Neutropenia & leukopenia
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Guidelines
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
ASCO
- 2023: Lehrnbecher et al. Guideline for the Management of Fever and Neutropenia in Pediatric Patients With Cancer and Hematopoietic Cell Transplantation Recipients: 2023 Update PubMed
- 2017: Lehrnbecher et al. Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update PubMed
- 2012: Lehrnbecher et al. Guideline for the management of fever and neutropenia in children with cancer and/or undergoing hematopoietic stem-cell transplantation PubMed
NCCN
- 2004: Freifeld et al. Fever and neutropenia clinical practice guidelines. PubMed
Definition
- Mild neutropenia: ANC (absolute neutrophil count) 1000 to 1500 cells/uL
- Moderate neutropenia: ANC 500 to <1000 cells/uL
- Severe neutropenia: ANC <500 cells/uL
Evaluation
May consist of:
- CBC with differential
- Basic metabolic panel (BMP)
- Reticulocyte count
- Vitamin B12
- Folic acid
- Copper
- Urinalysis
- LDH
- Uric acid
- C3, C4
- ANA, anti-DNA antibody
- Peripheral blood flow cytometry
- Peripheral smear
- Clinical/infection history, autoimmune/rheumatologic disease, lifestyle factors (e.g. alcohol)
- Medications
- Check for splenomegaly and lymphadenopathy
- Bone marrow biopsy