Pathophysiology

• Commonest cause of a clinically important low neutrophil count in children (<0.5 x 109/L) is myelosuppression due to drugs.

• Primary marrow stem cell failure failure either involving all cell lines or granulopoiesis alone is rare.

• Neutropenia can also be due to less serious inherited deficiencies of neutrophil production where neutropenia can be variable or cyclical and the problem seems to be one of production control rather than primary stem cell failure.

• Probably due to cytokine disturbances, several microbial infections can cause paradoxical neutropenia, particularly in neonates but also in older children.

• Autoimmune causes of neutropenia can arise in infancy or later in childhood.

• Isoimmune neutropenia in the newborn—due to maternal anti-neu-trophil antibodies and analogous to HDN.

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