{"id":4177,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/neutropenia\/"},"modified":"2024-09-04T14:50:13","modified_gmt":"2024-09-04T13:50:13","slug":"neutropenia","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/haematology\/neutropenia\/","title":{"rendered":"Neutropenia"},"content":{"rendered":"\n<h4 class=\"wp-block-heading\">Definition <\/h4>\n\n\n\n<p>Isolated neutrophil count below 1.5 x 10<sup>9<\/sup>\/l. (A neutrophil count of between 1-5-2.0 x 10<sup>9<\/sup>\/l whilst below the normal range is unlikely to be of any clinical significance).<\/p>\n\n\n\n<p>Patients with mild neutropenia (&gt;1) are not generally at any increased risk of infection.<\/p>\n\n\n\n<p>Drugs most often associated with neutropenia include antipsychotics, sulphonylureas, propylthiouracil, carbimazole, sulphonamides, co-trimoxazole, bendroflumethiazide, anticonvulsants, NSAIDs and ranitidine.<\/p>\n\n\n\n<p><strong>C.M &amp; L.W 31-07-23<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><strong>Who to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Neutrophil count &lt;0.5 and evidence of sepsis &#8211; contact the on-call haematology registrar for urgent advice<\/li>\n\n\n\n<li>Neutrophil count &lt;1 on repeat testing<\/li>\n\n\n\n<li>Neutrophil count &lt;2 on repeat testing and the presence of any of the clinical findings as described above.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer<\/strong>:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>People of Afro-Caribbean or Middle Eastern ethnicity have a lower normal range for the neutrophil count (constitutional or ethnic neutropenia). This is of no clinical consequence. Such patients should only be investigated if their neutrophils are &lt;1.0 on repeat testing. No further monitoring required.<\/li>\n\n\n\n<li>Neutrophil counts consistently &gt;1.5. These patients can be given the diagnosis of <strong>chronic idiopathic neutropenia.<\/strong> No further monitoring is required.<\/li>\n\n\n\n<li>Neutrophil count &gt;1 but &lt;1.5 repeat at 6 months. If clinical features of concern develop or neutrophil counts falls &lt;1 refer to haematology. Otherwise patients can be given a diagnosis of chronic idiopathic neutropenia and no further routine monitoring is required.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>How to refer<\/strong>:<\/h4>\n\n\n\n<p>SCI gateway to the Department of Haematology WGH or SJH.<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>For all:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assess patient for symptoms e.g. recurrent infections, mouth ulcers etc.<\/li>\n\n\n\n<li>Establish if patient is of an ethnic background known to be associated with lower neutrophil counts (See \u2018Who not to refer\u2019).<\/li>\n\n\n\n<li>Review medication (see above)<\/li>\n\n\n\n<li>Examine for lymphadenopathy and splenomegaly<\/li>\n\n\n\n<li>Repeat FBC:<ul><li>If neutrophil &gt;1 then repeat at 6 weeks<\/li><\/ul>\n<ul class=\"wp-block-list\">\n<li>If neutrophil count &lt;1 repeat at 1 week.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong><u>For persistent neutropenia do the following tests<\/u><\/strong>:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Blood film<\/li>\n\n\n\n<li>B12 and folate, Ferritin. Treat if deficiency is detected<\/li>\n\n\n\n<li>HIV, HBV, HCV serology<\/li>\n\n\n\n<li>If additional clinical features to suggest a diagnosis of SLE, RA or other connective tissue disorder check CCP, ANF, dsDNA (if ANF positive).<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Neutropenia in primary care. Hay et al. BMJ. 2014 Sep 11;349.<\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Definition Isolated neutrophil count below 1.5 x 109\/l. (A neutrophil count of between 1-5-2.0 x 109\/l whilst below the normal range is unlikely to be of any clinical significance). Patients with mild neutropenia (&gt;1) are not generally at any increased risk of infection. Drugs most often associated with neutropenia include antipsychotics, sulphonylureas, propylthiouracil, carbimazole, sulphonamides,<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3981,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[267],"class_list":["post-4177","page","type-page","status-publish","hentry","category-neutropenia"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/haematology\/neutropenia\/\" rel=\"tag\">Neutropenia<\/a>","rttpg_excerpt":"Definition Isolated neutrophil count below 1.5 x 109\/l. (A neutrophil count of between 1-5-2.0 x 109\/l whilst below the normal range is unlikely to be of any clinical significance). Patients with mild neutropenia (&gt;1) are not generally at any increased risk of infection. Drugs most often associated with neutropenia include antipsychotics, sulphonylureas, propylthiouracil, carbimazole, sulphonamides,","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4177","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4177"}],"version-history":[{"count":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4177\/revisions"}],"predecessor-version":[{"id":20705,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4177\/revisions\/20705"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3981"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4177"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}