Patient Evaluation

-Gordon Starkebaum, M.D., David C. Dale, M.D.

"Neutropenia Support Association Inc., Volume 9, Winter 1997"

Evaluation begins with a careful history and physical examination. The family history is important; it may reveal other individuals with recurrent fevers, infections, and leukopenia, as well as previously diagnosed autoimmune diseases. The drug history and current medications are also extremely important. The physical membranes, especially the gingiva, oropharynx, and perianal areas. Examination for arthritis, lymphadenopathy, splenomegaly, hepatomegaly, and bone tenderness are also very important.

Laboratory examination begins with a complete blood count. Measurement of the hematocrit and hemoglobin, reticulocytes, and platelets are helpful to recognize serious hamatologic diseases such as aplastic anemia, myelodysplasia, or leukemia. A bone marrow aspirate and biopsy may also be necessary. It may also be helpful to obtain serologic tests for autoimmune diseases such as antinuclear antibodies, rheumatoid factor and other specialized tests; liver function tests; and tests for chronic viral infections, including hepatitis, infectious mononucleosis, and HIV. Results from these tests will direct further work up and consultation, and assays for antineutrophil antibodies generally follow these preliminary assessments.

Measurements of neutrophil kinetics (i.e. glucocorticosteroid test of the bone marrow reserves), epinephrine infusion to measure the degree of neutrophil margination, and radioisotopic studies to measure neutrophil turnover are best performed by research laboratories. Measurement of the growth of bone marrow cells with in vitro culture systems is also a specialized procedure. Many clinical laboratories now examine the immunophenotype of blood leukocytes; this procedure itself may be useful in identifying clonal disorders of the immune system such as the large, granular lymphocyte syndrome that is associated with Neutropenia.