What constitutes a reasonable workup for neutropenia in an otherwise healthy young person?

English: Promyelocyte, bone marrow smear.

English: Promyelocyte, bone marrow smear. (Photo credit: Wikipedia)

Neutropenia is defined as a deficiency of circulating neutrophils or an absolute neutrophil count <1,500 µL. This condition can be attributable to a reduction in bone-marrow production or increased loss of bone marrow from the circulation. A thorough history is the best place to start in your evaluation of a healthy child with a low neutrophil count.

A viral infection is the most common cause in children (not infants). The neutropenia develops during the illness and persists for up to one week after resolution. Measles, mumps and rubella vaccine as well as varicella vaccine can also trigger transient neutropenia. Another possible cause is bacterial infection.

Nutritional deficits in folic acid, vitamin B12 or copper can also lead to a drop in neutrophils. Lastly, look carefully at any drugs the patient is currently taking or may have recently finished taking. Herbal therapies and supplements also deserve evaluation. — Julee B. Waldrop, DNP (175-1)

Ariana-Leilani has severe chronic neutropenia, absolute neutrophil count <500 µL.    As noted, drugs can cause neutropenia.  However, her medical providers at Medstar Georgetown University Hospital have refused to give her a toxicology test.   That is why she need GCSF medicine (to boost her ANC) and an independent medical examination as soon as possible.    Sign her petition today so she can live.


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