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Etiological causes and prognosis in children with neutropenia
Zeynep Canan Ozdemir1, Yeter Duzenli Kar1, Bilge Kasaci1
1Division of Pediatric Hematology-Oncology, Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Ekisehir, Turkey.
Insights
In pediatric neutropenia (absolute neutrophil count below 1500/mm³), infection is the most common cause. This study found that most children recover, with a low mortality rate, offering guidance for primary care physicians.
Area of Science:
- Pediatric Hematology
- Clinical Pediatrics
- Infectious Diseases
Background:
- Neutropenia, defined as an absolute neutrophil count (ANC) below 1500/mm³, is a frequent condition in childhood.
- Understanding the causes and outcomes of pediatric neutropenia is crucial for effective clinical management.
Purpose of the Study:
- To analyze the underlying etiological causes and prognoses of neutropenia in children.
- To provide a clinical guide for physicians in primary healthcare settings managing pediatric neutropenia.
Main Methods:
- Retrospective review of medical records of pediatric patients with neutropenia.
- Data collected from inpatients and outpatients between October 2014 and October 2017.
Main Results:
- A total of 94 children were studied, with a median ANC of 600/mm³.
- Post-infectious neutropenia was the most common diagnosis (58.5%), often linked to upper respiratory tract infections.
- Etiological causes were identified in approximately 75% of cases, including infections, drug use, and Vitamin B12 deficiency. No congenital neutropenia cases were found.
- A high recovery rate (96.8%) was observed, with a very low mortality rate.
Conclusions:
- Infections are the primary etiological factor in pediatric neutropenia.
- Less common causes include drug use, nutritional deficiencies, and chronic benign neutropenia.
- The clinical course of pediatric neutropenia is generally benign with a low mortality rate.
Objective:
Neutropenia is defined as an absolute neutrophil count (ANC) below 1500/mm3 in the peripheral blood and is a common condition in childhood. In this study, underlying etiological causes and prognoses in children in follow-up due to neutropenia were analyzed to form a guide for physicians working in primary health care institutions.
Methods:
The medical records of pediatric patients who were followed up as an inpatients or outpatients due to neutropenia between October 2014 and October 2017 were reviewed retrospectively.
Results:
A total of 94 patients were included in the study with a median age of 24 (8-77) months. The median ANC at the time of admission was 600 (300-970)/mm3. The ANC was 0-500/mm3 in 34 patients (36.2%), 500-1000/mm3 in 36 patients (38.3%), and 1000-1500/mm3 in 24 patients (25.5%). Of the total, 43 patients (45.7%) were followed up as inpatients and 51 (54.3%) were followed as outpatients. Fifty-five patients (58.5%) were diagnosed with post-infectious neutropenia. The most common focus of infection was the upper respiratory airway (38.4%). The etiological cause could not be identified in 23 (24.6%) patients, neutropenia developed during drug use in 6 patients (6.3%), 5 patients (5.3%) were diagnosed with Vitamin B12 deficiency (Vitamin B12 level: 168 [129-174] pg/ml, the levels were studied in 48 patients), 2 patients (2%) were diagnosed with chronic benign neutropenia, 1 patient (1.1%) was diagnosed with immune deficiency, 1 patient (1.1%) was diagnosed with autoimmune lymphoproliferative syndrome, and 1 patient (1.1%) was diagnosed with hemophagocytic lymphohistiocytosis secondary to a previous infection. No patient was diagnosed with congenital neutropenia. A total of 91 patients (96.8%) recovered from the neutropenia. Neutropenia did not improve in 3 patients (3.2%). One patient was lost due to infection.
Conclusion:
Etiological cause can be shown in approximately 75% of neutropenic children. The most common etiological cause is infection. Drug use, nutritional deficiencies, and chronic benign neutropenia are less common causes of neutropenia. The clinical course is largely benign and the mortality rate is very low.
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