neutropenia
Introduction
Introduction to Neutral White (granulocytopenia) When neutral white (granulum) cells are less than 0.5 x 109 / L, it is called neutral white (granulocyte) cytoreduction. Neutral white (granulocyte) cells play an important role in the elimination of decaying tissue cells and phagocytosis of pathogenic microorganisms in the body's defense. The reduction in the number of cells can significantly reduce the body's defense function and cause infection, and severe cases can cause death. The clinical symptoms of neutral white (granulocyte) reduction vary with the extent and cause of the reduction. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: perianal abscess sepsis
Cause
The cause of neutral white (granulocytopenia)
Neutrophils are over-utilized and damaged, often resulting in acute neutropenia (which can occur within a few days), reduced neutropenia or excessive spleen retention. Neutrophils often cause chronic neutrality. In neutropenia (sustained for months or years), neutropenia can be divided into two types: secondary (exogenous causes acting on myeloid myeloid cells) and endogenous progenitor cells.
Prevention
Neutral white (granulocytopenia) prevention
There are no effective preventive measures at present, and early detection and early treatment are the key to prevention.
Complication
Neutral white (granulocytopenia) complication Complications, perianal abscess
(1) Oral infection: This is the most common complication of leukopenia. Early tonsil swelling, pharyngeal mucosal ulcer, followed by necrotic edema, mucosal flushing and cervical lymphadenopathy.
(2) Acute perianal abscess: rapid formation of ulcers, necrosis and pseudomembrane.
(3) Systemic infections: Septicemia is the main threat of this disease, and the mortality rate is as high as 30% to 40%.
Symptom
Neutral white (granulocytopenia) symptoms common symptoms fatigue leukopenia reduce sepsis lymph node enlargement high fever low fever
The main manifestation is neutropenia, and if the infection is combined, the corresponding symptoms appear.
(1) The cause of acute disease can be found, such as the use of aminopyrines, sulfonamides, mercury preparations, alkylating agents, and contact chemicals (benzene, xylene, gasoline, organic phosphorus), radiation damage, viral infection, etc. .
(2) clinical high fever, chills, fatigue, lungs, urinary tract, skin, oral mucosa and other serious infections or sepsis, slow onset, often accompanied by low fever, fatigue, peripheral blood mononuclear cells may compensate for increased.
(3) Companion signs, such as liver, spleen and lymph node enlargement or (and other manifestations), help to identify the cause.
Examine
Check for neutral white (granulocytopenia)
Laboratory test results
(1) Blood: The absolute value of peripheral blood neutrophils, infants and young children less than 1 × 109 / L, children less than 1.5 × 109 / L, but hemoglobin, red blood cells, platelets are normal, blood should be checked weekly, at least for January In order to understand whether it is temporary, periodic or chronic, pay attention to the observation of granulocytes with or without nuclear left shift, excessive lobulation, poisoning particles, heterogeneous nuclei, cytoplasmic vacuoles and other abnormal phenomena, such as suspected familial or genetic For neutropenia, the white blood cell count and morphology of other members of the family should be examined simultaneously.
(2) Bone marrow: to understand the condition of myeloproliferation, whether granulocytes are proliferated or reduced, whether there are maturation disorders, whether there are invasive lesions (such as leukemia, Gaucher disease, etc.), infection, etc.
(3) Special tests: to further find the cause.
1) Granulocyte distribution and reserve test:
1 Adrenal hormone test: first subcutaneous injection of 0.1% adrenaline O.1ml, 5, 10, 15 and 30 minutes after injection to calculate the absolute value of granulocytes, such as increased granulocyte to the normal range or more than l times, suggesting edge pool The number of cells increases, while the granulocytes in the circulating pool are less than normal. This abnormal distribution is seen in leukopenia caused by viruses and other infections, such as pseudoneutropy.
2 typhoid vaccine stimulation test: subcutaneous injection of 0.5 ml of typhoid vaccine, the absolute value of neutrophils was calculated at 3, 6, 12 and 24 hours after injection, and the normal reaction decreased the absolute value of granulocytes 3 hours after injection, 6~ The absolute value of granulocytes increased by 3 to 4 times in 12 hours, and returned to the original level in 24 hours. If the granulocytes did not increase after injection, it indicated that the granulosa cells in the bone marrow storage pool were released into the blood. This test caused damage to certain bone marrow. Light cases of agranulocytosis and knowledge of bone marrow storage capacity are helpful.
2) Determination of increased neutrophil destruction:
1 Determination of leukolectin: Leukocyte lectin is found in serum, which has auxiliary diagnostic significance for immunogranulocytopenia.
2 serum lysozyme assay: serum lysozyme produced by neutrophils and monocytes, its concentration and lytic index increased, suggesting increased neutrophil destruction.
3 granulocyte life assay: labeling granulocytes with 3H-TdR (3H thymidine) or DF32p (32p-diisopropyl fluorophosphate) for direct determination of leukocyte half-life, measuring granulocyte lifespan, understanding granulocytes in peripheral blood The extent and speed of damage.
Diagnosis
Diagnosis and diagnosis of neutral white (granulocyte) cell reduction
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Low-proliferative leukemia: clinically visible anemia, fever or hemorrhage, peripheral blood is often reduced by whole blood cells, primordial cells can be seen or not seen, bone marrow hyperplasia is reduced, but granulocytes are >30%, while leukopenia is naive The number of cells is rare, and there is no bleeding, no obvious anemia.
2, aplastic anemia: onset or acute or slow, more bleeding, anemia, leukopenia, especially neutrophils, platelets and reticulocytes are significantly reduced, bone marrow is reduced by three cells, and grains Cell deficiency is acute, no bleeding, anemia is not obvious, white blood cell classification with granulocytes is extremely reduced, or even completely disappeared, platelets and reticulocytes are normal, bone marrow is granulocyte-suppressed, maturity disorder.
3, infectious mononucleosis: infectious mononucleosis can be seen ulcerative angina, neutropenia, easy to be confused with neutropenia, but infectious mononucleosis can be found in the blood A large number of atypical lymphocytes, and serum heterophilic agglutination test was positive.
