General mechanisms of neutropenia

Under normal physiological conditions, a stable equilibrium exits between marrow neutrophil production and peripheral utilization. Neutropenia occurs when neutrophil production by the marrow is outpaced by peripheral utilization. For example, abnormalities of hemopoietic stem cell development and decreased proliferation of neutrophil precursors in the marrow can reduce neutrophil production. Conversely, decreased neutrophil survival in the peripheral circulation owing to infection or immune destruction can also give rise to neutropenia. Many authors have classified neutropenia into broad categories of decreased production and increased elimination, akin to the classification of anemia. However, since specific pathophysiological mechanisms remain poorly defined for most neutropenias, these attempts have met with limited success. Here, acquired neutropenias, which account for the majority of clinical cases, will be considered separately from inherited neutropenias. Disorders of neutrophil function will also be discussed briefly.

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