From the Guidelines
Benign Neutropenia in children is typically diagnosed based on a low neutrophil count, and management involves monitoring and supportive care, as most cases are self-limiting and resolve on their own.
Diagnosis
- The diagnosis of benign neutropenia is based on a low neutrophil count, typically defined as an absolute neutrophil count (ANC) of less than 1,500 cells/mm^3 1.
- The severity of neutropenia is categorized based on the ANC, with severe neutropenia defined as an ANC of less than 500 cells/mm^3 1.
Management
- The management of benign neutropenia in children typically involves monitoring and supportive care, as most cases are self-limiting and resolve on their own 2, 3.
- Antibiotic prophylaxis is not typically recommended for benign neutropenia, unless there are other underlying conditions that increase the risk of infection 1, 4.
- Antifungal therapy may be considered in certain cases, such as in children with persistent fever and neutropenia, or in those with a high risk of invasive fungal disease 3.
- The choice of antifungal therapy depends on various factors, including the severity of neutropenia, the presence of underlying conditions, and the risk of invasive fungal disease 3.
- Caspofungin or liposomal amphotericin B (L-AmB) are recommended as first-line antifungal therapy in children with fever and neutropenia, due to their efficacy and safety profiles 3.
- The duration of antifungal therapy depends on the resolution of neutropenia and the presence of documented or suspected invasive fungal disease 3.
From the Research
Diagnosis of Benign Neutropenia in Children
- Benign neutropenia is a condition characterized by a low neutrophil count, defined as an absolute neutrophil count (ANC) below 1500/mm3 in the peripheral blood 5.
- The etiological cause of neutropenia can be identified in approximately 75% of neutropenic children, with infection being the most common cause 5.
- Other causes of neutropenia in children include drug use, nutritional deficiencies, and chronic benign neutropenia 5.
Management of Benign Neutropenia in Children
- The clinical course of benign neutropenia is largely benign, and the mortality rate is very low 5.
- A survey of pediatric hematology/oncology practitioners in Canada found that there is considerable variability in the management of benign neutropenia, with different approaches to diagnosis and treatment 6.
- Another survey of pediatric hematologist oncologists found that the most common tests ordered for patients with isolated neutropenia include complete blood cell count (CBC), peripheral smear, and antineutrophil antibody testing 7.
- The management of benign neutropenia may involve empiric intravenous antibiotics, outpatient antibiotic therapy, or no treatment at all, depending on the severity of the condition and the presence of underlying infections 6, 7.
Diagnostic Criteria and Investigation
- There are no established consensus guidelines for the diagnosis and management of patients with isolated, asymptomatic, and incidentally discovered neutropenia 7.
- A complete blood cell count (CBC) is the most common test ordered for patients with neutropenia, followed by peripheral smear and antineutrophil antibody testing 7.
- Bone marrow biopsy may be indicated in cases of severe infection, prolonged neutropenia, or before initiating granulocyte colony stimulating factor 6.
- Granulocyte colony stimulating factor may be used in cases of severe or frequent infections 6.