Neutropenia

Introduction to neutropenia Neutrophilic granulocytosis (neutrophilic granulotosis) refers to infants with age greater than 1 month and age-specific rod-shaped nucleus and nucleated granulocyte counts greater than 7.5 × 109 / L and less than 1 month More than 26 × 109 / L. basic knowledge The proportion of illness: 0.0035% Susceptible people: no specific population Mode of infection: non-infectious Complications: pulmonary embolism, cerebral embolism

Cause of neutropenia

Infection (25%):

A variety of local or systemic acute, chronic infections, such as bacterial infections, especially Staphylococcus, Streptococcus, pneumococcal, meningococcal and other diseases caused by Mycobacterium tuberculosis; viral infections such as rabies, polio, Varicella; rickettsial infection can cause neutrophil enlargement, the degree of increase is often proportional to the degree of infection, there is suppuration phenomenon, the increase is more obvious, and even cause leukemia-like reaction, the total number of white blood cells can reach 50×109/ Above L, or immature cells appear.

Physics and emotions (20%):

Stimulating physical stimuli such as cold, heat, exercise, severe pain, convulsions, trauma, pregnancy, electroshock, hypoxia, etc., emotional excitement, anxiety, fright, excessive excitement, etc. can temporarily increase neutrophils.

Inflammation and tissue necrosis (15%):

Rheumatic diseases such as rheumatic fever, rheumatoid arthritis, especially juvenile type, nodular polyarteritis, dermatomyositis, vasculitis, etc., neutrophils may increase, such as co-infection is more likely to occur, other inflammation such as nephritis , pancreatitis, colitis, thyroiditis, tissue necrosis such as myocardial infarction, pulmonary infarction, thromboembolic disease, etc., can also cause neutrophilia.

Tumor (10%):

Stomach, lung, liver, pancreas, breast, uterus, kidney cancer, etc. often have neutrophils, which may be leukemia-like reactions, and can be used as one of paraneplastic syndromes. Lymphoma, especially Huo Qijin disease may have neutrophils.

Metabolic and endocrine disorders (10%):

Thyroid crisis, diabetic acidosis, uremia, hepatic encephalopathy, acute gout, eclampsia, hyperadrenal hyperfunction, etc. can cause neutrophil enlargement.

Poisoning and allergic reactions (8%):

Some chemicals and drugs such as lead, mercury, arsenic, lithium, adrenaline, adrenocortical hormone, digitalis, serotonin, histamine, heparin, potassium chlorate, acetylcholine, etc., as well as carbon monoxide poisoning, antigen-antibody complexes, complement activation Can cause neutrophils.

Acute blood loss and hemolysis (5%):

2 hours after acute blood loss can see leukocytosis, chest, abdominal cavity, joint cavity, subarachnoid space and intracranial hemorrhage, leukocytosis is more significant, ectopic pregnancy rupture, liver, spleen rupture, leukocytosis is also obvious, a large number of acute hemolysis, white blood cell count And neutrophilia can reach the degree of leukemia-like reaction.

Blood disease (3%):

Myeloproliferative diseases, such as chronic myeloid leukemia, polycythemia vera, myelofibrosis, essential thrombocytopenia, increased white blood cells and neutrophils, and the appearance of immature cells; chronic neutral Leukocytes in patients with granulocyte leukemia also increased significantly, up to 100 × 109 / L, mature neutrophils are about 90%; megaloblastic anemia or recovery of granulocyte deficiency, and familial neutrophils.

Other (5%):

There is neutrophil enlargement 12 to 36 hours after surgery, the degree is proportional to the scope of surgery, the degree of blood loss and the degree of tissue damage. After spleen resection, neutrophils may increase and may be leukemia-like. These changes are after splenectomy. It may appear in the short term, or it may appear as late after several months. It will recover within a few weeks, and it will disappear after several months or years. The transfusion reaction can also cause leukocytosis.

Pathogenesis

Neutrophils are produced in the bone marrow from hematopoietic stem cells. The original, early and younger granulocytes have the ability to synthesize DNA, undergo mitosis and hyperplasia, and constitute a hyperplastic pool of granulocytes in the bone marrow. Normally, these cells Can not pass through the sinus wall of the bone marrow, so can not enter the peripheral blood circulation, late granules, rod-shaped nucleus, lobular granulocytes can not proliferate, late granulocytes are generally not seen in the peripheral blood, rod-shaped granulocytes It is also rare in peripheral blood. Part of the neutrophils of the nucleus nucleus enters the peripheral blood. The rest and the late granules, the rod-shaped nucleus cells are stored in the bone marrow to form an effective storage part (storage pool), the number is about blood. Circulating granulocytes 10 to 15 times, when needed, released into the peripheral blood. Under normal circumstances, about 107 to 108 granulocytes per minute enter the blood circulation from the bone marrow storage pool, mature lobular neutrophils After entering the blood circulation from the bone marrow, half of them migrate with the blood circulation. The circulating granulocyte is called the number of granulocytes that can be detected at ordinary times; the other half is present at the edge of the blood vessel wall or attached to the hair. Vascular endothelium, granulocyte said edge (marginal granulocyte), between these two cell types can be converted each other to form a dynamic balance, the total number of cell types in peripheral blood granulocytes total pool of (total blood granulocyte pool, TBGP).

There are three mechanisms for peripheral blood neutropenia:

1. The ratio of circulating granulocytes to marginal granulocytes is about 44.3:55.7. When marginal granulocytes are mobilized into the blood circulation, the number of neutrophils can be multiplied, called pseudoneutrophilic granulocytosis. ), severe pain, exercise, epilepsy, tachycardia or emotional agitation, blood flow is accelerated, marginal granulocytes rapidly enter the circulation pool, the number of granulocytes is increased, but the total pool of granulocytes is unchanged, this increase is temporary, no Will be more than 2 times, and no naive cells appear.

2. Neutrophils in blood vessels can enter the tissues or organs through capillaries, perform phagocytic and foreign body functions, such as the speed of their entry into tissues, which can lead to peripheral blood neutrophils, some drugs such as glucocorticoids , ethanol, phenylbutazone and indomethacin can prevent granulocytes from entering the blood circulation from the blood, increasing the number of neutrophils in the blood. This mechanism will increase, the number will not exceed 2 times, and there will be no childishness. cell.

3. The rate of granulocyte production and release into the bloodstream increases the number of granulocytes. The storage of granulocytes in the bone marrow is about 10-15 times that of circulating granulocytes in the blood. The ripening and release of the granulocytes can increase the number of granulocytes. Increased, such as the integrity of the bone marrow sinus wall is destroyed, naive cells can also be released into the blood, infection, inflammation, bacterial endotoxin can promote the mononuclear macrophage system to produce granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor Interleukin-6, tumor necrosis factor alpha and transforming growth factor beta stimulate the proliferation of myeloid cells, accelerate the release, increase the number of neutrophils in the blood, infiltrate the bone marrow by leukemia cells, metastasize the cancer cells and infiltrate the myelofibrosis. At the time, the sinus wall can be damaged and the naive cells enter the bloodstream.

Neutrophil prevention

There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.

Mitochondrial complications Complications, pulmonary embolism, cerebral embolism

The most common complication is embolism, found in the heart, brain, kidney, spleen and pulmonary embolism.

Symptoms of neutropenia Common symptoms Myocardial ischemia neutrophils increased neonatal neutrophilia myocardial infarction

Neutrophil has no specific clinical manifestations. Neutrophil enlargement can temporarily block capillaries, which can temporarily reduce local blood flow and cause ischemia, such as myocardial reperfusion injury and infarction.

Examination of neutropenia

1. Peripheral blood: neutrophil increased, absolute value > 7.5 × 10 ⁹ / L.

2. Neutrophil alkaline phosphatase: markedly elevated when infected, chronically not elevated.

3. Bone marrow: Late granules, increased rod-shaped nucleus, visible poisoning particles, Döhle body, cytoplasmic vacuoles.

According to clinical manifestations, symptoms, signs can choose ECG, B-ultrasound, X-ray, CT, MRI and other tests.

Diagnosis and differentiation of neutrophilia

Neutrophil morphology contributes to early diagnosis, poisoning granules, Döhle bodies, and the presence of cytoplasmic vacuoles often suggest significant or subclinical inflammation, poisoning, trauma or tumors, accompanied by fever or other inflammation for unknown reasons When rare infections, such as tuberculosis or osteomyelitis, should be considered, when eosinophils and basophils are present in the peripheral blood, the possibility of acute trauma and infection can be ruled out. Endocrine should be considered. Diseases and tumors, if accompanied by peripheral blood promyelocytic cells, promyelocytosis and unexplained splenomegaly, should consider myeloproliferative disorders in patients with inflammation or glucocorticoid therapy in their peripheral blood. The granulocyte alkaline phosphatase (ALP) is elevated, while the value of chronic myeloid leukemia is reduced, so the detection of ALP levels is also helpful for diagnosis.

The clinical features of some severe primary disease combined with neutrophilia help to identify.

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