HNY Policy and Pathway Repository - North Yorkshire

Neutrophil count <1.8 x 10⁹/L

None provided

Common causes

• Transient following acute (especially viral) infections
• Medication - many but commonly anti-thyroid drugs, antiepileptics, antipsychotics, quinine, co-trimoxazole, antimetabolites (MTX, AZA, 6-MP, hydroxycarbamide), antibiotics
• "Benign ethinic neutropenia" - Black and middle eastern people commonly have a lower neutrophil count (0.8-1.5) - this is a normal variant.
• B12 / folate deficiency, eating disorder with malnutrition
• Authoimmune / rheumatological disorders e.g. RA  (Felty's syndrome), SLE, IBD, thyroid diseases
• Congenital / cyclical neutropenia - rare
• BM disorders - MDS, aplastic anaemia, infiltration, LGL leukarmia - would generally expect pancytopenia as opposed to isolated neutropenia
• Idiopathic - common

Workup

If neutropenia persists on repeat:

• Medication history
• Blood film
• U+E, LFT
• B12 / folate
• TFT
• HIV, Hep B/C screen
• ANA, RF, anti-CCP ect if suggestive clinical features

Urgent referral

• Neutrophil count <0.5 x 10⁹/L
• Patient well with no fever
• Repeat FBC in 1 week
• Safety net RE: neutropenic sepsis
• If persists and no obvious cause then urgent referral

Admit to hospital for management of Neutropenic sepsis if:

• Neutrophil count <0.5 x 10⁹/L
• Evidence of sepsis

Consider routine referral to haematology if:

• Neutrophil count 0.5 - 1 x 10⁹/L
• Repeat FBC in 2-4 weeks
• Workup (see "guidelines on management" section)
• If no clear cause, consider routine referral to haematology

Consider A&G if:

• Neutrophil count >1 x 10⁹/L
• Repeat FBC in 6-12 weeks
• Workup (see "guidelines on management" section)
• If no clear cause, consider repeat in 6-12 months and A&G if still low at this point. 

• Harrogate and District