Leukopenia

Background

• Low or absent white blood cell count
  • Neutropenia is a subset

Clinical Features

• Immunosuppression--> increase risk of infection, including opportunistic pathogens
• +/- signs/symptoms of underlying disease

Differential Diagnosis

• Malignancy (infiltration in leukemia, myeloproliferative disorders or bony metastases)
• B12 or folate deficiency
• Aplastic anemia
• Infection
  • Sepsis
  • Acute viral infection (e.g. URI, influenza, HIV)
  • HIV/AIDS
  • Typhoid, dengue, malaria, rickettsia, lyme
• Autoimmune disorders (e.g. SLE, Crohn's, RA)
• Drugs/tox
  • Chemotherapeutics (antineoplastics, hydroxyurea, methotrexate)
  • Radiation exposure
  • Clozapine, chlorpromazine
  • Phenytoin
  • Sulfonamides, penicillin, cephalosporins, antiretrovirals
  • Cimetidine
• Hypersplenism/splenic sequestration
• Miscellaneous
  • Congenital, cyclic, "chronic benign neutropenia"

Evaluation

• Assess for infection
• Further evaluation dependant on presentation

Management

• Low threshold for empiric antimicrobials if any concern for infection
• May need only outpatient specialist referral if otherwise asymptomatic

Disposition

• Dependant on presentation

See Also

• Pancytopenia
• Neutropenia
• Immunocompromised antibiotics
• Aplastic anemia