From the Guidelines
An absolute neutrophil count (ANC) of 0.0 represents severe neutropenia, which is a medical emergency requiring immediate attention. This condition puts you at extremely high risk for life-threatening infections, with a mortality rate of up to 11% and major complications occurring in approximately 25% to 30% of cases 1. You should go to the emergency room right away, as prompt treatment is crucial to prevent severe outcomes.
While waiting for medical care, it is essential to take precautions to minimize the risk of infection, including:
- Avoiding crowds and anyone with illness
- Practicing meticulous hand hygiene
- Wearing a mask if available
At the hospital, expect to receive a thorough evaluation, including:
- Blood tests
- Cultures
- Possibly imaging
Treatment typically includes broad-spectrum antibiotics, such as piperacillin-tazobactam, meropenem, or cefepime, possibly with vancomycin, even without obvious infection 1. The medical team will investigate the underlying cause, which could include medication side effects, bone marrow disorders, autoimmune conditions, or severe infections. You may need hospitalization in isolation, growth factor medications like filgrastim to stimulate neutrophil production, and close monitoring. According to the most recent guidelines, the use of hematopoietic growth factors, such as G-CSF, should be considered in patients with severe neutropenia, with a recommended dosage of 5 µg/kg/day, 24-72 hours after the last day of chemotherapy, until sufficient ANC recovery 1.
This condition occurs when your body lacks neutrophils, which are white blood cells crucial for fighting bacterial and fungal infections, leaving you vulnerable to pathogens that normally wouldn't cause illness in people with healthy immune systems. Given the high risk of severe complications and mortality associated with severe neutropenia, it is essential to prioritize prompt medical attention and treatment to minimize these risks.
From the Research
Definition and Classification of Neutropenia
- Neutropenia is defined as an absolute neutrophil count (ANC) of less than 1,500/mcL 2, 3, 4
- Severe neutropenia is defined by an ANC less than 0.5 x 10(9)/L 5, 4
- Neutropenia can be classified as transient or chronic, with chronic neutropenia further described as extrinsic or intrinsic 2
Causes and Consequences of Neutropenia
- Neutropenia can be caused by a variety of factors, including impaired proliferation and maturation of myeloid progenitor cells in the bone marrow 2
- Severe chronic neutropenia can predispose to infection, chiefly by organisms resident on body surfaces 5
- Patients with neutropenia are at risk of developing life-threatening bacterial infections, particularly febrile neutropenia 2, 4
Diagnosis and Management of Neutropenia
- Diagnosis of neutropenia typically involves laboratory evaluation, including complete blood cell counts (CBCs) with differentials and bone marrow examination with cytogenetics 3
- 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) 3, 6, 4
- Patients with severe chronic neutropenia require monitoring for the risk of eventually developing myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) 3, 6
Specific Considerations for Absolute Neutrophil Count 0.0
- An absolute neutrophil count of 0.0 is considered severe neutropenia, which is a well-known risk factor for susceptibility to bacterial infections 5, 4
- Patients with an ANC of 0.0 should be managed with caution, including aggressive treatment of bacterial or fungal infections and administration of G-CSF as needed 3, 6, 4