Original Editor - Chloe Waller
Top Contributors - Chloe Waller

Introduction[edit | edit source]

Neutropenia is a low level of neutrophils in the blood[1]. Neutrophils are a type of white blood cell, that support the immune system to fight injection by ingesting and killing invading microorganisms[2]. Neutropenia is defined as less than 1500 neutrophils per micro-litre of blood. It can be classed as mild (1000 to 1500 neutrophils per micro-litre), moderate (500 to 1000 neutrophils per micro-litre) or severe (less than 500 neutrophils per micro-litre)[3]. Neutropenia leads to an increased risk of infection and this risk is directly correlated with how long a patient has been neutropenic and how severe the neutropenia is.   [3].

Types of white blood cells

Aetiology[edit | edit source]

Neutropenia can develop due to a wide range of one or more causes[4].

Neutropenia can be caused by[5]:

  • Dietary deficiencies

Clinical Presentation[edit | edit source]

Neutropenia itself is asymptomatic until an infection develops, whereby fever is the primary symptom[6]. Usual signs of inflammation and infection can occur but may be reduced in neutropenic patients, due to the reduced immune response[7].

Diagnostic Procedures[edit | edit source]

  • Subjective assessment to get full medical history[8].
  • Physical examination for focal symptoms[6].
  • Full blood count including creatinine and CRP[7].
  • Chest radiography for patients with respiratory symptoms[7].
  • Bacteria and fungi cultures[7].

Management[edit | edit source]

  • Antibiotics: timely administration when a patient is febrile significantly improves mortality rate[9][10][11].
  • Intervention to treat the underlying cause of the neutropenia[12].
  • Granulocyte-colony stimulating factor (G-CSF): stimulates the bone marrow to produce neutrophils[12].
  • Basic lifestyle modifications are advised to reduce risk of infection[12].

Implications for Physiotherapy[edit | edit source]

There are no specific exercise recommendations for patients with neutropenia, and their full clinical presentation needs to be considered[13]. Because of the increased risk of infection, patients should be treated following strict infection control guidelines – this includes patient and therapist wearing face masks, regular hand hygiene and sanitisation of equipment, and treating patients inside their room instead of in communal areas where possible[14].

References[edit | edit source]

  1. Copeland et al. Assessment of Neutropenia. BMJ. 2021
  2. Justiz Vaillant AA, Zito PM. Neutropenia. 2021 Nov 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan
  3. 3.0 3.1 Schwartzberg LS. Neutropenia: etiology and pathogenesis. Clin Cornerstone. 2006;8 Suppl 5:S5-11
  4. Frater JL. How I investigate neutropenia. Int J Lab Hematol. 2020 Jun;42 Suppl 1:121-132
  5. Christopher Gibson, Nancy Berliner; How we evaluate and treat neutropenia in adults. Blood 2014; 124 (8): 1251–1258.
  6. 6.0 6.1 M. Territo. Neutropenia. MSD Manual Professional Edition. 2021
  7. 7.0 7.1 7.2 7.3 A. Urabe, Clinical Features of the Neutropenic Host: Definitions and Initial Evaluation, Clinical Infectious Diseases, Volume 39, Issue Supplement_1, July 2004, Pages S53–S55
  8. Dale DC. How I diagnose and treat neutropenia. Curr Opin Hematol. 2016 Jan;23(1):1-4. doi: 10.1097/MOH.0000000000000208. PMID: 26554885; PMCID: PMC4668211.
  9. Peyrony O, Gerlier C, Barla I, Ellouze S, Legay L, Azoulay E, et al. Antibiotic prescribing and outcomes in cancer patients with febrile neutropenia in the emergency department. PLoS One. 2020 Feb 28;15(2):e0229828
  10. Sharma A, Lokeshwar N. Febrile neutropenia in haematological malignancies. J Postgrad Med. 2005;51 Suppl 1:S42-8.
  11. National Institute for Health and Care Guideline (2020) Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients.
  12. 12.0 12.1 12.2 Tim Newman. What’s to know about neutropenia? From: Medical New Today. 2017
  13. Jeevanantham D, Rajendran V, Tremblay L, Larivière C, Knight A. Evidence-based guidelines for physiotherapy management of patients with multiple myeloma: Study protocol. Syst Rev. 2018
  14. D. Jeevanantham, V. Rajendran, Z. McGillis, L. Tremblay, C. Larivière,, A. Knight, Mobilization and Exercise Intervention for Patients With Multiple Myeloma: Clinical Practice Guidelines Endorsed by the Canadian Physiotherapy Association, Physical Therapy, Volume 101, Issue 1, January 2021