Neutropenia

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Normal neutrophil count is 2.0 – 7.5X109/L

Neutropenia is classified as:

  • Mild neutropenia 1.0 – 1.8
  • Moderate neutropenia 0.5 – 1.0
  • Severe neutropenia < 0.5

Causes include:

  • Drugs:
    • antipsychotic drugs
    • carbimazole
    • sulpha drugs
    • NSAIDs
    • bendroflumethiazide
    • anticonvulsant
    • H2 Blockers
  • Chemotherapy
  • Radiotherapy
  • Viral infection, acute sepsis
  • Auto-immune conditions

Assessment

  • Careful history and clinical examination for evidence of recurrent infection, medication causes, organomegaly.
  • Repeat FBC and request blood film
  • Auto-immune screen
  • Viral serology for HIV
  • Haematinics

Primary care management

Cases with mild asymptomatic neutropenia is not an indication for referral – chronic idiopathic neutropenia.

In cases of mild neutropenia, recommend annual FBC monitoring. Referral is indicated when neutrophil count falls to less <1.0

Who to refer

Immediate referral for admission

Patients with severe neutropenia with evidence of sepsis require admission via Combined Assessment Unit

Urgent referral

  • Neutropenia with concomitant cytopenia
  • Neutropenia in the presence of adenopathy or splenomegaly

Routine referral

  • Moderate neutropenia; persistent neutrophils of <1.0
  • Neutropenia in association with recurrent infection or other abnormal findings

Editorial Information

Last reviewed: 01/10/2024

Next review date: 01/10/2026

Author(s): Muayed Lasebai, Ranjit Thomas, Paul Ames.

Version: 1.0