From the Guidelines
A WBC count of 1.67 × 10^9/L is a medical emergency that requires immediate attention, as it indicates severe neutropenia and a high risk of sepsis, particularly in patients with a history of chemotherapy or other immunosuppressive conditions 1. This low count may be caused by various factors, including chemotherapy, viral infections, bone marrow disorders, autoimmune conditions, or nutritional deficiencies. Given the severity of neutropenia, the risk of developing sepsis is significantly increased, with studies suggesting that 70%–100% of patients with intensive myelosuppressive chemotherapy may experience febrile episodes, and 10%–30% may develop bacteremic infections 1. Some key points to consider in managing this patient include:
- The severity and duration of granulocytopenia are significant risk factors for developing sepsis, and the presence of multiple organ dysfunction and septic shock can worsen the prognosis 1.
- The MASCC risk score can be used to identify patients at low risk of complications, but in this case, the severely low WBC count warrants aggressive management and monitoring 1.
- Treatment may involve granulocyte colony-stimulating factors, antibiotics, and supportive care to manage potential infections and prevent further complications. It is essential to seek medical attention immediately, as delayed treatment can lead to severe consequences, including septic shock and multiple organ failure syndrome, which are associated with high mortality rates 1. While awaiting medical care, it is crucial to practice good hand hygiene, avoid crowds and sick people, and monitor for signs of infection, such as fever, to minimize the risk of developing sepsis.
From the Research
Leukopenia Diagnosis and Management
- Leukopenia is an abnormal reduction of circulating white blood cells, especially the granulocytes, which can result from reduced production of white blood cells or increased utilization and destruction, or both 2.
- The major danger of neutropenia, a type of leukopenia, is the risk of infection, and management requires identification of the cause and effective antimicrobial therapy, especially when serious systemic infection is present 2.
- To diagnose leukopenia, it's useful to check previous blood counts of the patient to get a feeling for the dynamic development of the leukopenia, as well as the red blood cell count and platelet count, as a bi- or pancytopenia usually implies an insufficient production in the bone marrow 3.
Causes and Classification of Leukopenia
- Leukopenia can be caused by various factors, including infection, drugs, malignancy, megaloblastosis, hypersplenism, and immunoneutropenia 2.
- Neutropenia, a type of leukopenia, can be classified as transient or chronic, and chronic neutropenia can be further described as extrinsic or intrinsic, with intrinsic causes including impaired proliferation and maturation of myeloid progenitor cells in the bone marrow 4.
- Some medications, such as ciprofloxacin, can cause reversible leukopenia, and patients should be monitored for this side effect 5.
Treatment and Management of Leukopenia
- Treatment of leukopenia depends on the underlying cause and severity of the condition, and may include antibiotics, granulocyte colony-stimulating factor (G-CSF), and changes to immunosuppression and prophylaxis regimens 3, 4, 6.
- G-CSF has been used to accelerate white blood cell count recovery in patients with leukopenia, particularly in those with kidney transplantation, and may be helpful in achieving WBC count recovery in addition to changes in immunosuppression and prophylaxis medications 6.
- Patients with febrile neutropenia should undergo treatment with antibiotics, and other treatments should be aimed at managing the underlying cause of neutropenia 4.