Department of Hematology and Medicine, The Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Am J Hematol. 2020 May;95(5):521-528. doi: 10.1002/ajh.25756. Epub 2020 Mar 4.
Neutropenia (NP), that is, an absolute blood neutrophil count (ANC) <1.5 g/L, accompanies various diseases. However, the clinical significance of NP, detected in routine complete blood cell counts (CBC) in primary care, is poorly characterized. Here, from a primary care resource with ANCs from >370 000 individuals, we identified and followed neutropenic subjects for the next 4 years for novel ICD-10 based diagnoses of viral infections and hematological malignancies (ie, previously identified major outcomes in NP individuals) in Danish nationwide health registers. Risk estimates were assessed for children/adolescents (1-18 years) and adults (19-90 years) in relation to NP severity, and for isolated NP, bi- or pancytopenias. We found that NP was observed in 4.9% of children and in 1.9% of adults. The lower the ANC, the likelier was a diagnosis of viral infections or hematological malignancies established during the ensuing 4 years. Among neutropenic children, unspecified viral infections predominated, followed by mononucleosis (with other cytopenias in only 7% and 25% of the cases, respectively). All NP children with acute leukemia presented with bi- or pancytopenia from start of follow-up. In NP adults, hepatitis, followed by HIV, were the most common infections, and acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDSs) the predominating hematological malignancies. Adult NP patients, subsequently diagnosed with hepatitis, HIV or AML, MDS, were bi- or pancytopenic in 42%, 47%, 90% and 91% of cases, respectively. Thus, presence of NP in even one CBC may be the first sign of a latent viral or hematological disorder requiring careful follow-up.
中性粒细胞减少症（NP），即绝对中性粒细胞计数（ANC）<1.5g/L，伴随各种疾病。然而，在初级保健中常规全血细胞计数（CBC）检测到的 NP 的临床意义尚未得到充分描述。在这里，我们从一个拥有超过 37 万名个体的 ANC 的初级保健资源中，确定并在接下来的 4 年中对中性粒细胞减少的个体进行随访，以根据丹麦全国健康登记处的新 ICD-10 进行病毒感染和血液恶性肿瘤（即 NP 个体中先前确定的主要结局）的诊断。评估了儿童/青少年（1-18 岁）和成人（19-90 岁）与 NP 严重程度以及孤立性 NP、双或全血细胞减少症相关的风险估计。我们发现 NP 在 4.9%的儿童和 1.9%的成人中观察到。ANC 越低，在接下来的 4 年内诊断出病毒感染或血液恶性肿瘤的可能性就越大。在中性粒细胞减少的儿童中，未特指的病毒感染最为常见，其次是单核细胞增多症（仅分别有 7%和 25%的病例存在其他血细胞减少症）。所有从随访开始时就出现双或全血细胞减少症的 NP 儿童急性白血病患者。在 NP 成人中，肝炎，其次是 HIV，是最常见的感染，急性髓细胞性白血病（AML）和骨髓增生异常综合征（MDS）是最常见的血液恶性肿瘤。随后被诊断患有肝炎、HIV 或 AML、MDS 的 NP 成年患者，在 42%、47%、90%和 91%的病例中分别存在双或全血细胞减少症。因此，即使在一次 CBC 中出现 NP 也可能是潜伏性病毒或血液疾病的第一个迹象，需要仔细随访。
