Thursday, 5 December 2013

Neutropenia - Misdiagnosis and Diagnosis

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)
Misdiagnosis and Diagnosis
D.1. Misdiagnosis
1. Kikuchi's disease
Kikuchi's disease is usually a self limiting illness characterised by pyrexia, neutropenia, and cervical lymphadenopathy particularly in young women of Asian descent. This often leads to an initial misdiagnosis of lymphoma(31).

2. Myeloid sarcoma of the spleen
There is a report of a 58-year-old woman presented with a 3-day history of fever and abdominal pain. The results of hematological work-up were consistent with acute myeloblastic leukemia (M2, French-American-British classification). Being susceptible to infection in this leukemic patient with severe neutropenia, a diagnosis of splenic abscess was straightforward, plausibly supported by the radiographic findings. Despite empiric broad-spectrum antibiotic treatment, hyperleukocytosis with resultant pulmonary leukostasis supervened. Histological sections from ultrasound-guided percutaneous core-needle biopsy of the spleen confirmed the diagnosis of myeloid sarcoma. However, delayed leukemia-targeted therapy, unfortunately, resulted in catastrophic mortality(32).

3. Acute myeloblastic leukemia M3v
Splenic abscesses in therapy-resistant acute myeloblastic leukemia presenting as recurrent febrile neutropenia and unresolved splenomegaly, according to the study by the Ankara Oncology Hospital(33).

4. Appendicitis
There is a report of a 13-year-old boy with acute myelogenous leukemia developed 2 episodes of febrile neutropenia during induction therapy. The second one was treated with a 5-day course of parenteral antimicrobial therapy, but the patient then presented with right lower quadrant abdominal tenderness, guarding, and rebound tenderness. Abdominal ultrasonography and computed tomography revealed appendicitis. Conservative medical management was unsuccessful, and appendectomy was performed 5 days after appendicitis was diagnosed(34).

D.2. Diagnosis
If you are experience of certain symptoms above, after a complete physical examination and recording family and health history, the tests which your doctor order may include
1. A complete blood count, or CBC
It is also known as  also known as full blood count (FBC) or full blood exam (FBE) or blood panel with an aim to check for information of the concentration of white blood cells, red blood cells, and platelets in the blood of a patient's blood

2. Bone Marrow biopsy
The procedure of bone marrow biopsy involves the use of a syringe to withdraw a sample of liquid bone marrow (aspiration) from the hip bone and then checking the samples for any abnormality of neutrophils.

Other tests may also be necessary, depending to the underlined causes of the diseases of which include(35)

4. Test for antineutrophil antibodies
5. Autoantibody screen, 
6. Vitamin B12 and folate assays
7. Acidified serum test, and tests for detecting systemic lupus erythematosus.   

No comments:

Post a comment