Lima Carmen S P, Paula Erich V, Takahashi Tatiana, Saad Sara T O, Lorand-Metze Irene, Costa Fernando F
Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Rua Alexander Flemming no 181, Barão Geraldo, Campinas, São Paulo, CP: 6111, Cep: 13083-970, Brazil.
Ann Hematol. 2006 Oct;85(10):705-9. doi: 10.1007/s00277-006-0150-0. Epub 2006 Jun 29.
The incidental discovery of neutropenia during routine blood counting represents a common problem for clinicians. However, there are no reported data of systematic evaluations of adults with incidental neutropenia. As such, this was the aim of the present study. Ninety-seven adults with incidental neutropenia were submitted to a clinical and laboratory approach including medical evaluation, complete blood count (CBC), serial CBC, direct and indirect antiglobulin test, bone marrow smear and biopsy, assessment of folate, vitamin B12 and iron status, serum liver enzymes, serum proteins, serological exams for hepatitis B and C virus, cytomegalovirus, mononucleosis, human immunodeficiency virus and toxoplasmosis, detection of lupus erythematosus cells, antinuclear and anti-DNA antibodies and rheumatoid factor, dosage of free thyroxin and thyrotropin, chest roentgenogram and abdominal echography. Chronic idiopathic neutropenia of adults was identified in 34.0% of the individuals, neutropenia due to exposure to chemical agents was seen in 16.5%, infectious diseases in 9.3%, autoimmune diseases in 9.3%, haematological diseases in 9.3%, thyroid disorders in 8.2%, ethnic neutropenia in 7.2%, drug-related neutropenia in 2.1%, cyclic neutropenia in 2.1% and iron deficiency in 2.1%. Recovery or improvement of the neutrophil count was seen upon treatment or recuperation from infectious, autoimmune, haematological and thyroid diseases and iron supplementation. We conclude that the evaluation of individuals with incidental neutropenia using a structured approach may make the identification of clinically silent diseases possible, and provide an opportunity for early treatment, avoiding complications of the diseases and consequences of neutropenia.
在常规血细胞计数时偶然发现中性粒细胞减少是临床医生常见的问题。然而，目前尚无关于成人偶然中性粒细胞减少症系统评估的报道数据。因此，本研究的目的即在于此。97例成人偶然中性粒细胞减少症患者接受了临床和实验室检查，包括医学评估、全血细胞计数（CBC）、连续CBC、直接和间接抗球蛋白试验、骨髓涂片和活检、叶酸、维生素B12和铁状态评估、血清肝酶、血清蛋白、乙肝和丙肝病毒、巨细胞病毒、单核细胞增多症、人类免疫缺陷病毒和弓形虫病的血清学检查、红斑狼疮细胞检测、抗核抗体和抗DNA抗体以及类风湿因子检测、游离甲状腺素和促甲状腺激素测定、胸部X线片和腹部超声检查。34.0%的个体被诊断为成人慢性特发性中性粒细胞减少症，16.5%为接触化学物质所致中性粒细胞减少症，9.3%为感染性疾病，9.3%为自身免疫性疾病，9.3%为血液系统疾病，8.2%为甲状腺疾病，7.2%为种族性中性粒细胞减少症，2.1%为药物相关性中性粒细胞减少症，2.1%为周期性中性粒细胞减少症，2.1%为缺铁性中性粒细胞减少症。在感染性、自身免疫性、血液系统和甲状腺疾病以及补充铁剂治疗或恢复后，中性粒细胞计数出现恢复或改善。我们得出结论，采用结构化方法对偶然中性粒细胞减少症患者进行评估可能有助于识别临床无症状疾病，并提供早期治疗机会，避免疾病并发症和中性粒细胞减少症的后果。
