Prevalence and clinical significance of neutropenia discovered in routine complete blood cell counts: a longitudinal study

Neutropenia, defined as an absolute blood neutrophil count (ANC) <1.5 G L−1, may accompany a variety of diseases. However, the clinical significance of neutropenia detected in a routine complete blood cell count is poorly understood. Neutropenia is associated with viral infections and hematological malignancies in a dose-dependent manner, according to a study published online Jan. 21 in the Journal of Internal Medicine.

C.L. Andersen, from the University of Copenhagen in Denmark, and colleagues examined the clinical significance of neutropenia. A primary care resource was used to examine the correlation with various conditions and all-cause mortality in the four years following neutropenia identification for more than 370,000 individuals.

Neutropenia was observed in approximately 1% of all individuals and was associated dose dependently with viral infections, haematological malignancies (but not autoimmune disorders or solid cancers) and mortality. Neutropenia was particularly associated with HIV, acute leukaemias and myelodysplastic syndromes. Odds ratios [95% confidence interval (CI)] for viral infections were 2.32 (1.84–2.91), 2.80 (2.20–3.57) and 4.77 (3.22–7.07) for subnormal (≥1.5–1.8 G L−1), mild (≥1.0–1.5 G L−1) and moderate–severe (≥0.0–1.0 G L−1) neutropenic individuals, respectively (all P < 0.001). Likewise, odds ratios (95% CI) for haematological malignancies were 3.23 (2.35–4.45), 8.69 (6.58–11.47) and 46.03 (33.98–62.35 ), for the same neutropenia levels, respectively (all P < 0.001). Thus, the lower the ANC, the greater the likelihood of these diseases. The relative risk estimates observed for severe neutropenia corresponded to absolute risks of haematological malignancies and mortality from any cause of 40% and >50%, respectively.

Neutropenia is an ominous sign necessitating careful follow-up. The risk estimates presented support focusing attention to viral diseases and haematological malignancies when neutropenia is observed.  “The risk estimates presented here support focusing attention to viral diseases and hematological malignancies when neutropenia is observed,” the authors write.

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Authors of the study were:  C. L. Andersen, D. Tesfa, V. D. Siersma, H. Sandholdt, H. Hasselbalch, O. W. Bjerrum, P. Felding, B. Lind, Niels de. F. Olivarius andJ. Palmblad,

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