Neutropenia in the Elderly: A Rheumatology Perspective

Yeoh, Su-Ann; Fox, Christine; Hull, Richard

doi:10.1007/s40266-016-0383-0

Cited by 4 publications

(3 citation statements)

References 178 publications

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“…The diagnosis of idiopathic or autoimmune neutropenia should not be applied to patients with these conditions or to patients with drug-induced neutropenia, chronic neutropenia after cancer chemotherapy or neutropenia caused by prolonged immunosuppressive or disease modifying agents. [23] This is important because the prognosis for these conditions differs significantly from CIN and AIN. At present there is no clear evidence that patients with CIN or AIN progress to develop other autoimmune disorders, but there may be yet undiscovered relationships.…”

Section: Diagnosismentioning

confidence: 99%

An update on the diagnosis and treatment of chronic idiopathic neutropenia

Dale¹,

Bolyard

2017

Current Opinion in Hematology

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Purpose of Review Neutropenia lasting for at least for 3 months and not attributable to drugs or a specific genetic, infectious, inflammatory, autoimmune or malignant cause is called chronic idiopathic neutropenia. (CIN) CIN and autoimmune neutropenia (AIN) are very similar and overlapping conditions. The clinical consequences depend upon the severity of neutropenia, but it is not considered a premalignant condition. Recent findings Long-term observational studies in children indicate that the disease often lasts for 3 to 5 years in children, then spontaneously remits, but it rarely remits in adult cases. The value of anti-neutrophil antibody testing in both children and adults is uncertain. Most recent data suggest that CIN and AIN are immune mediated diseases, but there are no new clinical or genetic tests to aid in diagnosis. Treatment with granulocyte colony stimulating factor (G-CSF) is effective to increase blood neutrophils in almost all cases; this treatment is reserved, however for patients with both neutropenia and evidence of recurrent fevers, inflammatory symptoms and infections. There is little or no evidence to indicate that G-CSF treatment predisposes to myeloid malignancies in this population. Summary It is important to recognize CIN and AIN, the most common causes of chronic neutropenia in both children and adults. If the neutropenia is not severe, i.e. > 0.5 × 109/L, most patients can be observed and not treated prophylactically with antibiotics or a growth factor. When neutropenia is severe treatment with G-CSF is often beneficial.

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Section: Diagnosismentioning

confidence: 99%

An update on the diagnosis and treatment of chronic idiopathic neutropenia

Dale¹,

Bolyard

2017

Current Opinion in Hematology

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“…These results could be partially explained by the fact that older people—especially in the context of an autoimmune rheumatic disease—seem to be more prone to develop neutropaenia. 24 Various factors have been proposed to contribute to this increase with age, including comorbidities, bone marrow suppression and aberrant drug metabolism. 24 …”

Section: Discussionmentioning

confidence: 99%

“… 24 Various factors have been proposed to contribute to this increase with age, including comorbidities, bone marrow suppression and aberrant drug metabolism. 24 …”

Section: Discussionmentioning

confidence: 99%

Neutropaenia in early rheumatoid arthritis: frequency, predicting factors, natural history and outcome

et al. 2018

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ObjectivesTo determine the frequency, severity and natural history of neutropaenia in early rheumatoid arthritis (RA), explore its associations with clinical features and assess its impact on clinical management.MethodsThe Scottish Early Rheumatoid Arthritis inception cohort prospectively recruited patients with newly diagnosed RA and followed them up every 6 months. Patients with RA who developed at least one episode of neutropaenia (grade 1: <2.0×10^9/L; grade 2: <1.5×10^9/L; grade 3: <1.0×10^9/L; grade 4: <0.5×10^9/L) were compared with those who did not. Comparisons were also made between patients who experienced one or more episodes of neutropaenia and between patients with different neutropaenia grades.Results77 neutropaenia episodes were recorded in 58 of 771 (7.5%) patients with RA, who were followed up for a median (range) of 18 (6–48) months. Neutropaenia occurred at a median (range) of 12 (0–120) months after RA diagnosis. The majority had mild neutropaenia (grade 1: n=42; grade 2: n=14; grade 3: n=1; grade 4: n=1). Neutropaenia was transient (single episode) in the majority (44; 75.8%) of cases but led to treatment discontinuation in 14 (24.1%) patients. Patients who developed neutropaenia were more likely to be female (p=0.01) and non-smokers (p=0.007) and had lower baseline neutrophil levels (p<0.0001). Binomial regression analysis confirmed the latter (p<0.0001, B: −0.491) as neutropaenia predictor. The rate of infections did not differ between patients who developed neutropaenia and those who did not (p=0.878).ConclusionNeutropaenia was a common finding in this cohort. It was usually mild, transient and not associated with increased infection rates. Neutropaenia occurrence was associated with non-smoking, female gender and lower baseline neutrophil levels.

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