Diagnosis of neutropenia

Neutropenia is defined as a reduction of the absolute neutrophil count below the normal range. However, the normal concentration is influenced by gender, age, physiological status, and ethnic origin. To avoid a misdiagnosis of neutropenia, it is imperative that any definition of the normal range takes account of these factors. For example, the normal neutrophil count for an adult Caucasian male is usually between 1.5 * 109 and 6.5 * 109/l, and for females it is between 1.8 * 109 and 7.4 * 109/l. In contrast, the neutrophil count for a normal baby during the first day of life is much higher at 4.8 * 10 9 to 17.1 * 109/l. Many individuals of African, Afro-Caribbean, and Middle Eastern origin have average neutrophil counts that are significantly lower than those of adult Caucasians but can still mount a normal response to infection.

Automated full blood count analyzers have made a great impact on the definition of the normal neutrophil range because of their speed and accuracy in assessing neutrophil numbers. However, in certain circumstances they produce spuriously low counts, for example following excessive clumping of neutrophils in the presence of a paraprotein, and disintegration of neutrophils due to excessive delay between blood withdrawal and analysis. An unexpected neutropenia should always be confirmed on a blood film, which may also provide clues to the likely cause. Bone marrow examination may become necessary in circumstances where history or blood-film examination do not reveal an underlying cause.

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