From the Guidelines
Neutropenia in adolescents can be caused by various factors, including congenital neutropenia syndromes, bone marrow disorders, autoimmune diseases, and certain medications, as highlighted in a recent study published in 2024 1.
Causes of Neutropenia
The causes of neutropenia in adolescents can be categorized into several groups, including:
- Congenital neutropenia syndromes, such as severe congenital neutropenia (SCN) and Shwachman-Diamond syndrome (SDS), which are associated with genetic mutations and can increase the risk of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) 1.
- Bone marrow disorders, such as leukemia and aplastic anemia, which can disrupt normal neutrophil production.
- Autoimmune diseases, such as lupus and rheumatoid arthritis, which can attack neutrophils or their precursors.
- Certain medications, such as antibiotics, chemotherapy drugs, antiseizure medications, and some antipsychotics, which can suppress bone marrow production of neutrophils.
Management of Neutropenia
Management of neutropenia in adolescents depends on identifying the underlying cause, with treatment ranging from simply monitoring mild cases to addressing specific deficiencies, discontinuing offending medications, or treating underlying conditions.
Recent Findings
A recent study published in 2024 found that certain genetic mutations, such as those associated with the ERCC6L2 gene, can increase the risk of MDS and AML in adolescents with congenital neutropenia syndromes 1. Therefore, it is essential to identify the underlying cause of neutropenia in adolescents and provide appropriate treatment to prevent complications and improve outcomes, as recommended in the recent study 1.
From the Research
Causes of Neutropenia in Adolescents
The causes of neutropenia in adolescents can be categorized into several groups, including:
- Congenital neutropenia due to genetic abnormalities, which is severe and chiefly seen in the pediatric population 2
- Acquired neutropenia, which is the most common cause in patients with rheumatoid arthritis, often due to medications used to treat the condition 2
- Autoimmune neutropenia, caused by neutrophil-specific autoantibodies, which is a common phenomenon in autoimmune disorders such as Felty's syndrome and systemic lupus erythematosus 3
- Viral infections, which can cause transient neutropenia, and are often benign but may require careful follow-up 4, 5
- Bacterial and fungal agents, which can also cause transient neutropenia, although fever with severe neutropenia constitutes a medical emergency 4
Specific Causes and Associations
Some specific causes and associations of neutropenia in adolescents include:
- Neutropenia with reduced bone marrow reserve, which can be due to congenital or acquired conditions 4
- Secondary neutropenia with reduced bone marrow reserve, which can be caused by cytotoxic chemotherapies or other medications 4
- Neutropenia with normal bone marrow reserve, which can be due to autoimmune or viral causes 4
- Association with other cytopenias, such as bi- or pancytopenia, which can increase the risk of viral infections or hematological malignancies 5
Clinical Significance and Diagnosis
The clinical significance and diagnosis of neutropenia in adolescents depend on the severity and duration of the condition, as well as the presence of other symptoms or underlying conditions 2, 4, 5, 6. A practical diagnostic algorithm for managing neutropenic children has been proposed, which takes into account the age of the child, clinical observations, and laboratory tests 4, 6.