Reduction in cell counts - neutropenia
Description
- Neutrophils <1.5 x10^9/L
| Grade | Neutrophils (x10^9/L) | Infection risk |
|---|---|---|
| Mild | 1.0-1.5 | Negligible |
| Moderate | 0.5-1.0 | Modest |
| Severe | <0.5 | High |
| Profound | <0.2 | Very high, endogenous flora |
- *Duration matters as much as depth* - >7 days of severe neutropenia is the threshold for invasive fungal risk
- Agranulocytosis = <0.2 with an otherwise preserved count, usually drug-induced
- Benign ethnic (Duffy-null associated) neutrophil count
- Common in people of African, Middle Eastern and West Indian ancestry; ~4.5% of Australians of African ancestry
- ACKR1/Duffy-null promoter variant - marginated rather than reduced neutrophil mass
- Normal marrow, normal infection risk. Do not investigate, do not withhold chemotherapy or clozapine on it alone
- Infection risk is modified by mucosal barrier integrity, steroid exposure, and central lines - not by the number alone
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