Caviglia I, Tucci F, et al. Infectious complications in children with severe congenital, autoimmune or idiopathic neutropenia: a retrospective study from the Italian Neutropenia Registry. Pediatr Infect Dis J 2013;32:410–2.
APA Özdemir Z, düzenli kar y, Kasacı B, Bör Ö (2021). Etiological causes and prognosis in children with neutropenia. , 236 - 242. 10.14744/nci.2020.65624
Chicago Özdemir Zeynep Canan,düzenli kar yeter,Kasacı Bilge,Bör Özcan Etiological causes and prognosis in children with neutropenia. (2021): 236 - 242. 10.14744/nci.2020.65624
MLA Özdemir Zeynep Canan,düzenli kar yeter,Kasacı Bilge,Bör Özcan Etiological causes and prognosis in children with neutropenia. , 2021, ss.236 - 242. 10.14744/nci.2020.65624
AMA Özdemir Z,düzenli kar y,Kasacı B,Bör Ö Etiological causes and prognosis in children with neutropenia. . 2021; 236 - 242. 10.14744/nci.2020.65624
Vancouver Özdemir Z,düzenli kar y,Kasacı B,Bör Ö Etiological causes and prognosis in children with neutropenia. . 2021; 236 - 242. 10.14744/nci.2020.65624
IEEE Özdemir Z,düzenli kar y,Kasacı B,Bör Ö "Etiological causes and prognosis in children with neutropenia." , ss.236 - 242, 2021. 10.14744/nci.2020.65624
ISNAD Özdemir, Zeynep Canan vd. "Etiological causes and prognosis in children with neutropenia". (2021), 236-242. https://doi.org/10.14744/nci.2020.65624
APA Özdemir Z, düzenli kar y, Kasacı B, Bör Ö (2021). Etiological causes and prognosis in children with neutropenia. İstanbul Kuzey Klinikleri, 8(3), 236 - 242. 10.14744/nci.2020.65624
Chicago Özdemir Zeynep Canan,düzenli kar yeter,Kasacı Bilge,Bör Özcan Etiological causes and prognosis in children with neutropenia. İstanbul Kuzey Klinikleri 8, no.3 (2021): 236 - 242. 10.14744/nci.2020.65624
MLA Özdemir Zeynep Canan,düzenli kar yeter,Kasacı Bilge,Bör Özcan Etiological causes and prognosis in children with neutropenia. İstanbul Kuzey Klinikleri, vol.8, no.3, 2021, ss.236 - 242. 10.14744/nci.2020.65624
AMA Özdemir Z,düzenli kar y,Kasacı B,Bör Ö Etiological causes and prognosis in children with neutropenia. İstanbul Kuzey Klinikleri. 2021; 8(3): 236 - 242. 10.14744/nci.2020.65624
Vancouver Özdemir Z,düzenli kar y,Kasacı B,Bör Ö Etiological causes and prognosis in children with neutropenia. İstanbul Kuzey Klinikleri. 2021; 8(3): 236 - 242. 10.14744/nci.2020.65624
IEEE Özdemir Z,düzenli kar y,Kasacı B,Bör Ö "Etiological causes and prognosis in children with neutropenia." İstanbul Kuzey Klinikleri, 8, ss.236 - 242, 2021. 10.14744/nci.2020.65624
ISNAD Özdemir, Zeynep Canan vd. "Etiological causes and prognosis in children with neutropenia". İstanbul Kuzey Klinikleri 8/3 (2021), 236-242. https://doi.org/10.14744/nci.2020.65624