By: Roger L. Berkow, MD, FAAP & Elaine Morgan, MD, FAAP
Neutropenia is a term that means the body is low on a type of white blood cells called neutrophils. Neutrophils fight infection caused by bacteria, fungi and parasites.
Having fewer neutrophils than normal can make a child more prone to get certain kinds of infections. If your child has neutropenia, it's important to work closely with their doctor and take steps to keep them healthy.
Here are answers to some common questions families may have about neutropenia.
How is neutropenia diagnosed?
Neutropenia is detected with a blood test called a complete blood count (CBC). This test counts the blood cells including the different types of white blood cells.
Neutropenia is classified as mild, moderate, severe or very severe. The classification is based on the number of neutrophils from a blood test. The lower the number of neutrophils, the greater is the risk of serious infection.
What causes neutropenia?
Neutropenia may be caused by certain medications, chemicals, nutrient deficiencies, other illnesses or infections. Neutropenia can also develop when neutrophils are destroyed by the body's immune system.
Sometimes, neutropenia can happen after replacement of the normal bone marrow by cells that do not belong there. While this is a less common cause of neutropenia, it may signal a more serious disease.
More rarely, neutropenia may be a result of a condition which a child is born with, called inherited or congenital neutropenia.
In some children with neutropenia, a specific cause is not identified.
What treatment helps a child with neutropenia?
Most children who have neutropenia that is not inherited only have the condition for a few months. The neutropenia goes away after the cause is addressed. Examples include treating an infection, stopping a medication, replacing a missing vitamin or mineral or treating the illness that is causing the neutropenia.
Some rare inherited causes of neutropenia may result in severe infections or other abnormalities in the bone marrow. Inherited types of neutropenia need to be evaluated by a pediatric hematologist. If neutropenia is severe for a long time, the doctor may prescribe an injectable medication that can stimulate the bone marrow to make more neutrophils. This would be after a medical workup to determine the cause.
What kind of tests can help find the cause of neutropenia?
If your child's doctor is concerned about the neutropenia's severity, they may recommend a
bone marrow test. This test involves looking at the neutrophils in the bone marrow under a microscope. It can evaluate for
leukemia or other types of bone marrow problems. This type of test is especially important if there are abnormal or a low number of different cell types in the blood.
Other tests may be recommended to:
monitor patterns in the neutropenia
measure immune function
check for nutritional problems
look for inherited or non-inherited genetic types of neutropenia
What to watch for if your child has neutropenia
Fever
Seek prompt medical care whenever your child has an elevated temperature. Your child's health care provider may order a CBC to check your child's neutrophil count when they have the fever, a condition called febrile neutropenia. They may also want to order a blood culture test to check for causes of infection. Culture tests to check for germs in other locations such as the urine or the throat, may also be needed.
Fortunately, common viral infections like
colds are usually not a significant risk in children with neutropenia and usually do not require specific treatment. Treatment of the febrile neutropenic patient should be determined by the primary treating team.
Based on your child's neutrophil count at the time of the fever, your child may be given intravenous (IV) antibiotics. They may also be
admitted to the hospital.
Mouth sores
Mouth ulcers (sores) can be common in children with severe neutropenia. That makes good oral hygiene extra important. Brush teeth with a soft bristle toothbrush and fluoride toothpaste twice daily. In older children who can swish liquids in their mouth and spit, mouth rinses with salt water or sodium bicarbonate water twice daily can be helpful.
Broken skin
Any area on the body with skin breakdown (especially in the genital and rectal area) or redness need medical attention. Ongoing attention to skin care, including gentle cleansing with soap and water, also is important.
Remember
By working with your child's health care team, you can help protect your child from infections.
About Dr. Berkow
Roger L. Berkow, MD, FAAP is a pediatric hematologist and a Professor of Pediatrics at Morehouse School of Medicine.
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About Dr. Morgan
Elaine Morgan, MD, FAAP, is a pediatric hematologist/oncologist at Lurie Children’s Hospital of Chicago.
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Editor’s note: Mary-Jane Staba Hogan, MD, MPH, FAAP, an Associate Clinical Professor of Pediatric Hematology Oncology at Yale University School of Medicine, also contributed to this article.