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Thursday, 5 December 2013

Neutropenia Treatments - Types of Therapy

Neutropenia is defined as a condition of  abnormally low number of neutrophils, as a  result of granulocyte disorder of that leads to Immunodeficiency with lower than normal  circulating white blood cells. Patients with neutropenia are susceptible to bacterial infections causes of neutropenic sepsis.
Neutropenia is either problems in the production of the cells by the bone marrow and destruction of the cells from somewhere else in the body, if  neutrophil count falls below 1,000 cells per microliter of blood.
Neutropenia can be classified into acute and chronic types, depending to the duration of the illness. Some researchers divided severity of the disease, depending to the absolute neutrophil count (ANC) and is described as follows(a).
1. Mild neutropenia, when the ANC falls below a lower limit of 1500 per mm3 (1.5 x 109 /1), but remains higher than 1000 per mm3 (1.0 x 109 /1).
2. Moderate neutropenia, when the ANC falls between 500 per mm3 and 1000 per mm3 (0.5 x 109 /1 - 1.0 x 109 /1)
3. Severe neutropenia, when the ANC falls below 500 per mm3 (0.5 x 109 /1)
Types of therapy depending to the underlined causes of the disease but not limit to include
1. Corticosteroids 
Corticosteroids is the synthetic form of cortisol produced hat your adrenal glands produce naturally.
The aims of the medicine is to reduce autoantibody production, There is a report of a case of neutropenia in an infant, associated with repeated minor infections which responded to treatment with antibiotics. A granulocyte agglutinin was detected in the serum. Following treatment with prednisolone the neutropenia remitted, the antibody disappeared and the infections ceased(55).

2. Antibiotics 
There is a report by the Urmia University of Medical Sciences, of a 22-year-old male with idiopathic autoimmune thrombocytopenia whose diagnosis was made at age of eight. He underwent splenectomy at age ten and ITP recurred at age 21 with episodes of infection and severe neutropenia (absolute count around 170/μl). He showed no response to immunoglobulin, corticosteroids, danazol, cyclosporine and azathioprine. Anti-CD20 antibody was administered at a dose of 375 mg/m(2) once a week for 2 weeks. After the second infusion of rituximab, the platelet count increased from 4,000 to 516,000/mm(3) and neutrophils count raised from 180 to 545/mm(3). The response improvement persisted during follow up for 9 months (neutrophil count 4,390/mm(3))(56).
 
3. Granulocyte colony-stimulating factor (G-CSF) 
Granulocyte colony-stimulating factor (G-CSF) also known as colony-stimulating factor 3 (CSF 3), is a proteins that contain oligosaccharide chains (glycans) used to stimulate the bone marrow in production of granulocytes and stem cells and release them into the bloodstream. In a report of a  treated a case of autoimmune neutropenia in a 57-year-old, by the  Kyushu University, because neutropenia persisted despite the administration of prednisolone for 30 days, daily subcutaneous injection of human recombinant granulocyte colony-stimulating factor (rhG-CSF) at a dosage of 100 micrograms was started. Neutrophil count increased gradually and reached a plateau of 5,000/microliters by day 25 after administration of rhG-CSF(57).

4.  Intravenous immunoglobulin therapy
Intravenous immunoglobulin (IVIG) is an immunomodulating agent that induces beneficial therapeutic responses in children and adults. IVIG is not only used for prophylaxis and therapy of infections in patients with primary and secondary immunodeficiencies associated with defective antibody production, but also used for treatment of patients with systemic inflammatory disorders, autoimmune diseases, and neuroimmunologic conditions(58).  There is a report of a young woman presenting respiratory infections, polyarthritis, severe neutropenia, and increased serum IgM was treated with intravenous immunoglobulin (IVIG) with good clinical and laboratory outcome followed by a loss of efficacy(59). Other in the study of performed serial hematology, including differentiation of white blood cells (WBC), before and after 22 instances of IVIG in 16 patients with neuroimmunologic disorders indicated that WBC and neutrophils showed a significant decrease with a nadir 2 days after IVIG, but returned to previous values by 14 days with no treatment except in 2 cases. No patient showed any infectious complication(60).

5. Supplements for patients with Copper, Vitamin B12, Folate deficiency

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Sources
(a) http://www.neutropenia.ca/about/what-is-neutropenia
(55) http://www.ncbi.nlm.nih.gov/pubmed/662793
(56) http://www.ncbi.nlm.nih.gov/pubmed/23730020
(57) http://www.ncbi.nlm.nih.gov/pubmed/1719726
(58) http://www.ncbi.nlm.nih.gov/pubmed/21843660
(59) http://www.ncbi.nlm.nih.gov/pubmed/22230404
(60) http://www.ncbi.nlm.nih.gov/pubmed/14646610