Neutropenia
Neutropenia is common in refugees and is mainly due to benign ethnic neutropenia (BEN) in patients of African and Middle Eastern descent. The diagnosis of BEN is based on persistent mild neutropenia in a patient with an appropriate ethnic background and without a history of recurrent infections. This is a benign condition with no increased incidence or severity of infection.
Patients from other ethnic descents with neutropenia should be investigated for other etiologies. Potential systemic symptoms (e.g. fever), medications that can cause neutropenia and signs of infection, malignancy and liver disease should all be assessed.
Our recommended approach for asymptomatic patients with neutropenia based on their absolute neutrophil count (ANC) in 10E9/L*:
No follow-up is required.
We recommend repeating at least one CBC (with an interval of at least 2 weeks between the tests). If the neutropenia is still mild and not clearly trending down, and the patient is of African or Middle Eastern descent, we usually consider BEN as the cause of the neutropenia. Since this is a genetic condition, BEN is even more likely if other family members are also neutropenic.
Although the ANC in BEN can occasionally be <1.0 (especially in women), this is not a common finding (usually >1.2). In these cases, a repeat CBC as well as a blood smear should be ordered, and potential etiologies should be sought on history and exam. Again, neutropenia in other family members could suggest BEN as the cause of the neutropenia.
These patients should be evaluated immediately if symptomatic, preferably in a hospital setting. If they are asymptomatic, it is reasonable to call a Hematologist before referring the patient to the hospital. |
* Keep in mind that the values above apply mainly to adult patients. Children will have different normal neutrophil count values depending on their age.