Thursday, 5 December 2013

Neutropenia - The Advises

Neutropenia is defined as a condition of  abnormally low number of neutrophils, as a  result of granulocyte disorder of that leads to Immunodeficiency with lower than normal  circulating white blood cells. Patients with neutropenia are susceptible to bacterial infections causes of neutropenic sepsis.
Neutropenia is either problems in the production of the cells by the bone marrow and destruction of the cells from somewhere else in the body, if  neutrophil count falls below 1,000 cells per microliter of blood.
Neutropenia can be classified into acute and chronic types, depending to the duration of the illness. Some researchers divided severity of the disease, depending to the absolute neutrophil count (ANC) and is described as follows(a).
1. Mild neutropenia, when the ANC falls below a lower limit of 1500 per mm3 (1.5 x 109 /1), but remains higher than 1000 per mm3 (1.0 x 109 /1).
2. Moderate neutropenia, when the ANC falls between 500 per mm3 and 1000 per mm3 (0.5 x 109 /1 - 1.0 x 109 /1)
3. Severe neutropenia, when the ANC falls below 500 per mm3 (0.5 x 109 /1)
F.1. In conventional medicine perspective
F.1.2. Treatments is depending to the underlined causes of the disease, patient with Neutropenia are advised to the lists of below
1. Good oral hygiene and dental care
According to the study in a report of clinical periodontal findings and microflora profiles of 2 children, 1 with severe congenital neutropenia (SCN, Kostmann type) and 1 with cyclic neutropenia (CN), by the Hiroshima University Faculty of Dentistry showed that Use of 1% povidone iodine solution and local antibiotic application under supervised oral hygiene were helpful to improve gingival conditions in patients with chronic neutropenia(51). Other study indicated that in the study of Benign familial neutropenia (BFN), it is a condition where there is a decrease in circulating neutrophils in the blood and patients suffer from oral manifestations which include: persistant periodontal disease, recurrent neutropenic ulceration and candidal infections(52).

2. Others according to the article of WebMD and Medscape include
2.1. WebMD(53)
a. Avoiding contact with sick people
b. Always wearing shoes
c. Cleaning cuts and scrapes, then covering them with a bandage
d. Using an electric shaver rather than a razor
e. Avoiding animal waste and, when possible, not changing infants' diapers
f. Avoiding unpasteurized dairy foods; undercooked meat; and raw fruits, vegetables, grains, nuts, and honey
g. Staying out of hot tubs, ponds, and rivers

2.2. Medscape(54)
a. Remove any offending drugs or agents in cases involving drug exposure: If the identity of the causative agent is not known, stop administration of all drugs until the etiology is established
b. Use careful oral hygiene to prevent infections of the mucosa and teeth
c. Avoid rectal temperature measurements and rectal examinations
d. Administer stool softeners for constipation
e. Use good skin care for wounds and abrasions: Skin infections should be managed by someone with experience in the treatment of infection in neutropenic patients.
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