From the Guidelines
A neutropenia of 0.3 indicates a severe deficiency in neutrophils, significantly increasing the risk of serious infections, and requires immediate medical attention. This condition is characterized by an absolute neutrophil count (ANC) of 0.3 × 10^9 cells per liter of blood (or 300 neutrophils per microliter), which is substantially lower than the normal range of 1.5 to 8.0 × 10^9/L 1. Neutrophils play a crucial role in defending against bacterial and fungal infections, and their severe deficiency puts patients at a high risk of developing febrile neutropenia, a condition that can lead to major complications, such as hypotension, acute renal, respiratory, or heart failure, with a mortality rate of up to 11% 1.
Key Considerations
- Patients with severe neutropenia are at a high risk of developing febrile neutropenia, which is a medical emergency requiring prompt antibiotic treatment 1.
- The underlying cause of neutropenia, such as medication side effects, bone marrow disorders, or certain infections, must be identified and addressed to effectively manage this condition.
- Protective isolation, prophylactic antibiotics, and possibly granulocyte colony-stimulating factor (G-CSF) medications like filgrastim may be necessary to stimulate neutrophil production and prevent infections 1.
- The use of hematopoietic growth factors, such as G-CSF, should be guided by evidence-based recommendations, taking into account the risk of complications, such as severe thrombocytopenia and potential long-term risks, like acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) 1.
Management
- Immediate medical attention is required for patients with severe neutropenia, and treatment should be guided by evidence-based guidelines and individual patient needs.
- Fever in someone with severe neutropenia is considered a medical emergency, and prompt antibiotic treatment is essential to prevent serious complications.
- The dosage schedule, route of application, and potential risks of G-CSF and pegfilgrastim should be carefully considered, with a recommended dose of 5 µg/kg/day of G-CSF, and a single dose of either 100 µg/kg or a total dose of 6 mg of pegfilgrastim 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Neutropenia Definition
- Neutropenia is defined as an absolute neutrophil count (ANC) less than 1.5 × 10(9)/L 2, 3.
- Severe neutropenia is defined as an ANC less than 0.5 × 10(9)/L 2.
Interpretation of ANC 0.3
- An ANC of 0.3 × 10(9)/L falls into the category of severe neutropenia, which is a well-known risk factor for susceptibility to bacterial infections 2.
- Patients with severe neutropenia are at a higher risk of developing life-threatening sepsis, shock, and even death 4.
Management and Treatment
- Management of severe chronic neutropenia includes commonsense precautions to avoid infection, aggressive treatment of bacterial or fungal infections, and administration of granulocyte colony-stimulating factor (G-CSF) 2, 3.
- G-CSF may be administered to facilitate the recovery process with daily monitoring of neutrophil count 4.
- Patients with severe chronic neutropenia have a risk of eventually developing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) and require monitoring for this complication 3.