Neutropenia – causes, symptoms & therapy

The limit value, which should not be fallen below in the blood , is approx. 1800 neutrophilic granulocytes per microliter. There is also an upper limit of around 8000 cells per microliter, which is not exceeded in healthy people.

As a very important part of our non-specific defense system, the neutrophilic granulocytes primarily fight off infections. There is also the superordinate term of leukopenia for the decrease in white blood cells in general, which are also referred to as leukocytes ; so neutropenia is just one particularly common form of leukopenia.

“Mild neutropenia” is present when the affected person has fewer than 1800 but still more than 1000 cells per microliter; With regard to the interval below from 500 to 1000 cells per microliter, the doctor speaks of “moderate neutropenia” and correspondingly of “severe neutropenia” if the patient has fewer than 500 neutrophilic granulocytes per microliter in the blood.

The very severe form is called agranulocytosis . If there is also a fever over 38°C that lasts for a longer period of time (> 1 hour), then it is a case of “febrile neutropenia”. The so-called “Kostmann syndrome” is a congenital neutropenia.

causes

The neutrophilic granulocytes are mainly formed in the bone marrow. Therefore, damage to the bone marrow is a common cause of neutropenia. The bone marrow is z. B. attacked by intensive antibiotic therapy or chemotherapy.

But poisonous plants, some poisonous snakes and other poisonous chemicals can also be triggers. In the case of organ transplantation, suppression of the immune system is expressly required in order to minimize the intensity of the body’s rejection reactions. In such cases, a neutropenia may be artificially (drugged) initiated.

Diagnose

In acute inflammation , neutrophilic granulocytes are consumed to a large extent. If an intense inflammation persists for a very long time, the bone marrow can no longer keep up with the new production of neutrophilic granulocytes and their concentration in the blood inevitably falls.

In addition, the newly formed cells are still immature, so to speak (progenitor cells), and doctors then speak of a “left shift”.

This means: In acute phases of severe illnesses such. peritonitis or sepsis , there is a relatively high probability of also developing neutropenia. AIDS can also be a cause for the development of neutropenia.

treatment and therapy

Because of the generally reduced immune system, hygiene is a first step in the treatment of neutropenia that should not be underestimated. This not only means washing your hands frequently, but also disinfecting your hands and wearing a suitable face mask, and this also means the patient’s visitor. In the hospital, accommodation in a single room (isolation) may have to be arranged.

The formation or maturation of neutrophilic granulocytes can be stimulated and accelerated with a specific growth factor known as G-CSF. This drug is manufactured on the basis of mammalian cells or Escherichia coli.

In what is known as PEGylation, G-CSF forms a chemical bond with polyethylene glycol (PEG). In this way, the actual active ingredient is protected by a complete shell of long-chain molecules, which can prevent premature degradation by the body’s own enzymes or antibodies for a while. This is also referred to as masking. This “time gain” allows the active substance to reach its destination.

G-CSF is actually an endogenous peptide hormone and the abbreviation stands for “Granulocyte-Colony Stimulating Factor). Better known as a cytokine, it is almost automatically released by the body in the event of inflammation in order to stimulate the formation of granulocytes.

prevention

G-CSF is also used in cancer therapy, particularly in the case of severe infections, to accompany intensive antibiotic therapy in such a way that neutropenia as a side effect can be avoided in advance.In the case of chemotherapy, the rule applies: the more intense the “chemo”, the longer the neutropenia. And this is exactly where the administration of the G-CSF comes in, because it can usually shorten the neutropenia phase by several days. At the same time, this also has the beneficial side effect that the time intervals (breaks) between the individual chemotherapy cycles can be shortened, which can significantly increase the probability of defeating the cancer.