From the Guidelines
The treatment and work up for a low white blood cell count (leukopenia) should prioritize identifying and addressing the underlying cause, with initial evaluation including a complete blood count with differential, peripheral blood smear, and comprehensive metabolic panel, as recommended by the most recent guidelines 1. The initial evaluation should include a comprehensive medical history and physical examination, laboratory evaluations such as a comprehensive metabolic panel, and a complete blood cell (CBC) count including platelets and a differential of white blood cells.
- Common causes of leukopenia include viral infections, certain medications (antibiotics, chemotherapy drugs), autoimmune disorders, bone marrow disorders, and nutritional deficiencies.
- If medication-induced, discontinuing the offending drug may resolve the condition.
- For mild cases without symptoms, monitoring may be sufficient without specific treatment.
- For more severe cases, granulocyte colony-stimulating factors like filgrastim (Neupogen) at 5-10 mcg/kg/day subcutaneously may be prescribed to stimulate white blood cell production, as supported by recent studies 1.
- Nutritional support with vitamin B12 (1000 mcg daily) and folate (1 mg daily) supplements can help if deficiencies are present.
- Infection prevention is crucial, including good hand hygiene, avoiding crowds during illness outbreaks, and prompt treatment of infections.
- Severe neutropenia (neutrophil count below 500/mm³) may require prophylactic antibiotics like levofloxacin 500 mg daily. The body normally maintains white blood cell counts through regulated production in the bone marrow and controlled cell death, so treatment aims to restore this balance by addressing the specific disruption in this process, with recent guidelines emphasizing the importance of individualized treatment plans 1.
From the FDA Drug Label
Obtain a complete blood count (CBC) and platelet count before instituting ZARXIO therapy and monitor twice weekly during therapy. Monitor CBCs and platelet counts frequently following marrow transplantation. Monitor neutrophil counts after 4 days of ZARXIO‚ and discontinue ZARXIO if the white blood cell (WBC) count rises to greater than 100‚000/mm3. Monitor CBCs for Dosage Adjustments During the initial 4 weeks of ZARXIO therapy and during the 2 weeks following any dosage adjustment‚ monitor CBCs with differential and platelet counts
The treatment and work up for low white blood count involves monitoring CBCs and platelet counts. The dosage of ZARXIO should be adjusted based on the patient's clinical course and ANC.
- Key steps in the treatment and work up include:
- Obtaining a baseline CBC
- Monitoring CBCs and platelet counts frequently
- Adjusting the dosage of ZARXIO based on the patient's clinical course and ANC
- Discontinuing ZARXIO if the WBC count rises to greater than 100,000/mm3 2
From the Research
Diagnosis of Low White Blood Count
- The diagnosis of low white blood count, also known as leukopenia, involves checking previous blood counts to understand the dynamic development of the condition 3.
- A manual counted peripheral blood smear is essential in diagnosing leukopenia, as it provides information on cell counts of single subgroups of leucocytes and potential causes such as dysplasia 3.
- The red blood cell count and platelet count should also be checked, as a bi- or pancytopenia usually implies insufficient production in the bone marrow 3.
Treatment of Low White Blood Count
- In cases of life-threatening leukopenia, such as agranulocytosis with fever, admission and immediate treatment with broad-spectrum antibiotics are necessary to reduce mortality 3.
- For other cases of low white blood count, treatment may involve addressing the underlying cause, such as infection or bone marrow disorders.
- In some cases, such as neonatal neutropenia, treatment with recombinant granulocyte stimulating factor or recombinant granulocyte macrophage-colony-stimulating factor may be considered 4.
Diagnostic Evaluation
- A bone marrow biopsy can be useful in cases of prolonged, unusual, or refractory neutropenia 4.
- Laboratory tests, such as a blood film and complete blood count, can provide a specific diagnosis 4.
- In some cases, additional tests, such as maternal neutrophil antigen typing and an anti-neutrophil antibody screen, may be necessary 4.
- Bone marrow aspiration and trephine biopsy can provide diagnostic information in cases of cytopenias, myelofibrosis, and suspicion of lymphoma or metastatic tumor 5, 6.