Neutropenia In Children (Agranulocytosis In Children)

Neutropenia In Children
Body Parts: Whole Body
Medical Subjects: Children's Health Blood Genetic disease

What Is Neutropenia In Children?

What are neutrophils?

Neutrophils are derived from the granulocyte lineage of hematopoietic stem cells. They mature in the bone marrow and enter the blood circulation, and can escape the blood vessel wall to enter tissues or inflammation sites. They have chemotaxis, phagocytosis and bactericidal effects.

What is neutropenia in children?

Absolute values of neutrophils vary with age and race. In yellow and white, the normal low limit is 1.0 × 109/L for neonates and infants under 1 year of age and 1. 5 x 9/L for children over 1 year of age. Agranulocytosis is defined as a severe decrease in granulocytes less than < 0.5 × 109/L.

Is neutropenia common in children?

Neutropenia in children is uncommon and includes chronic neutropenia that usually develops within 1 year of age (2 to 54 months) and resolves at 2 to 4 years of age. The incidence is < 1 in 10 000 in pediatric patients.

Severe congenital neutropenia (SCN) is a rare disorder of hematopoiesis with an incidence of approximately 1 in 200,000.

Is neutropenia and leukopenia the same disease?

Leukopenia and neutropenia are not the same disease. White blood cells can be divided into neutrophils, eosinophils, basophils, lymphocytes, and monocytes.

  • The leukopenia may be one or more of leukopenia caused by a decrease in the number of cells.
  • Neutropenia refers to that the neutrophil count is less than the normal range, and is not related to other cell count decreases.

However, neutropenia occurs in almost all patients with leukopenia.

How is neutropenia in children graded?

Neutropenia is generally classified as mild, moderate, or severe according to the level of ANC:

  • Mild: ANC 1.0–1.5× 109/L
  • Moderate: ANC 0.5–1.0× 109/L
  • Severe: ANC < 0.5× 109/L

At ANC < 1.0 × 109/L, the risk of infection begins to increase, but the risk also depends on the adequacy of the myeloid granulocyte reservoir.。

How is neutropenia in children classified?

Neutropenia in children can be classified as acquired neutropenia and severe congenital neutropenia (SCN). Acquired neutropenia can be divided into chronic neutropenia and transient neutropenia.


What Is The Cause Of Neutropenia In Children?

What are the common causes of neutropenia in children?

Neutropenia in children is divided into three aspects according to the different causes and action sites:

Acting on bone marrow

  • Bone marrow injury: drugs, radiation, chemicals such as benzene, DDT, and arsenic acid, immunological diseases, decrease of certain congenital and hereditary neutrophils, and infection;
  • Maturity disorders.

Acting on peripheral blood

  • Conversion of neutral extracellular circulation pool to marginal pool intravascular detention

Acting on extravascular

  • Severe bacterial, viral, fungal infections and allergic diseases, hypersplenism.

What are the normal conditions of neutropenia in children?

Neutropenia occurs in the normal population, which is medically referred to as benign familial (ethnic) neutropenia, and is present in multiple ethnic groups, including Yemeni Jews, black people of South African descent, West Indians, and Arabs and Jordanians.

These populations had normal bone marrow reserves and no other abnormal symptoms other than granulocytopenia, and did not require treatment and follow-up. However, it should be distinguished from granulocytopenia caused by other causes.

Which children are susceptible to neutropenia?

Children with poor immune ability are prone to neutropenia caused by virus infection. Patients taking antiepileptic, antibiotic, antithyroid and antirheumatic drugs orally are liable to cause transient neutropenia.

Is neutropenia in children inherited?

Congenital neutropenia is hereditary, such as:

Severe congenital neutropenia is an inherited disease associated with different genes in a way that is still unclear and can be autosomal dominant, autosomal recessive and sexually linked. However, it is generally considered as autosomal recessive inheritance.

Familial or sporadic cases of X-linked recessive inheritance have been reported in patients with neutropenia with immunoglobulin abnormalities.

Neutropenia with congenital malformations such as achondroplasia and Shwachman-Diamond syndrome is an autosomal recessive inherited disease.


What Is The Symptoms Of Neutropenia In Children?

What are the common manifestations of neutropenia in children?

Children with neutropenia present with various forms of infection in various parts of the body and other clinical symptoms, which seriously affect the quality of life of children.

For example, the clinical manifestations of neutropenia caused by drugs are mainly fatigue and easily fatigued, and the severe ones may include chills, sore throat, pneumonia, fever, bone pain, etc.

Severe infection causes neutrophils to drop to below (0.5–1.0) × 109/L, with clinical manifestations of high fever and intolerance of cold.

If the disease is caused by chronic viral hepatitis, the patient will present with fatigue, costalgia, appetite deficiency and nausea.

Headache, dizziness and hypomnesis are mostly caused by chronic benzene poisoning.

How does neutropenia develop in children?

Transient neutropenia The decrease in neutrophil production or increase in destruction caused by drugs, infection, antibodies, and other factors.

Severe congenital neutropenia is an inherited disease associated with different genes and manifests as severe neutropenia and bone marrow maturation disorders.

What are the serious consequences of neutropenia in children?

Drug-induced transient neutropenia (excluding the expected bone marrow suppression associated with tumor chemotherapy) can be classified into mild neutropenia (ANC > 0.5 × 109/L) and life-threatening neutropenia (ANC < 0.2 × 109/L), with a mortality rate of up to 5%.

Children with severe congenital neutropenia usually die within 1 year of age.


How To Check For Children With Neutropenia?

How is it diagnosed that a child has neutropenia?

It is usually found during physical examination or routine examination for other diseases, and the cause is further evaluated by detailed medical history collection and physical examination by the doctor, including routine blood test, hematopoietic ingredients, rheumatology-related examinations, bone marrow aspiration and biopsy.

What tests are needed to diagnose neutropenia in children?

  • Ask for a detailed medical history, patient symptoms, signs, and medications, and decide on follow-up or further tests.
  • Connective tissue disease complete set is mainly used to exclude rheumatic immune disease.
  • Folic acid+vitamin B12 rule out the possibility of leukopenia due to malnutrition and try to do this without oral administration of folic acid and vitamin B12.
  • Color Dopplar ultrasound of liver, gallbladder and pancreas is mainly used to assess the size of spleen and the possibility of hypersplenism.
  • Bone marrow cytology and bone marrow biopsy are mainly used to exclude the presence of hematopoietic failure and pathological hematopoiesis.

Which diseases are easily confused with neutropenia in children?

Neutropenia in children is easily diagnosed. Various etiologies of neutropenia are distinguished primarily by detailed history and laboratory tests.


How To Prevent Neutropenia In Children?

Can neutropenia in children be prevented?

Can prevent and avoid contact with drugs causing leukopenia and toxic and harmful radioactive substances and antibiotics causing leukopenia.

How to prevent neutropenia in children relapse?

Avoid contact with drugs causing leukopenia and toxic and harmful substances, radioactive substances and antibiotics causing leukopenia.

How can children with neutropenia prevent other concurrent diseases?

In children with neutropenia, transient neutropenia usually resolves spontaneously or after treatment for a potential etiology.

  • There were no definite complications, and neutropenia due to medication generally only required discontinuation.
  • Patients with chronic autoimmune/benign neutropenia generally do not require treatment and severe infections are rare.
  • Allogeneic hematopoietic stem cell transplantation is an effective option in patients with severe congenital neutropenia. Graft-versus-host disease may occur and may be prevented or controlled by immunosuppressive agents.


How To Treat Neutropenia In Children?

Which clinic should you visit for neutropenia in children?

Consult a hematologist or pediatric hematologist. Transient neutropenia can resolve itself.

Can neutropenia in children self-heal?

Transient neutropenia can improve by oneself after removing the cause, and the causes for other causes should be analyzed based on the specific cause.

How to treat neutropenia in children?

Treatment varied according to the degree and etiology of neutropenia. It is mainly etiological treatment. For example, stopping taking drugs and contacting suspected toxicants. Infection causes neutropenia and actively controls infection, with drugs that increase white cells when needed.

Does neutropenia in children need hospitalization?

In children with neutropenia, clinical symptoms such as infection and other discomforts may cause hospitalization according to the needs of the disease.

Can neutropenia in children be completely cured?

Depending on the specific etiology, transient neutropenia can be cured after the etiology is removed. Severe congenital neutropenia can be improved by hematopoietic stem cell transplantation and cannot be completely cured.


What Should Children With Neutropenia Pay Attention To In Daily Life?

What should be paid attention to in the diet of children with neutropenia?

In the diet, pay attention to eat more fresh fruits and vegetables. The vegetable do not need to be cook excessively, and that nutritional components of the food are preserved.

A reasonable mix of vegetables and meat. If you are a vegetarian, pay attention to eat more soy products to supplement protein, you can drink milk, eat eggs, pay attention to ensure that the daily intake of milk and eggs.

A balanced diet provide that necessary nutrients and doe not stimulate neutrophil growth.

Leukopenia can also be caused by a lack of nutrients vitamin B12, folic acid, copper, or protein caloric deficiency, but nutritional factors are rarely considered in the diagnosis of the cause of independent neutropenia.

Chronic neutropenia due to nutritional deficiency, usually accompanied by other peripheral blood count abnormalities such as anemia and thrombocytopenia.

What should be paid attention to in life for children with neutropenia?

Pay attention to clean and sanitary in daily life, clean diet, do not eat raw and cold food, leftovers, etc. Drying clothes and bed linen frequently. Wash your hands and mouth frequently.

Does neutropenia in children need reexamination?

Need to review. If there are no symptoms, the disease can be re-examined once every 2 weeks to 1 month during the treatment of primary disease to observe the changes of white blood cells. If the value is stable, can review once in March.

What should be noticed in the nursing of children with neutropenia?

Pay attention to clean diet, and pay attention to disinfection in daily life. When the weather changes, add clothes and reduce clothes in time.

Can neutropenia in children be vaccinated?

Simple neutropenia, children without other pathological diseases, can be vaccinated. Other concomitant decreases in neutrophils will vary depending on the specific condition.

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