From the Guidelines
The management of neutrophilia primarily involves treating the underlying cause rather than the elevated neutrophil count itself, with a focus on identifying the etiology through a thorough history, physical examination, and additional testing as needed. The first step is to identify the cause of the elevated neutrophil count, which can include bacterial infections, inflammation, stress, medications (particularly corticosteroids), malignancies (especially leukemias), and physiologic responses like exercise or pregnancy. For infection-related neutrophilia, appropriate antimicrobial therapy directed at the specific pathogen is essential, as highlighted in the guidelines for antimicrobial prophylaxis in cancer-related immunosuppression 1. If medication-induced, consider discontinuing or adjusting the offending agent when possible. For inflammatory conditions, treating the underlying disorder with anti-inflammatory medications or disease-specific therapies is recommended. In cases of hematologic malignancies, referral to hematology-oncology for specialized treatment is necessary. Stress-induced neutrophilia typically resolves once the stressor is removed. Monitoring with serial CBCs is important to assess response to treatment and ensure resolution. No specific medication exists to directly lower neutrophil counts in most clinical scenarios, as neutrophilia is typically a symptom rather than a disease itself. The prognosis generally depends on the underlying cause, with infection or stress-related neutrophilia having better outcomes than malignancy-associated elevations.
Some key considerations in the management of neutrophilia include:
- Identifying the underlying cause of the elevated neutrophil count
- Providing appropriate antimicrobial therapy for infection-related neutrophilia
- Discontinuing or adjusting medications that may be contributing to the elevated neutrophil count
- Treating underlying inflammatory or malignant conditions
- Monitoring with serial CBCs to assess response to treatment
- Recognizing that neutrophilia is often a symptom rather than a disease itself, and that treatment should be focused on the underlying cause. The use of myeloid growth factors, such as colony-stimulating factors (CSFs), can reduce the risk, severity, and duration of febrile neutropenia, a major dose-limiting toxicity of chemotherapy 1. However, the management of neutrophilia itself is focused on treating the underlying cause, rather than the elevated neutrophil count.
In terms of specific treatment approaches, the guidelines for antimicrobial prophylaxis in cancer-related immunosuppression provide recommendations for the management of febrile neutropenia, which can be a complication of neutrophilia 1. However, the management of neutrophilia itself is focused on treating the underlying cause, rather than the elevated neutrophil count. The prognosis and outcomes for patients with neutrophilia depend on the underlying cause, with infection or stress-related neutrophilia generally having better outcomes than malignancy-associated elevations. Overall, the key to managing neutrophilia is to identify and treat the underlying cause, rather than focusing on the elevated neutrophil count itself.
From the Research
Neutrophilia Management
- Neutrophilia, or an elevated neutrophil count, can be caused by various factors, including infections, inflammation, and certain medications 2, 3.
- The management of neutrophilia depends on the underlying cause, and treatment may involve addressing the underlying condition, such as administering antibiotics for infections 4, 5.
- In cases of ceftriaxone-induced neutropenia, alternative β-lactam antibiotics, such as ampicillin sodium, may be used as a safe and effective treatment option 5.
- For patients with severe chronic neutropenia, management may include granulocyte colony-stimulating factor (G-CSF) therapy, aggressive treatment of infections, and monitoring for potential complications, such as myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) 2, 3.
Diagnostic Approach
- A stepwise approach to diagnosing neutropenia involves reaching a provisional diagnosis and treatment plan, followed by further evaluation to determine the underlying cause 2.
- Laboratory tests, such as complete blood cell counts (CBCs) with differentials and bone marrow examination with cytogenetics, may be used to evaluate patients with isolated neutropenia 3.
- Neutrophil antibody testing may be useful in certain cases, but its utility is limited to specific clinical and bone marrow findings 3.
Treatment Considerations
- Patients with severe chronic neutropenia require careful management to prevent infections and monitor for potential complications 2, 3.
- The use of ceftaroline or ceftriaxone for prolonged periods may be associated with an increased risk of neutropenia, and clinicians should be aware of the need for monitoring absolute neutrophil counts (ANC) in these scenarios 6.
- Hematopoietic stem cell transplantation may be a curative therapy for congenital neutropenia with MDS/AML or with cytogenetic abnormalities indicating impending conversion 3.