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)
Complications and diseases associated to Neutropenia
C.1. Complications
1. Unstable hemodynamic status,
respiratory distress, altered mental status, newly developed arrhythmia
that required intervention, and death
In the study to evaluate associations between the risk factors and serious complications in patients presenting to the ED with febrile neutropenia by reviewing the health information system database to identify a retrospective cohort of patients with febrile neutropenia who visited the ED of a tertiary medical hospital from January to December 2008, showed that serious complications
during hospitalization were defined as unstable hemodynamic status,
respiratory distress, altered mental status, newly developed arrhythmia
that required intervention, and death during hospitalization. Only episodes of febrile neutropenia caused by chemotherapy for underlying cancer were included(22).
2. High risk for septic complications
In the study to evaluate pentraxin 3 as a marker for complications
of neutropenic fever in 100 hematologic patients receiving intensive
chemotherapy with Pentraxin 3 and C-reactive protein measured at fever
onset and then daily to day 3, showed that in comparison to C-reactive protein, pentraxin 3 achieved its maximum
more rapidly. Pentraxin 3 correlated not only with the same day
C-reactive protein but also with the next day C-reactive protein. High
pentraxin 3 on day 0 was associated with the development of septic shock (P=0.009) and bacteremia (P=0.046). The non-survivors had constantly high pentraxin 3 levels(23).
C.2. Diseases associated to Neutropenia
Chronic neutropenia with autoimmune diseases
is associated mainly with rheumatoid arthritis (RA), as Felty's
syndrome or large granular lymphocyte (LGL) leukemia, and with systemic
lupus erythematosus (SLE)(23a).
1. Rheumatoid arthritis (RA)
T cell large granular lymphocyte leukemia (T-LGL) is a disease
characterized by clonal expansion of cytotoxic T cells (CTLs). It
generally follows an indolent course and is notable for an association
with chronic inflammation, neutropenia and rheumatoid arthritis (RA), according to the study by the Duke University Medical Center(24).
2. Felty’ssyndrome or large granular lymphocyte (LGL)
Large granular lymphocyte (LGL) leukemia is a clonal proliferation of
cytotoxic cells, either CD3(+) (T-cell) or CD3(-) (natural killer, or
NK). Both subtypes can manifest as indolent or aggressive disorders.
T-LGL leukemia is associated with cytopenias and autoimmune diseases and
most often has an indolent course and good prognosis. Rheumatoid arthritis
and Felty syndrome are frequent, according to the study by Michal G.
Rose, M.D., The Comprehensive Cancer Center (IIID), VA Connecticut
Healthcare System(25).
3. Leukemia and related disorders
T-cell large granular lymphocyte (LGL) leukemia is a clonal proliferation of cytotoxic T cells, which causes neutropenia, anemia, and/or thrombocytopenia. This condition is often associated with autoimmune disorders, especially rheumatoid arthritis, and other lymphoproliferative disorders(26).
4. Systemic lupus erythematosus (SLE)
In the study of 89 SLE patients
(92% females), with their mean (SD) age and disease duration at the
study entry of 31.7 (12.2) years and 2.4 (2.9) months, leukopenia was
found at the diagnosis in 51.6% of the cases. The cumulative prevalence
of leukopenia, lymphopenia, and neutropenia was observed in 57.3%, 96.6%, and 60.7%, respectively(27).
5. Crohn's disease
There is a report of a 29-year-old woman with a 20-year history of Crohn's disease and neutropenia. Because of repeated complications of Crohn's disease, she has undergone three intestinal resections and also has had recurrent skin abscesses, sinusitis, and pneumonia. Persistent neutropenia has been noted throughout the course of her disease, and antineutrophil antibodies have been detected in her serum and that of her younger brother, who also has Crohn's disease and neutropenia(28).
6. Graves' disease
There is a report of a 38-year-old man with Graves' disease taking propylthiouracil (PTU) for 6 years developed neutropenia and marked splenomegaly(29).
7. Poikiloderma
Poikiloderma with neutropenia
(PN, OMIM 604173) is a rare autosomal-recessive genodermatosis.
Mutations in the C16orf57 gene have been recently identified as the
cause(29a).
8. without serious complications in children with acquired neutropenia
In the study to to identify the relationship of acquired neutropenia with childhood infections and to assess its clinical course, complications, and outcome of 161 previously healthy children with febrile neutropenia/leukopenia
aged (mean ± SD) 3.02 ± 3.86 years (range, 0.1-14). One hundred and
thirty-six out of 161 patients (84.5 %) had transient neutropenia (TN), while in 25 patients, neutropenia
was chronic (CN) and persisted for ≥180 days, indicated that a
infectious agent was isolated in 98/161 (60.9 %) cases, in 68.4 %
patients with TN, and in 20 % of those with CN (p = 0.001). Among the
patients with CN, seven had positive antineutrophil antibodies (autoimmune neutropenia)
and four were eventually diagnosed with hematological malignancy. In
all age groups, TN was of short duration (<1 month), of mild to
moderate severity, and was predominantly associated with viral
infections. Two years after diagnosis, 143/161 children (88.8 %) were
available for follow-up. One hundred and thirty-seven of 143 (95.8 %)
had recovered completely, while the rest remained neutropenic(30).
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Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(22) http://www.ncbi.nlm.nih.gov/pubmed/23303687
(23) http://www.ncbi.nlm.nih.gov/pubmed/21880642
(23a) http://www.ncbi.nlm.nih.gov/pubmed/11957195
(24) http://www.ncbi.nlm.nih.gov/pubmed/19394280
(25) http://theoncologist.alphamedpress.org/content/9/3/247.full
(26) http://www.ncbi.nlm.nih.gov/pubmed/17596907
(27) http://www.ncbi.nlm.nih.gov/pubmed/23519174
(28) http://www.ncbi.nlm.nih.gov/pubmed/2066550
(29) http://www.ncbi.nlm.nih.gov/pubmed/3841726
(29a) http://www.ncbi.nlm.nih.gov/pubmed/23823120
(30) http://www.ncbi.nlm.nih.gov/pubmed/23408310
Thursday, 5 December 2013
.Neutropenia - The Rsk Factors
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)
Risk factors
1. H-ficolin
According to the study by the Department of Pediatrics, University of Bern, Bern, low concentration of H-ficolin was associated with an increased risk of FN, particularly FN with bacteraemia, in children treated with chemotherapy for cancer. Low H-ficolin thus represents a novel risk factor for chemotherapy-related infections(16).
2. Deficiency of mannose-binding lectin
Mannose-binding lectin-associated serine protease-2 (MASP-2) is an essential component of the lectin pathway of complement activation. According to the study by the University of Bern, MASP-2 deficiency was associated with an increased risk of FN in children treated with chemotherapy for cancer. MASP-2 deficiency represents a novel risk factor for chemotherapy-related infections(17).
3. Poison
Exposure to certain poison are associated to the increased risk of the disease(18).
According to the article of Delaware physician care, an aetna health plan, indicated the following risk factors(19).
4. Chemotherapy Regimen
The aggressiveness of the chemotherapy regimen can be taken into account by giving to each individual drug a score (ranging from 0 to 4), according to its expected hem atological toxicity . For combination drug regimens, the regimen’s score is calculated by taking the mean of the individual agent’s weights. (Example: vinblastine + carboplatin = 5 ÷ 2= 2.5). A score ≥3 is considered high risk for neutropenia
5. Pre-existing neutropenia
a. Age >65 of age
b. Previous chemotherapy or radiation therapy
c. Advanced disease or uncontrolled cancer
d. Pre - existing n eutropenia, anemia or other cytopenias, or b one marrow involvement of tumor
e. Act ive Infection/open wounds, pneumonia, sepsis o Poor performance status (e.g., poor nutritional status, low albumin)
f. Renal impairment (GFR<30 or age >65 and elevated creatinine)
g. Liver dysfunction (elevated bilirubin, alkaline phosphatase)
h. Other serious co - morbidities (heart disease, hypertension, COPD)
i. Previous episodes of FN
g. A previous neutropenic complication in the immediate previous cycle with no plan to reduce dose intensity(19).
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Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(16) http://www.ncbi.nlm.nih.gov/pubmed/19659773
(17) http://www.ncbi.nlm.nih.gov/pubmed/17984804
(18) http://www.mdguidelines.com/neutropenia
(19) http://www.delawarephysicianscare.com/Content/Docs/ColonyStimulatingFactors-PharmacyPAGuideline-DE.pdf
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)
Risk factors
1. H-ficolin
According to the study by the Department of Pediatrics, University of Bern, Bern, low concentration of H-ficolin was associated with an increased risk of FN, particularly FN with bacteraemia, in children treated with chemotherapy for cancer. Low H-ficolin thus represents a novel risk factor for chemotherapy-related infections(16).
2. Deficiency of mannose-binding lectin
Mannose-binding lectin-associated serine protease-2 (MASP-2) is an essential component of the lectin pathway of complement activation. According to the study by the University of Bern, MASP-2 deficiency was associated with an increased risk of FN in children treated with chemotherapy for cancer. MASP-2 deficiency represents a novel risk factor for chemotherapy-related infections(17).
3. Poison
Exposure to certain poison are associated to the increased risk of the disease(18).
According to the article of Delaware physician care, an aetna health plan, indicated the following risk factors(19).
4. Chemotherapy Regimen
The aggressiveness of the chemotherapy regimen can be taken into account by giving to each individual drug a score (ranging from 0 to 4), according to its expected hem atological toxicity . For combination drug regimens, the regimen’s score is calculated by taking the mean of the individual agent’s weights. (Example: vinblastine + carboplatin = 5 ÷ 2= 2.5). A score ≥3 is considered high risk for neutropenia
5. Pre-existing neutropenia
a. Age >65 of age
b. Previous chemotherapy or radiation therapy
c. Advanced disease or uncontrolled cancer
d. Pre - existing n eutropenia, anemia or other cytopenias, or b one marrow involvement of tumor
e. Act ive Infection/open wounds, pneumonia, sepsis o Poor performance status (e.g., poor nutritional status, low albumin)
f. Renal impairment (GFR<30 or age >65 and elevated creatinine)
g. Liver dysfunction (elevated bilirubin, alkaline phosphatase)
h. Other serious co - morbidities (heart disease, hypertension, COPD)
i. Previous episodes of FN
g. A previous neutropenic complication in the immediate previous cycle with no plan to reduce dose intensity(19).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(16) http://www.ncbi.nlm.nih.gov/pubmed/19659773
(17) http://www.ncbi.nlm.nih.gov/pubmed/17984804
(18) http://www.mdguidelines.com/neutropenia
(19) http://www.delawarephysicianscare.com/Content/Docs/ColonyStimulatingFactors-PharmacyPAGuideline-DE.pdf
Neutropenia - The Causes
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)
A.1. Causes
1. Decreased production in the bone marrow
a. Aplastic anemia
According to the study by the Jichi Medical University, patients with aplastic anemia (AA) or myelodysplastic syndrome (MDS) often have persistent severe neutropenia and are susceptible to infectious complications(1).
b. Arsenic poisoning
There is a report of a case of the death by arsenic poisoning of a 62-year-old white man is presented. One year prior to death, he developed intermittent bouts of severe gastroenteritis with vomiting and diarrhea, hyperpigmentation and keratosis of the skin, neutropenia, and Guillain-Barré-like neuropathy for which he was hospitalized several time(2).
c. Cancers
In the study to determine the impact of primary prophylactic colony-stimulating factor (CSF) use on febrile neutropenia in a large patient population receiving contemporary chemotherapy regimens to treat breast cancer, colorectal cancer, or non-small cell lung cancer (NSCLC), showed that of the 998 patients with breast cancer, 72 (7.2%) experienced febrile neutropenia, 28 of whom received primary prophylactic CSF. In the patients with breast cancer, we observed that primary prophylactic CSF use was associated with reduced febrile neutropenia rates; however, the analysis may have been confounded by unmeasured factors associated with febrile neutropenia(3).
d. Hereditary disorders
Certain prenatal conditions can be result of Neutropenia
d. 1. Homozygous G6PC3 mutations
Severe congenital neutropenia type 4 (SCN4) is an autosomal recessive disorder caused by mutations in the third subunit of the enzyme glucose-6-phosphatase (G6PC3). Its core features are congenital neutropenia and a prominent venous skin pattern, and affected individuals have variable birth defects, according to the study by the Memorial University of Newfoundland(4).
d.2. Hematologic condition
There is a report results for six patients with Severe congenital neutropenia (SCN) who underwent Hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) between 1997 and 2001 at two transplant centers. Two patients transplanted for MDS survived. Both of these patients were transplanted without being given induction chemotherapy. Four patients, who all received induction chemotherapy for AML prior to HSCT, died. Administering induction chemotherapy prior to HSCT resulted in significant morbidity(5).
d.3. Cyclic neutropenia
there is a report of a 22 years old patient presented with recurrent episodes of diarrhoea, pharyngitis, apthous ulcers and fever for the past 6 months. The patient was admitted and blood studies revealed neutropenia with increased number of Large Granular Lymphocytes. Later on it was found out that his neutrophil count dropped to less than 0.2 x 10(9)/L after every 3 weeks. Bone marrow study revealed decreases neutrophil precursors during these episodes. He was diagnosed with adult onset cyclic neutropenia and his episodes were treated with G-CSF and Ceftriaxone, according to the Medical Ward-D, Khyber Teaching Hospita(6).
d.4, HAX1 deficiency
HAX1 is a major regulator of myeloid homeostasis and underline the significance of genetic control of apoptosis in neutrophil development.(6a).
e. Copper, Vitamin B12, Folate deficiency
e.1. Copper deficiency
Copper deficiency is an under-recognized cause of reversible refractory anemia and leukopenia, particularly neutropenia, often misdiagnosed as myelodysplastic syndrome (MDS)(7).
e.2. Vitamin B12 and Folate deficiency
Women with breast carcinoma were asked to complete a questionnaire that recorded their use of dietary supplements. Blood samples were obtained for the assessment of serum vitamin B12 and folate levels before and after the first cycle of chemotherapy and for weekly complete blood counts, according to the study by the University of Vermont(8).
2. Increased destruction in the bone marrow
a. Autoimmune neutropenia
Antineutrophil antibodies are well recognized causes of neutropenia, producing both quantitative and qualitative defects in neutrophils and increased risk for infection. In primary autoimmune neutropenia (AIN) of infancy, a moderate to severe neutropenia is the sole abnormality; it is rarely associated with serious infections and exhibits a self-limited course. Chronic idiopathic neutropenia of adults is characterized by occurrence in late childhood or adulthood, greater prevalence among females than among males, and rare spontaneous remission. Secondary AIN is more commonly seen in adults and underlying causes include collagen disorders, drugs, viruses and lymphoproliferative disorders, according to the study by the University of Milan(9).
b. Chemotherapy-induced neutropenia
Thirty-two patients on treatment for solid cancers who were admitted with febrile neutropenia between January and December 2010, according to the Cambridge University Hospitals NHS FoundationTrust(2).
There is a study indicated that chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings for a solid tumor or non-Hodgkin's lymphoma(10).
3. Medication induced neutropenia
According to the study by the University Hospital of Strasbourg, over the last 20 years, the incidence of idiosyncratic drug-induced agranulocytosis or acute neutropenia has remained stable at 2.4-15.4 cases per million, despite the emergence of new causative drugs: antibiotics (beta-lactam and cotrimoxazole), antiplatelet agents (ticlopidine), antithyroid drugs, sulfasalazine, neuroleptics (clozapine), antiepileptic agents (carbamazepine), nonsteroidal anti-inflammatory agents and dipyrone. Drug-induced agranulocytosis remains a serious adverse event due to the occurrence of severe sepsis with severe deep infections (such as pneumonia), septicemia and septic shock in around two thirds of patients(11).
4. Hemodialysis
Neutropenia and degranulation of neutrophils during hemodialysis with cellulosic membranes have been linked to complement activation, whereas in the synthetic polymethyl methacrylate (PMMA) membrane, degranulation occurs without notable complement activation, according to the study by the University of Freiburg(12).
5. Bacteria and viral infections
a. Bacteria infection
The College of Medicine, Korea University, reported of a 259 cases of febrile neutropenia occurring in 137 patients with hematologic disease(13). Also according to the Universidad Pontificia Bolivariana, in the study of 101 episodes of FN in 43 patients with the median age was 44 years. 63.5% of patients had no apparent clinical focus of infection at admission, 11.8% had soft tissue compromise and 8.9% urinary tract infection. Bacteremia was documented in 41.5% and catheter-associated bacteremia in 3.9%. The most common organisms were Escherichia coli 43.4%, Klebsiella pneumoniae 17.3% and Staphylococcus aureus 8.6%. Of those isolated in blood 84.7% were Gram negative rods and 15.2% were Gram positive bacteria. Piperacillin/tazobactam was the most common empirically prescribed antibiotic (81.1%). Mortality of FN episodes occurred in 8 (7.92%) patients, 5 (62.5%) attributable to infection and 3 (37.5%) due to progression of hematologic malignancy with a resolution of FN(14).
b. Viral infections
Patients with hematological malignancies and therapy induced neutropenia (n = 159) were screened regarding a broad range of common respiratory viruses in the nasopharynx and for viruses commonly detected in severely immunosuppressed patients in peripheral blood. Quantitative PCR was used for detection of viruses. A viral pathogen was detected in 35% of the patients. The detection rate was rather similar in blood (22%) and NPA (18%) with polyoma BK virus and rhinovirus as dominating pathogens in blood and NPA, respectively. Patients with chronic lymphocytic leukemia (CLL) (p<0.01) and patients with fever (p<0.001) were overrepresented in the virus-positive group(15).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(1) http://www.ncbi.nlm.nih.gov/pubmed/21692099
(2) http://www.ncbi.nlm.nih.gov/pubmed/2220708
(3) http://www.ncbi.nlm.nih.gov/pubmed/22392824
(4) http://www.ncbi.nlm.nih.gov/pubmed/23171239
(5) http://www.ncbi.nlm.nih.gov/pubmed/15640815
(6) http://www.ncbi.nlm.nih.gov/pubmed/22764469
(6a) http://www.ncbi.nlm.nih.gov/pubmed/17187068
(7) http://www.ncbi.nlm.nih.gov/pubmed/22080848
(8) http://www.ncbi.nlm.nih.gov/pubmed/15329916
(9) http://www.ncbi.nlm.nih.gov/pubmed/16207350
(10) http://www.ncbi.nlm.nih.gov/pubmed/23824496
(11) http://www.ncbi.nlm.nih.gov/pubmed/18043241
(12) http://www.ncbi.nlm.nih.gov/pubmed/8785392
(13) http://www.ncbi.nlm.nih.gov/pubmed/19762083.
(14) http://www.ncbi.nlm.nih.gov/pubmed/23677158
(15) http://www.ncbi.nlm.nih.gov/pubmed/22570724
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)
A.1. Causes
1. Decreased production in the bone marrow
a. Aplastic anemia
According to the study by the Jichi Medical University, patients with aplastic anemia (AA) or myelodysplastic syndrome (MDS) often have persistent severe neutropenia and are susceptible to infectious complications(1).
b. Arsenic poisoning
There is a report of a case of the death by arsenic poisoning of a 62-year-old white man is presented. One year prior to death, he developed intermittent bouts of severe gastroenteritis with vomiting and diarrhea, hyperpigmentation and keratosis of the skin, neutropenia, and Guillain-Barré-like neuropathy for which he was hospitalized several time(2).
c. Cancers
In the study to determine the impact of primary prophylactic colony-stimulating factor (CSF) use on febrile neutropenia in a large patient population receiving contemporary chemotherapy regimens to treat breast cancer, colorectal cancer, or non-small cell lung cancer (NSCLC), showed that of the 998 patients with breast cancer, 72 (7.2%) experienced febrile neutropenia, 28 of whom received primary prophylactic CSF. In the patients with breast cancer, we observed that primary prophylactic CSF use was associated with reduced febrile neutropenia rates; however, the analysis may have been confounded by unmeasured factors associated with febrile neutropenia(3).
d. Hereditary disorders
Certain prenatal conditions can be result of Neutropenia
d. 1. Homozygous G6PC3 mutations
Severe congenital neutropenia type 4 (SCN4) is an autosomal recessive disorder caused by mutations in the third subunit of the enzyme glucose-6-phosphatase (G6PC3). Its core features are congenital neutropenia and a prominent venous skin pattern, and affected individuals have variable birth defects, according to the study by the Memorial University of Newfoundland(4).
d.2. Hematologic condition
There is a report results for six patients with Severe congenital neutropenia (SCN) who underwent Hematopoietic stem cell transplantation (HSCT) for myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) between 1997 and 2001 at two transplant centers. Two patients transplanted for MDS survived. Both of these patients were transplanted without being given induction chemotherapy. Four patients, who all received induction chemotherapy for AML prior to HSCT, died. Administering induction chemotherapy prior to HSCT resulted in significant morbidity(5).
d.3. Cyclic neutropenia
there is a report of a 22 years old patient presented with recurrent episodes of diarrhoea, pharyngitis, apthous ulcers and fever for the past 6 months. The patient was admitted and blood studies revealed neutropenia with increased number of Large Granular Lymphocytes. Later on it was found out that his neutrophil count dropped to less than 0.2 x 10(9)/L after every 3 weeks. Bone marrow study revealed decreases neutrophil precursors during these episodes. He was diagnosed with adult onset cyclic neutropenia and his episodes were treated with G-CSF and Ceftriaxone, according to the Medical Ward-D, Khyber Teaching Hospita(6).
d.4, HAX1 deficiency
HAX1 is a major regulator of myeloid homeostasis and underline the significance of genetic control of apoptosis in neutrophil development.(6a).
e.1. Copper deficiency
Copper deficiency is an under-recognized cause of reversible refractory anemia and leukopenia, particularly neutropenia, often misdiagnosed as myelodysplastic syndrome (MDS)(7).
e.2. Vitamin B12 and Folate deficiency
Women with breast carcinoma were asked to complete a questionnaire that recorded their use of dietary supplements. Blood samples were obtained for the assessment of serum vitamin B12 and folate levels before and after the first cycle of chemotherapy and for weekly complete blood counts, according to the study by the University of Vermont(8).
2. Increased destruction in the bone marrow
a. Autoimmune neutropenia
Antineutrophil antibodies are well recognized causes of neutropenia, producing both quantitative and qualitative defects in neutrophils and increased risk for infection. In primary autoimmune neutropenia (AIN) of infancy, a moderate to severe neutropenia is the sole abnormality; it is rarely associated with serious infections and exhibits a self-limited course. Chronic idiopathic neutropenia of adults is characterized by occurrence in late childhood or adulthood, greater prevalence among females than among males, and rare spontaneous remission. Secondary AIN is more commonly seen in adults and underlying causes include collagen disorders, drugs, viruses and lymphoproliferative disorders, according to the study by the University of Milan(9).
b. Chemotherapy-induced neutropenia
Thirty-two patients on treatment for solid cancers who were admitted with febrile neutropenia between January and December 2010, according to the Cambridge University Hospitals NHS FoundationTrust(2).
There is a study indicated that chemotherapy-induced febrile neutropenia in the inpatient and outpatient settings for a solid tumor or non-Hodgkin's lymphoma(10).
3. Medication induced neutropenia
According to the study by the University Hospital of Strasbourg, over the last 20 years, the incidence of idiosyncratic drug-induced agranulocytosis or acute neutropenia has remained stable at 2.4-15.4 cases per million, despite the emergence of new causative drugs: antibiotics (beta-lactam and cotrimoxazole), antiplatelet agents (ticlopidine), antithyroid drugs, sulfasalazine, neuroleptics (clozapine), antiepileptic agents (carbamazepine), nonsteroidal anti-inflammatory agents and dipyrone. Drug-induced agranulocytosis remains a serious adverse event due to the occurrence of severe sepsis with severe deep infections (such as pneumonia), septicemia and septic shock in around two thirds of patients(11).
4. Hemodialysis
Neutropenia and degranulation of neutrophils during hemodialysis with cellulosic membranes have been linked to complement activation, whereas in the synthetic polymethyl methacrylate (PMMA) membrane, degranulation occurs without notable complement activation, according to the study by the University of Freiburg(12).
5. Bacteria and viral infections
a. Bacteria infection
The College of Medicine, Korea University, reported of a 259 cases of febrile neutropenia occurring in 137 patients with hematologic disease(13). Also according to the Universidad Pontificia Bolivariana, in the study of 101 episodes of FN in 43 patients with the median age was 44 years. 63.5% of patients had no apparent clinical focus of infection at admission, 11.8% had soft tissue compromise and 8.9% urinary tract infection. Bacteremia was documented in 41.5% and catheter-associated bacteremia in 3.9%. The most common organisms were Escherichia coli 43.4%, Klebsiella pneumoniae 17.3% and Staphylococcus aureus 8.6%. Of those isolated in blood 84.7% were Gram negative rods and 15.2% were Gram positive bacteria. Piperacillin/tazobactam was the most common empirically prescribed antibiotic (81.1%). Mortality of FN episodes occurred in 8 (7.92%) patients, 5 (62.5%) attributable to infection and 3 (37.5%) due to progression of hematologic malignancy with a resolution of FN(14).
b. Viral infections
Patients with hematological malignancies and therapy induced neutropenia (n = 159) were screened regarding a broad range of common respiratory viruses in the nasopharynx and for viruses commonly detected in severely immunosuppressed patients in peripheral blood. Quantitative PCR was used for detection of viruses. A viral pathogen was detected in 35% of the patients. The detection rate was rather similar in blood (22%) and NPA (18%) with polyoma BK virus and rhinovirus as dominating pathogens in blood and NPA, respectively. Patients with chronic lymphocytic leukemia (CLL) (p<0.01) and patients with fever (p<0.001) were overrepresented in the virus-positive group(15).
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Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(1) http://www.ncbi.nlm.nih.gov/pubmed/21692099
(2) http://www.ncbi.nlm.nih.gov/pubmed/2220708
(3) http://www.ncbi.nlm.nih.gov/pubmed/22392824
(4) http://www.ncbi.nlm.nih.gov/pubmed/23171239
(5) http://www.ncbi.nlm.nih.gov/pubmed/15640815
(6) http://www.ncbi.nlm.nih.gov/pubmed/22764469
(6a) http://www.ncbi.nlm.nih.gov/pubmed/17187068
(7) http://www.ncbi.nlm.nih.gov/pubmed/22080848
(8) http://www.ncbi.nlm.nih.gov/pubmed/15329916
(9) http://www.ncbi.nlm.nih.gov/pubmed/16207350
(10) http://www.ncbi.nlm.nih.gov/pubmed/23824496
(11) http://www.ncbi.nlm.nih.gov/pubmed/18043241
(12) http://www.ncbi.nlm.nih.gov/pubmed/8785392
(13) http://www.ncbi.nlm.nih.gov/pubmed/19762083.
(14) http://www.ncbi.nlm.nih.gov/pubmed/23677158
(15) http://www.ncbi.nlm.nih.gov/pubmed/22570724
Appendicitis Treatment in Traditional Chinese medicine perspective
Appendicitis is defined as a condition of inflammation of
Appendix. It is classified as an emergency, in many required the
removal of the appendix. If burst, or perforate, spilling infectious
materials into the abdominal cavity can be life threatening.
Treatment in Traditional Chinese medicine perspective
Traditional Chinese medicine on a weight basis, includes 190-210 parts of gentrin knotweed, 190-210 parts of sargentodoxa cuneata, 190-210 parts of common reed rhizome, and 140-160 parts of licorice. The medication has the effects of clearing heat clearing and removing toxicity, antibiosis and antiphlogosis, dispelling wind and expelling parasites, dispersing blood stasis and relieving pain, removing edema and dissipating binds on acute and chronic appendicitis patients, can gradually restore the appendix tissue and the functions, causes less recurrence after a patient is cured, is convenient for use, can reduce pain, has no toxic or side effect, and is cheap and highly-effective, according to the Abstract of study (English, CN 102266504 B) posted in Ip.com(39).
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(39) http://ip.com/patfam/en/45049084
Treatment in Traditional Chinese medicine perspective
Traditional Chinese medicine on a weight basis, includes 190-210 parts of gentrin knotweed, 190-210 parts of sargentodoxa cuneata, 190-210 parts of common reed rhizome, and 140-160 parts of licorice. The medication has the effects of clearing heat clearing and removing toxicity, antibiosis and antiphlogosis, dispelling wind and expelling parasites, dispersing blood stasis and relieving pain, removing edema and dissipating binds on acute and chronic appendicitis patients, can gradually restore the appendix tissue and the functions, causes less recurrence after a patient is cured, is convenient for use, can reduce pain, has no toxic or side effect, and is cheap and highly-effective, according to the Abstract of study (English, CN 102266504 B) posted in Ip.com(39).
Chinese Secrets To Fatty Liver And Obesity Reversal
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Optimal Health And Loose Weight
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Sources
(39) http://ip.com/patfam/en/45049084
Appendicitis Treatment in Herbal medicine perspective
Appendicitis is defined as a condition of inflammation of
Appendix. It is classified as an emergency, in many required the
removal of the appendix. If burst, or perforate, spilling infectious
materials into the abdominal cavity can be life threatening.
Treatment in Herbal medicine perspective
1. Phaseolus angularis Wight (adzuki bean)
Phaseolus angularis Wight (adzuki bean) is an ethnopharmacologically well-known folk medicine that is prescribed for infection, edema, and inflammation of the joints, appendix, kidney and bladder in Korea, China and Japan. According to the study by the, Pa-EE dose-dependently suppressed the release of PGE(2) and NO in LPS-, Poly(I:C)-, and pam3CSK-activated macrophages. Phaseolus angularis ethanol extract (Pa-EE) strongly down-regulated LPS-induced mRNA expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2. Interestingly, Pa-EE markedly inhibited NF-κB, activator protein (AP)-1, and cAMP response element binding protein (CREB) activation; further, according to direct kinase assays and immunoblot analyses, Pa-EE blocked the activation of the upstream signaling molecules spleen tyrosine kinase (Syk), p38, and transforming growth factor β-activated kinase 1 (TAK1). Finally, orally administered Pa-EE clearly ameliorated EtOH/HCl-induced gastritis in mice(37).
2. Cinnamomum cassia
Cinnamomum cassia Blume (Aceraceae) has been traditionally used to treat various inflammatory diseases such as gastritis. According to the study by the Sungkyunkwan University, 95% ethanol extract (Cc-EE) of Cinnamomum cassia exerts strong anti-inflammatory activity by suppressing Src/Syk-mediated NF-κB activation, which contributes to its major ethno-pharmacological role as an anti-gastritis remedy. Future work will be focused on determining whether the extract can be further developed as an anti-inflammatory drug(38).
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Use The Revolutionary Findings To Achieve
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Sources
(37) http://www.ncbi.nlm.nih.gov/pubmed/21821108
(38) http://www.ncbi.nlm.nih.gov/pubmed/22155395
Treatment in Herbal medicine perspective
1. Phaseolus angularis Wight (adzuki bean)
Phaseolus angularis Wight (adzuki bean) is an ethnopharmacologically well-known folk medicine that is prescribed for infection, edema, and inflammation of the joints, appendix, kidney and bladder in Korea, China and Japan. According to the study by the, Pa-EE dose-dependently suppressed the release of PGE(2) and NO in LPS-, Poly(I:C)-, and pam3CSK-activated macrophages. Phaseolus angularis ethanol extract (Pa-EE) strongly down-regulated LPS-induced mRNA expression of inducible NO synthase (iNOS) and cyclooxygenase (COX)-2. Interestingly, Pa-EE markedly inhibited NF-κB, activator protein (AP)-1, and cAMP response element binding protein (CREB) activation; further, according to direct kinase assays and immunoblot analyses, Pa-EE blocked the activation of the upstream signaling molecules spleen tyrosine kinase (Syk), p38, and transforming growth factor β-activated kinase 1 (TAK1). Finally, orally administered Pa-EE clearly ameliorated EtOH/HCl-induced gastritis in mice(37).
2. Cinnamomum cassia
Cinnamomum cassia Blume (Aceraceae) has been traditionally used to treat various inflammatory diseases such as gastritis. According to the study by the Sungkyunkwan University, 95% ethanol extract (Cc-EE) of Cinnamomum cassia exerts strong anti-inflammatory activity by suppressing Src/Syk-mediated NF-κB activation, which contributes to its major ethno-pharmacological role as an anti-gastritis remedy. Future work will be focused on determining whether the extract can be further developed as an anti-inflammatory drug(38).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(37) http://www.ncbi.nlm.nih.gov/pubmed/21821108
(38) http://www.ncbi.nlm.nih.gov/pubmed/22155395
Appendicitis Treatment in conventional medicine perspective
Appendicitis is defined as a condition of inflammation of
Appendix. It is classified as an emergency, in many required the
removal of the appendix. If burst, or perforate, spilling infectious
materials into the abdominal cavity can be life threatening.
III. Complications and Diseases associated to Appendicitis
Treatments
A. Treatment in conventional medicine perspective
1. Laparoscopic and Open Appendectomy
In the study using the data from the 2007 to 2009 Taiwan National Health Insurance Research Database. The study sample included 65,339 patients, hospitalized with a discharge diagnosis of acute appendicitis (33.8% underwent laparoscopic appendectomy). A generalized estimated equation (GEE) was performed to explore the relationship between the use of laparoscopy and 30-day re-admission. Hierarchical linear regressions were performed to examine the relationship between the use of laparoscopy, the length of stay (LOS), and the cost per discharge, showed that a significantly lower proportion of patients undergoing laparoscopic appendectomies were re-admitted within 30 days of their index appendectomy, in comparison to patients undergoing open appendectomies (0.66% versus 1.925, p<0.001). Compared with patients undergoing open appendectomies, patients undergoing laparoscopic appendectomies had a shorter LOS (4.01 versus 5.33 days, p<0.001) and a higher cost per discharge (NT$40,554 versus NT$38,509, p<0.001. In 2007, the average exchange rate was US$1 = NT$31.0). GEE revealed that the odds ratio of 30-day readmission for patients undergoing laparoscopic appendectomy was 0.38 (95% CI = 0.33-0.46) that of patients undergoing open appendectomies, after adjusting for surgeon, hospital, and patient characteristics, as well as for the clustering effect of particular surgeons and the propensity score(35).
2. Draining an abscess before appendix surgery
If in case if your appendix has burst and an abscess has formed around it. In the study to analyze retrospectively our experience with this disease to value the results of drainage of the abscess and appendectomy in one stage in presence of appendiceal abscesses, showed that preoperative ultrasonography showed an accuracy of 85.7% in detecting the presence of an abscess. Mean size of the abscesses were 5 cm (from a minimum of 3 cm to a maximum of 9 cm). The mean duration of surgical operation was 48 minutes (min 35'-max 95'), with a mean in-hospital stay of 6.2 days. Morbidity rate was 9% and was due in 75% of cases to wound infection and in 25% of cases to wound dehiscence. Neither major morbidity nor mortality were observed. In consideration of the results the authors conclude that even in presence of an appendiceal abscess, appendectomy with abscess drainage is not only a safe operation with a low morbidity rate but the procedure of choice allowing a significative reduction of hospitalization and health cost(36).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
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Sources
(35) http://www.ncbi.nlm.nih.gov/pubmed/23874710
(36) http://www.ncbi.nlm.nih.gov/pubmed/9228826
III. Complications and Diseases associated to Appendicitis
Treatments
A. Treatment in conventional medicine perspective
1. Laparoscopic and Open Appendectomy
In the study using the data from the 2007 to 2009 Taiwan National Health Insurance Research Database. The study sample included 65,339 patients, hospitalized with a discharge diagnosis of acute appendicitis (33.8% underwent laparoscopic appendectomy). A generalized estimated equation (GEE) was performed to explore the relationship between the use of laparoscopy and 30-day re-admission. Hierarchical linear regressions were performed to examine the relationship between the use of laparoscopy, the length of stay (LOS), and the cost per discharge, showed that a significantly lower proportion of patients undergoing laparoscopic appendectomies were re-admitted within 30 days of their index appendectomy, in comparison to patients undergoing open appendectomies (0.66% versus 1.925, p<0.001). Compared with patients undergoing open appendectomies, patients undergoing laparoscopic appendectomies had a shorter LOS (4.01 versus 5.33 days, p<0.001) and a higher cost per discharge (NT$40,554 versus NT$38,509, p<0.001. In 2007, the average exchange rate was US$1 = NT$31.0). GEE revealed that the odds ratio of 30-day readmission for patients undergoing laparoscopic appendectomy was 0.38 (95% CI = 0.33-0.46) that of patients undergoing open appendectomies, after adjusting for surgeon, hospital, and patient characteristics, as well as for the clustering effect of particular surgeons and the propensity score(35).
2. Draining an abscess before appendix surgery
If in case if your appendix has burst and an abscess has formed around it. In the study to analyze retrospectively our experience with this disease to value the results of drainage of the abscess and appendectomy in one stage in presence of appendiceal abscesses, showed that preoperative ultrasonography showed an accuracy of 85.7% in detecting the presence of an abscess. Mean size of the abscesses were 5 cm (from a minimum of 3 cm to a maximum of 9 cm). The mean duration of surgical operation was 48 minutes (min 35'-max 95'), with a mean in-hospital stay of 6.2 days. Morbidity rate was 9% and was due in 75% of cases to wound infection and in 25% of cases to wound dehiscence. Neither major morbidity nor mortality were observed. In consideration of the results the authors conclude that even in presence of an appendiceal abscess, appendectomy with abscess drainage is not only a safe operation with a low morbidity rate but the procedure of choice allowing a significative reduction of hospitalization and health cost(36).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(35) http://www.ncbi.nlm.nih.gov/pubmed/23874710
(36) http://www.ncbi.nlm.nih.gov/pubmed/9228826
Appendicitis Preventions - The Diet
Appendicitis is defined as a condition of inflammation of
Appendix. It is classified as an emergency, in many required the
removal of the appendix. If burst, or perforate, spilling infectious
materials into the abdominal cavity can be life threatening.
III. Complications and Diseases associated to Appendicitis
Preventions
1. A vegetarian diet
Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis, according to the study by the University of Oxford(31).
2. Dietary fiber
In the study of means of food diaries the average daily fiber consumption in 31 patients with acute appendicitis and in 30 control patients, matched for age and sex with the average daily dietary fiber intake was 17.4 g in the group with appendicitis and 21.0 g in the control group, showed that the difference is statistically significant. Adjustment for the total energy intake in each instance did not change this conclusion. The results support the hypothesis that diet, in particular a lack of fiber, may be an important factor in the pathogenesis of acute appendicitis(32).
3. Less non-potato vegetables and fruit
In the study of comparison of food consumption between the four countries, and between the health board areas of Eire and regions of Scotland, shows that appendicitis rates are highest in communities that consume more potatoes, sugar, and cereals, and less non-potato vegetables and fruit(33).
4. Green vegetables and tomatoes
In the study to assess the rates of acute appendicitis in 59 areas of England and Wales with consumption of different foods per caput, measured from household food purchases, showed that there was a statistically significant positive correlation with potato consumption and a negative correlation with non-potato vegetables. This negative correlation depended mainly on green vegetables and tomatoes. There was no consistently significant correlation with any other main food group. In particular the correlations with cereal foods, cereal fibre, and total dietary fibre were small and not significant. Green vegetables and tomatoes may protect against appendicitis, possibly through an effect on the bacterial flora of the appendix(34).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
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Sources
(31) http://www.ncbi.nlm.nih.gov/pubmed/10466166
(32) http://www.ncbi.nlm.nih.gov/pubmed/6305309
(33) http://www.ncbi.nlm.nih.gov/pubmed/3668458
(34) http://www.ncbi.nlm.nih.gov/pubmed/3008904
III. Complications and Diseases associated to Appendicitis
Preventions
1. A vegetarian diet
Compared with non-vegetarians, Western vegetarians have a lower mean BMI (by about 1 kg/m2), a lower mean plasma total cholesterol concentration (by about 0.5 mmol/l), and a lower mortality from IHD (by about 25%). They may also have a lower risk for some other diseases such as constipation, diverticular disease, gallstones and appendicitis, according to the study by the University of Oxford(31).
2. Dietary fiber
In the study of means of food diaries the average daily fiber consumption in 31 patients with acute appendicitis and in 30 control patients, matched for age and sex with the average daily dietary fiber intake was 17.4 g in the group with appendicitis and 21.0 g in the control group, showed that the difference is statistically significant. Adjustment for the total energy intake in each instance did not change this conclusion. The results support the hypothesis that diet, in particular a lack of fiber, may be an important factor in the pathogenesis of acute appendicitis(32).
3. Less non-potato vegetables and fruit
In the study of comparison of food consumption between the four countries, and between the health board areas of Eire and regions of Scotland, shows that appendicitis rates are highest in communities that consume more potatoes, sugar, and cereals, and less non-potato vegetables and fruit(33).
4. Green vegetables and tomatoes
In the study to assess the rates of acute appendicitis in 59 areas of England and Wales with consumption of different foods per caput, measured from household food purchases, showed that there was a statistically significant positive correlation with potato consumption and a negative correlation with non-potato vegetables. This negative correlation depended mainly on green vegetables and tomatoes. There was no consistently significant correlation with any other main food group. In particular the correlations with cereal foods, cereal fibre, and total dietary fibre were small and not significant. Green vegetables and tomatoes may protect against appendicitis, possibly through an effect on the bacterial flora of the appendix(34).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(31) http://www.ncbi.nlm.nih.gov/pubmed/10466166
(32) http://www.ncbi.nlm.nih.gov/pubmed/6305309
(33) http://www.ncbi.nlm.nih.gov/pubmed/3668458
(34) http://www.ncbi.nlm.nih.gov/pubmed/3008904
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