How I investigate neutropenia

Frater, John L.

doi:10.1111/ijlh.13210

Cited by 26 publications

(31 citation statements)

References 42 publications

(37 reference statements)

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“…Restricted cubic splines showed a decrease of the risk within the lower range of neutrophil counts, which reached the lowest risk around the median and then increased after that. Neutrophil aggregation is reported acting as a subclinical inflammation stage, while neutropenia reflects a physiological condition that the body may be in disorder, such as serious inflammation or myelosuppression [ 24 , 25 ]. The effect of preoperative and postoperative NLPR on AKI was a ‘J’ shape.…”

Section: Discussionmentioning

confidence: 99%

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Zou

Zhang

et al. 2021

Renal Failure

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Background: In this study, we applied a composite index of neutrophil-lymphocyte Ã platelet ratio (NLPR), and explore the significance of the dynamics of perioperative NLPR in predicting cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: During July 1 st and December 31 th 2019, participants were prospectively derived from the 'Zhongshan Cardiovascular Surgery Cohort'. NLPR was determined using neutrophil counts, lymphocyte and platelet count at the two-time points. Dose-response relationship analyses were applied to delineate the non-linear odds ratio (OR) of CSA-AKI in different NLPR levels. Then NLPRs were integrated into the generalized estimating equation (GEE) to predict the risk of AKI. Results: Of 2449 patients receiving cardiovascular surgery, 838 (34.2%) cases developed CSA-AKI with stage 1 (n ¼ 658, 26.9%), stage 2-3 (n ¼ 180, 7.3%). Compared with non-AKI patients, both preoperative and postoperative NLPR were higher in AKI patients (1.

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Section: Discussionmentioning

confidence: 99%

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Zou

Zhang

et al. 2021

Renal Failure

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“…1,2 There are many causes of neutropenia, whether congenital or acquired. 3 Work-up of neutropenia is usually dictated by the associated clinical scenario but when chronic, stable, and mild or moderate in nature, isolated neutropenia is usually a benign condition with no increased risk of infection or progression to hematological malignancies.…”

Section: Introductionmentioning

confidence: 99%

<p>The Prevalence of Isolated Neutropenia at High Altitude in Southern Saudi Arabia: Does Altitude Affect Leucocyte Count?</p>

Alkhaldy¹,

Awan²,

Abouzaid³

et al. 2020

IJGM

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Introduction: Isolated neutropenia is a common problem in hematology practice. Benign ethnic neutropenia (BEN) is the common form of neutropenia worldwide and it affects mainly African and Middle Eastern ethnicities. Most cases of isolated mild and moderate neutropenia are benign and associated with no clinical significance. The aim of this study was to estimate the prevalence of isolated neutropenia at high-altitude southern Saudi Arabia. Methods: A large dataset of complete blood counts (CBCs) was analyzed for walk-in patients of both genders, of age ranges from 12 to 60 years doing blood tests at a commercial lab for high altitude − 2,270 meters above sea level-(HA) group, and from sea level SL group. Abnormal biochemical or CBC results were excluded before analysis. Results: For HA group, 3123 CBCs were analyzed and for SL group 18,427 CBCs were analyzed. The prevalence of mild neutropenia, defined as absolute neutrophil count (ANC) in the range of 1.0−.5× 10 9 /L, was 12.4% (n=399) versus 5.6% (n=1025), while moderate neutropenia, defined as ANC of 0.5-1 × 10 9 /L, was present 6% (n=191) versus 1.45% (n=269) in the high altitude and sea level groups, respectively. Severe neutropenia, defined as neutrophil count less than 0.5-1 × 10 9 /L, was rare in both groups. Conclusion: Isolated neutropenia is common in Saudis living at high altitude. While benign ethnic neutropenia (BEN) is thought to be the major contributing factor to this high prevalence, other factors including environmental factors and altitude are possible contributing factors along with underlying ethnic neutropenia.

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“…Furthermore, the mean time to BEN registration from clozapine initiation was 2.7 years (SD = 4.0). Despite BEN often being an incidental finding in routine clinical care [32,33], our findings highlight the need for more definitive and precise guidelines for the screening of BEN in potential clozapine candidates, especially considering that BEN identification can be complicated in some individuals by periods of ANC readings within the widely accepted reference range [34]. In addition, the psychological impact of uncertainty experienced with clozapine interruption, continual monitoring and possible relapse cannot be overstated.…”

Section: Stage Of Ben Identification and Red Results After Benmentioning

confidence: 79%

Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

et al. 2021

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Background Benign ethnic neutropenia (BEN) is the most common cause of chronic neutropenia seen in individuals of African, Middle Eastern and West Indian descent. This phenotype is broadly defined by an absolute neutrophil counts (ANC) below 1.8 × 109 cells/L in the absence of other causes, without an increased risk of infection. BEN has been implicated as a potential source of disparity in patients treated with clozapine, the antipsychotic of choice in treatment-resistant schizophrenia. Our main objective was to examine the current level of BEN recognition in a cohort of patients treated with clozapine and the potential impact of unidentified BEN on the initiation and maintenance of clozapine treatment. Methods This was an observational, retrospective analysis of patients registered with clozapine haematological monitoring systems in two large mental health trusts, chosen because they serve an ethnically diverse population. The first objective was to establish certified BEN prevalence in current users of clozapine. The second objective was to explore the stage of treatment at which BEN was identified. The third objective was to evaluate the extent of unrecognised BEN in patients registered on the Central Non-Rechallenge Database (CNRD), a database for patients whose haematological parameters fall below set thresholds when receiving clozapine treatment, meaning they cannot ordinarily be prescribed clozapine again. Results The study population comprised of 2020 patients on the clozapine register. 111 patients were monitored under BEN criteria. BEN was mostly identified after a below threshold haematological result or clozapine rechallenge (68%) compared to at clozapine initiation (32%). Eight of the 18 (42%) black patients registered on the CNRD were classified as BEN after assessment by a haematologist. Of these 8 patients, none would have met CNRD criteria again if monitored with BEN criteria at clozapine initiation. Conclusions Current evidence suggests that BEN remains an uncommonly recognised haematological phenotype. Improved timely identification of BEN will reduce unnecessary interruption or discontinuation of clozapine treatment. Our results suggest consideration should also be given to determining BEN status prior to initiating clozapine. Moreover, adoption of current FDA BEN monitoring criteria in the UK may further reduce clozapine discontinuation due to perceived neutropenia as drug toxicity, particularly in treatment-refractory schizophrenia patients.

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How I investigate neutropenia

Cited by 26 publications

References 42 publications

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

Dynamics in perioperative neutrophil-to-lymphocyte*platelet ratio as a predictor of early acute kidney injury following cardiovascular surgery

<p>The Prevalence of Isolated Neutropenia at High Altitude in Southern Saudi Arabia: Does Altitude Affect Leucocyte Count?</p>

Benign ethnic neutropenia: an analysis of prevalence, timing and identification accuracy in two large inner-city NHS hospitals

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