Ozdemir Zeynep Canan, Kar Yeter Duzenli, Kasaci Bilge, Bor Ozcan
Division of Pediatric Hematology-Oncology, Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Ekisehir, Turkey.
North Clin Istanb. 2021 May 24;8(3):236-242. doi: 10.14744/nci.2020.65624. eCollection 2021.
Neutropenia is defined as an absolute neutrophil count (ANC) below 1500/mm in the peripheral blood and is a common condition in childhood. In this study, underlying etiological causes and prognoses in children in follow-up due to neutropenia were analyzed to form a guide for physicians working in primary health care institutions.
The medical records of pediatric patients who were followed up as an inpatients or outpatients due to neutropenia between October 2014 and October 2017 were reviewed retrospectively.
A total of 94 patients were included in the study with a median age of 24 (8-77) months. The median ANC at the time of admission was 600 (300-970)/mm. The ANC was 0-500/mm in 34 patients (36.2%), 500-1000/mm in 36 patients (38.3%), and 1000-1500/mm in 24 patients (25.5%). Of the total, 43 patients (45.7%) were followed up as inpatients and 51 (54.3%) were followed as outpatients. Fifty-five patients (58.5%) were diagnosed with post-infectious neutropenia. The most common focus of infection was the upper respiratory airway (38.4%). The etiological cause could not be identified in 23 (24.6%) patients, neutropenia developed during drug use in 6 patients (6.3%), 5 patients (5.3%) were diagnosed with Vitamin B12 deficiency (Vitamin B12 level: 168 [129-174] pg/ml, the levels were studied in 48 patients), 2 patients (2%) were diagnosed with chronic benign neutropenia, 1 patient (1.1%) was diagnosed with immune deficiency, 1 patient (1.1%) was diagnosed with autoimmune lymphoproliferative syndrome, and 1 patient (1.1%) was diagnosed with hemophagocytic lymphohistiocytosis secondary to a previous infection. No patient was diagnosed with congenital neutropenia. A total of 91 patients (96.8%) recovered from the neutropenia. Neutropenia did not improve in 3 patients (3.2%). One patient was lost due to infection.
Etiological cause can be shown in approximately 75% of neutropenic children. The most common etiological cause is infection. Drug use, nutritional deficiencies, and chronic benign neutropenia are less common causes of neutropenia. The clinical course is largely benign and the mortality rate is very low.
中性粒细胞减少症定义为外周血绝对中性粒细胞计数（ANC）低于1500/mm³，是儿童期的常见病症。本研究分析了因中性粒细胞减少症进行随访的儿童的潜在病因及预后情况，以为基层医疗机构的医生提供指导。
回顾性分析2014年10月至2017年10月期间因中性粒细胞减少症住院或门诊随访的儿科患者的病历。
本研究共纳入94例患者，中位年龄为24（8 - 77）个月。入院时的中位ANC为600（300 - 970）/mm³。34例患者（36.2%）的ANC为0 - 500/mm³，36例患者（38.3%）为500 - 1000/mm³，24例患者（25.5%）为1000 - 1500/mm³。其中，43例患者（45.7%）为住院随访，51例患者（54.3%）为门诊随访。55例患者（58.5%）被诊断为感染后中性粒细胞减少症。最常见的感染部位是上呼吸道（38.4%）。23例患者（24.6%）病因不明，6例患者（6.3%）在用药期间出现中性粒细胞减少症，5例患者（5.3%）被诊断为维生素B12缺乏（维生素B12水平：168 [129 - 174] pg/ml，对48例患者进行了该水平检测），2例患者（2%）被诊断为慢性良性中性粒细胞减少症，1例患者（1.1%）被诊断为免疫缺陷，1例患者（1.1%）被诊断为自身免疫性淋巴增殖综合征，1例患者（1.1%）被诊断为既往感染继发噬血细胞性淋巴组织细胞增生症。无患者被诊断为先天性中性粒细胞减少症。共有91例患者（96.8%）中性粒细胞减少症得以恢复。3例患者（3.2%）中性粒细胞减少症未改善。1例患者因感染死亡。
约75%的中性粒细胞减少症儿童可明确病因。最常见的病因是感染。药物使用、营养缺乏和慢性良性中性粒细胞减少症是中性粒细胞减少症较不常见的病因。临床病程大多为良性，死亡率很低。
