Neutropenia

Who to refer:

• Neutrophil count <0.5 and evidence of sepsis – contact the on-call Haematologist for urgent advice
• Neutrophil count <1 on repeat testing
• Neutrophil count <2 on repeat testing and the presence of any of the clinical findings as described below.

Who not to refer:

• People of Afro-Caribbean or Middle Eastern ethnicity have a lower normal range for the neutrophil count (constitutional or ethnic neutropenia). This is of no clinical consequence. Such patients should only be investigated if their neutrophils are <1.0 on repeat testing. No further monitoring required.
• Neutrophil counts consistently >1.5. These patients can be given the diagnosis of chronic idiopathic neutropenia. No further monitoring is required.
• Neutrophil count >1 but <1.5 repeat at 6 months. If clinical features of concern develop or neutrophil counts falls <1 refer to haematology. Otherwise patients can be given a diagnosis of chronic idiopathic neutropenia and no further routine monitoring is required.

How to refer:

SCI gateway to the Department of Haematology BGH.

For all:

• Assess patient for symptoms e.g. recurrent infections, mouth ulcers etc.
• Establish if patient is of an ethnic background known to be associated with lower neutrophil counts (See ‘Who not to refer’).
• Review medication (see above)
• Examine for lymphadenopathy and splenomegaly
• Repeat FBC:
• If neutrophil >1 then repeat at 6 weeks
• If neutrophil count <1 repeat at 1 week.

For persistent neutropenia do the following tests:

• Blood film
• B12 and folate, Ferritin. Treat if deficiency is detected
• HIV, HBV, HCV serology
• If additional clinical features to suggest a diagnosis of SLE, RA or other connective tissue disorder check CCP, ANF, dsDNA (if ANF positive) (connective tissue disease screen)

Neutropenia in primary care. Hay et al. BMJ. 2014 Sep 11;349.