Talk:Neutropenia

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[edit] Merge agranulocytosis with neutropenia

I think agranulocytosis can be merged here as it is just a severe gradation of neutropenia. Neutropenia is usually defined as less than 1500 neutrophils / microliter and agranulocytosis less than 100 neutrophils / microliter, so I think it would be more clear if they were in one article even though they can have different causes. --WS 19:49, 16 August 2005 (UTC)

I'm not sure. They are not used interchangably. PTU & carbimazole, clozapine and antiepileptices are always said to cause agranulocytosis, not neutropenia. Perhaps Googling on the various terms will clarify the matter. Also, haematologists call N = 0.0 still neutropenia and not agranulocytosis. JFW | T@lk 22:04, 16 August 2005 (UTC)
Drug-induced agranulocytosis cannot happen before first going through neutropenia. --WS 18:06, 17 August 2005 (UTC)

I agree that they are not used interchangeably. While they may be the same in principle, they are used differently in different situations. However, a note should be made in each article that agranulocytosis is considered a form of neutropenia. 162.129.44.19 (talk · contribs)

Don't you mean the other way round? Agranulocytosis implies that non-neutrophil granulocytes (eosinophils and basophils) are also affected. I would not be happy with every article containing more terminology. JFW | T@lk 17:31, 17 August 2005 (UTC)

Two definitions of agranulocytosis are being used. Strictly defined, it would mean low levels of all granulocytes. But most times, despite of its name, it seems to be used for a near-zero count of neutrophil granulocytes (not all granulocytes). In practice, when neutrophil granulocytes are low, the other granulocytes are are almost always low as well. --WS 18:01, 17 August 2005 (UTC)

Even in most medical text books I have looked up, agranulocytosis and neutropenia are used almost interchangeably. I think they would be best merged, with a mention of the difference between the two (practical the level of neutrophiles and theoretical about the difference in blood cells involved). Both are almost always caused by mechanisms (diseases or drugs) which inhibit the granulocyte precursors and thereby can cause neutropenia as well as agranulocytosis. --WS 18:16, 17 August 2005 (UTC)

Oh, and the term granulocytopenia exist as well, which would be less severe than agranulocytosis. It currently redirects to granulocyte. --WS 18:19, 17 August 2005 (UTC)

I'd suggest it's a good idea to keep agranulocytosis as a seperate article with a brief description of what it means, possible causes, and then a reference to neutropenia, explaining the interchangability of the terms (despite the technical difference). It is always far more confusing to have to dig through articles trying to find a quick description of the term you are searching for. But certianly, keep agranulocytosis brief and restrict information on it to that which is very specific to it (as opposed to other forms of neutropenia). 220.235.91.175 13:09, 3 November 2005 (UTC)

Agranulocytosis and neutropenia are technically not interchangeable terms. They shouldn't be merged. I agree with the above in keeping agranulocytosis as a brief separate article --203.122.202.71 22:38, 12 November 2005 (UTC)

I think it is good that it has its own article. it is much easier to look up. Maybe just a reference link at the top/bottom to the other article would suffice.

Agranulocytosis and neutropenia however related they are different things agranulocytosis is as the name describes it, a lack of granulocytes in general including neutrophil, basophil, and eosinophils, whilst the term neutropenia describes a hemotological lack of only neutrophil granucolytes. This is why I feel that each should be included in each others articles like they already are, and not combined due to there large differences. Steven age 15 Canada.

[edit] Vote on Merger

I'm working on merging articles and it seems that there isn't much of a consenus on this one. Could those users who have been dicussing this vote on the merge down here? Just a simple show of metaphorical hands with Merge of Don't Merge. Thanks. Kerowyn 00:14, 7 January 2006 (UTC)

I'll abstain for now, but for what its worth, ICD seems to prefer Agranulocytosis, with Neutropenia listed as an subordinate term, so if we merge, we might want to merge the other direction. --Arcadian 01:13, 7 January 2006 (UTC)
I'm working in haematology at the moment and although, as mentioned in the discussion above, neutropenia and agranulocytosis may well sound similar, they are distinct entities. In many cases neutropenia is caused by reduced granulopoiesis - there are cases, however, where neutrophils are removed by the RES (reticuloendothelial system) or other tissues, leading to a strict neutropenia, with normal levels of other granulocytes. They are distinct and should stay that way. drjermy 12:06, 31 January 2006 (UTC)

My mother is a myeloma patient and a nurse, and we agree with Drjermy on this one. She has been neutropenic without being agranulocytosic due to the cancer and various treatments for it. We see it is the same argument as, all oranges are fruit, but not all fruit are oranges. Neutropenia is a component of agranylocytosis, but agranulocytosis is not just neutropenia. Thanks for allowing disucssion on this. Kelelain

[edit] Data falsification

I will remove claims that data was falsified unless reliable sources are cited that support this controversial claim. JFW | T@lk 22:52, 21 March 2007 (UTC)


This is not controversial. The authors themselves retracted the paper:

http://bloodjournal.hematologylibrary.org/cgi/content/full/103/2/389

RETRACTION

Retraction of Aprikyan et al. Re: Aprikyan A, Carlsson G, Stein S, et al. Neutrophil Elastase Mutations in Severe Congenital Neutropenia Patients of the Original Kostmann Family. Blood First Edition Paper, prepublished online January 16, 2003; DOI 10.1182/blood-2002-04-1255. The authors respectfully withdraw this paper from final publication consideration. As noted in the journal's published Notice of Investigation, errors in some of the digital images in the manuscript are under investigation. Additional findings concerning patient data make some of the conclusions of our report uncertain. We therefore retract the prepublished paper and extend our deepest apologies to the scientific community.

Andrew A. Aprikyan, Goran Carlsson, Steve Stein, Anush Oganesian, Bengt Fadeel, David C. Dale, Jan Palmblad, and Jan-Inge Henter (authors)


AND NOTE that the journal never concluded the investigation (at least nothing to that effect was published).

[edit] Moved for review

The following section was removed:

Severe chronic neutropenia may be present at birth (congenital neutropenia) or may occur at any stage in life (acquired neutropenia).
There are several types of severe chronic neutropenia:
Severe congenital neutropenia — a rare inherited form of the disease usually detected soon after birth. It affects children mainly and may result in premature loss of teeth and peremptory gum infections. The most severe form of chronic congenital neutropenia is known as Kostmann’s syndrome. It is genetically heterogeneous. Most commonly, it arises as a result of new, autosomal dominant mutations in the gene, ELA2, encoding the neutrophil granule protease, neutrophil elastase, NE. The gene responsible for many cases of autosomal recessively inherited severe congenital neutropenia is HAX1. The mechanism for congenital neutropenia is not well-understood. There is evidence that mutations in neutrophil elastase, or in other genes associated with syndromic forms of neutropenia, disrupt its intracellular trafficking. Apoptosis may be a final effector for neutropenia, but the original studies from Dale and Aprikian supporting this pathway were retracted.
Cyclic neutropenia — tends to occur every three weeks and lasting three to six days at a time due to changing rates of cell production by the bone marrow. It is often present among several members of the same family. Cyclic neutropenia is also the result of autosomal dominantly inherited mutations in ELA2, the gene encoding neutrophil elastase.
Idiopathic neutropenia — a rare form of neutropenia which develops in children and adults usually in response to an illness. It is diagnosed when the disorder cannot be attributed to any other diseases and often causes life-threatening infections.
Myelokathexis — a rare form of inherited autosomal dominant disease associated with severe neutropenia. Some but not all patients have warts, hypogammaglobulinemia, and recurrent infections. Therefore myelokathexis is also known as the W.H.I.M. syndrome. In spite of severe neutropenia (low number of neutrophils) in peripheral blood of myelokathexis patients, their bone marrow is hypercellular and it is packed with mature neutrophils indicating an impaired mobilization of hematopoietic cells in this disorder. Truncating mutations in the human cytokine receptor CXCR4 gene were identified in most of the families afflicted by myelokathexis. The molecular mechanism is not yet defined. Recent reports demonstrate that CXCR4 mutations appear to result in an increased sensitivity of bone marrow hematopoietic cells to its ligand, a stromal-derived growth factor SDF-1 that provides proliferative and survival signals.
Autoimmune neutropenia — most common in infants and young children where the body identifies the neutrophils as enemies and makes antibody to destroy them. This form usually lessens in severity within two years of diagnosis.
Chemotherapy Induced Neutropenia is a condition characterized by abnormally low blood levels of infection-fighting neutrophils, a specific kind of white blood cell. The most common reason that cancer patients experience neutropenia is as a side effect of chemotherapy. Chemotherapy involves the use of drugs to destroy cancer cells. Chemotherapy works by destroying cells that grow rapidly, a characteristic of cancer cells. Unfortunately, chemotherapy also affects normal cells that grow rapidly, such as blood cells in the bone marrow, cells in the hair follicles, or cells in the mouth and intestines. Chemotherapy-induced neutropenia typically occurs 3-7 days following administration of chemotherapy and continues for several days before neutrophil levels return to normal. The type and dose of chemotherapy affects how low the neutrophil count drops and how long it will take to recover.
Chemotherapy-induced neutropenia is important because it may: Increase a patients risk of life-threatening infection and or disrupt delivery of cancer treatment, resulting in a change to the planned dose and time. The fewer the neutrophils in the blood and the longer patientsremain without enough neutrophils, the more susceptible patients are to developing a bacterial or fungal infection. Neutrophils are a major component of antibacterial defense mechanisms. As the neutrophil count falls below 1.0, 0.5, and 0.1 x 109/L, the frequency of life-threatening infection rises steeply from 10% to 19% and 28%, respectively. If patients develop a fever during neutropenia they may require treatment with intravenous antibiotics and admission to the hospital until the number of neutrophils in the blood returns to sufficient levels to fight the infection.
Another reason neutropenia is important is that, in some cases, it can be severe enough that it can cause the chemotherapy treatment to be delayed or dose reduced, which reduces some patients’ chance for cure. When patients are treated with chemotherapy, it is for the purpose of destroying cancer cells in order to reduce symptoms from your cancer, prolong your survival or increase your chance of cure. The dose and time schedule of chemotherapy drugs administered have been scientifically determined to produce the best chance of survival or cure. If patients develop neutropenia, doctors may have to delay your treatment or reduce the doses of chemotherapy until the neutrophil counts have recovered. Clinical studies have shown that, for certain cancers, reducing the dose of chemotherapy or lengthening the time between treatments lowers cure rates compared to full-dose, on-time treatment. There are however strategies for the prevention of chemotherapy-induced neutropenia that have been proven to reduce the incidence of fever, infection, admission to the hospital and allow patients to receive treatment on schedule.
Who is at a higher risk for chemotherapy-induced neutropenia?
Patients receiving chemotherapy that decreases the number of white blood cells
Patients who already have a low white blood cell count, or who have previously received chemotherapy or radiation treatment
Patients age 70 and older who may be at risk of more severe infection and longer hospitalizations
Patients with other conditions affecting their immune system
Chemotherapy-induced neutropenia can be prevented in most patients with the use of white blood cell growth factors. Blood cell growth factors are naturally occurring substances called cytokines that regulate certain critical functions in the body. They are responsible for stimulating cells in the bone marrow to produce more blood cells. The white blood cell growth factors approved by the U.S. Food and Drug Administration for the prevention of chemotherapy-induced neutropenia are Neupogen® (filgrastim) and Neulasta® (pegfilgrastim).

Much of the new content was copyvioed. The old content, entirely unsourced, is a mixed bag of conditions that is best dealt with in an organised list with subarticles split off when necessary. JFW | T@lk 22:34, 17 February 2008 (UTC)