Clinical features—when severe neutropenia: throat/mouth infection, oral ulceration, septicaemia.

Diagnosis—examine peripheral blood film, check haematinics, autoimmune profile, anti-neutrophil antibodies, haematinics, bone marrow aspirate and trephine biopsy if indicated (e.g. severe or prolonged neutropenia, or features suggestive of infiltration of marrow failure syndrome).

Treatment—consists of prompt antibiotic therapy if infection, IVIg and corticosteroids may be helpful but effects unpredictable. In seriously ill patients consider use of G-CSF (need to exclude underlying leukaemia before starting therapy with growth factors). Consider prophylaxis with low dose antibiotics (e.g. ciprofloxacin 250mg bd) and antifungal (e.g. fluconazole 100mg od) agents. Drug-induced neutropenia usually recovers on stopping suspected agent (may take 1-2 weeks).

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