From the Guidelines
A neutrophil count of 1.18 x 10^9/L is considered neutropenic and requires careful management to prevent infections, especially in patients with underlying conditions like hairy cell leukemia, as highlighted in a 2021 study published in Leukemia 1. This condition necessitates prompt medical evaluation, particularly if the patient exhibits symptoms such as fever or signs of infection. The management approach may involve a temporary delay in leukemia therapy for patients with mild neutropenia who are not actively infected, allowing for close monitoring and potential immunization before initiating immunosuppressive therapy, as suggested by experts in the context of the COVID-19 pandemic 1. Key considerations in managing a patient with a neutrophil count of 1.18 x 10^9/L include:
- Avoiding exposure to potential infectious agents by avoiding crowds and practicing good hand hygiene
- Monitoring for signs of infection, such as fever, and seeking immediate medical attention if these occur
- Potential use of granulocyte colony-stimulating factors (G-CSF) to stimulate neutrophil production, depending on the underlying cause and severity of neutropenia
- Addressing any underlying conditions that may be contributing to the low neutrophil count, such as medication side effects, viral infections, autoimmune disorders, or bone marrow problems, as discussed in the context of hairy cell leukemia management 1. Regular follow-up and monitoring of neutrophil counts are crucial to assess the effectiveness of the management strategy and adjust it as necessary to prevent complications associated with neutropenia.
From the FDA Drug Label
The use of ZARXIO prior to confirmation of a correct diagnosis of SCN may impair diagnostic efforts and may thus impair or delay evaluation and treatment of an underlying condition‚ other than SCN‚ causing the neutropenia Prior to starting ZARXIO in patients with suspected chronic neutropenia, confirm the diagnosis of severe chronic neutropenia (SCN) by evaluating serial CBCs with differential and platelet counts‚ and evaluating bone marrow morphology and karyotype
The patient has a neutrophil count of 1.18. Severe chronic neutropenia (SCN) is typically defined as an absolute neutrophil count (ANC) less than 0.5 x 10^9/L. Since the patient's neutrophil count is above this threshold, it is not possible to confirm a diagnosis of SCN based on this information alone.
- To confirm the diagnosis of SCN, serial CBCs with differential and platelet counts should be evaluated, as well as bone marrow morphology and karyotype.
- The patient's neutrophil count should be monitored over time to determine if it is consistently low, which could indicate SCN.
- If the diagnosis of SCN is confirmed, filgrastim (ZARXIO) may be considered as a treatment option to reduce the incidence and duration of sequelae of neutropenia 2, 2, 2.
From the Research
Neutrophil Count
- The given neutrophil count is 1.18, which is below the normal range of absolute neutrophil count (ANC) ≥ 1.5 × 10(9)/L 3.
- Neutropenia is defined as an ANC < 1.5 × 10(9)/L, and severe neutropenia is defined as an ANC < 0.5 × 10(9)/L 3, 4.
Diagnosis and Treatment
- The diagnosis and treatment of neutropenia depend on the underlying cause, which can range from normal variants to life-threatening acquired and congenital disorders 4.
- Patients with severe chronic neutropenia are at increased risk of bacterial infections and may require treatment with granulocyte colony-stimulating factor (G-CSF) 3, 5.
- G-CSF treatment has been shown to be effective in increasing neutrophil counts and reducing the risk of infections in patients with severe chronic neutropenia 5.
Prognosis
- The prognosis for patients with severe chronic neutropenia depends on the underlying etiology, with congenital neutropenias carrying a higher risk of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) 5.
- Patients with cyclic, idiopathic, or autoimmune neutropenia have a more favorable prognosis, with minimal risk of evolving to MDS or AML 4, 5.
Treatment Options
- G-CSF treatment is a common therapy for severe chronic neutropenia, but it requires daily injections, which can be inconvenient and expensive 6.
- Researchers are exploring alternative strategies for using G-CSF, including understanding the mechanism of action and how it induces neutrophil mobilization 6.