Dr David Dale on Neutropenia: Symptoms, Causes, Dangers, and Costs

In an interview with The American Journal of Managed Care^®, David Dale, MD, professor, internal medicine, University of Washington Medical Center, discussed neutropenia diagnosis and symptoms; causes of neutropenia; when neutropenia requires hospitalization; and the costs associated with neutropenia.

Diagnosing neutropenia and symptoms to look for

Neutropenia turns up in 2 ways, said Dale. First, people have routine blood counts because a complete blood cells count is one of the most common lab tests done, so sometimes it’s found just by chance, especially if it’s mild. Second, when people have neutropenia, particularly severe neutropenia, they’re prone to infection. They present with a fever and some other sort of sign, such as a sore throat, pharyngitis, or sinusitis. Sometimes, they can also present with pneumonia or a skin infection.

The causes of neutropenia

There are 4 major causes for neutropenia, according to Dale. The most common cause is drugs, such as drugs to treat cancer. In addition, there are drugs that cause an unexpected reaction, such as penicillin. Second, blood and hematological diseases can cause neutropenia. The disease most people think about is leukemia, said Dale, but there are also a whole variety of other blood cell diseases. The third cause is infectious diseases, such as malaria and HIV. Lastly, genetic diseases can cause neutropenia when a mutation in a gene can reduce neutrophil production.

When neutropenia becomes dangerous and requires hospitalization

For more than 50 years, for simplicity and guiding care, a count less than 500 cells per microliter, or less than 5x10⁹ per liter, was associated with susceptibility to infection; the lower the count is, the greater the risk. Behind that is a whole diversity, said Dale. It depends on the cause of neutropenia, so if the count is 500 and the numbers are going down or going up, the more information you have, the more you will know about the risk.

The costs associated with neutropenia

The biggest costs of neutropenia are hospitalization, antibiotics, and intensive care, said Dale. People with neutropenia get over infections slowly, so the costs add up when patients with neutropenia have a fever or severe infection. There are also general medical practice costs such as ambulatory costs and the costs of testing blood counts. Third, drugs to treat neutropenia cost a lot more than they used to, said Dale. The major drug used to prevent neutropenia, and sometimes to treat neutropenia, is granulocyte colony stimulating factor, which is a natural regulator of neutrophil production.