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Question: "... My doctor sent me three times to the lab because I have a "slightly lower count of white blood cells". She doesn't tell me what is my blood count. I am worried that I may be ill, have HIV, can you tell me what are my options."

Dr. Keti:

A reduction in the circulating White Blood Count (WBC) to less than 4000 cells per microliter, is referred to as leukopenia.

Leukopenia is usually characterized by a reduced number of blood neutrophils, called neutropenia. That often leads to increased susceptibility to bacterial and fungal infections. Blacks have somewhat lower neutrophil counts compared with whites, so find out "how low is your WBC" and which blood cells are affected in particular. The signs and symptoms of neutropenia depend on its severity. However, patients with even mild forms of neutropenia can develop major problems. Even in the most severe cases, neutropenia may have no signs at all, or it may cause fever and infection.


Causes
Neutropenia can be acute (occurring over a few days) when neutrophils are rapidly used and their production is impaired or chronic (lasting months or years) which usually arises from reduced production or excessive destruction of neutrophils in the spleen. Many factors and diseases can cause neutropenia. Here is the list of some:
Drugs are one of the most common causes of neutropenia,
Chemotherapy,
Often as an early feature of megaloblastic anemias caused by vitamin B12 or folate deficiency.
Alcohol may inhibit the response of the marrow to infection in pneumococcal pneumonia.
In leukemia, myeloma, lymphoma, or metastatic solid tumors (eg, breast, prostate) when they infiltrate and replace the bone marrow;
Bone marrow failure, as seen in some rare conditions;
Splenomegaly (increased spleen) of any cause can lead to moderate neutropenia;
Viral infections, eg, early-stage infectious Mononucleosis, Mumps;
Bacterial infections, e.g. Tuberculosis (disseminated) and Typhoid fever;
Fungal infections; in Malaria;
HIV;
Immune neutropenias;
In rare cases neutropenia may be congenital or of unknown cause (idiopathic).

Signs and Symptoms
Some patients with chronic neutropenia with low neutrophil counts (< 200/ÁL )do not experience many serious infections. Others may have reccurent fever. In chemotherapy induced neutropenia patients are more likely to develop serious bacterial infections, mouth ulcers, skin and other infections.

Diagnosis
Physical examination should detect the most common primary sites of infection.
At least two sets of bacterial and fungal blood cultures should be obtained from all febrile (with increased temperature) patients.
Urine cultures are indicated if symptoms or signs of Urinary tract Infection are present.
If diarrhea is present, stool should be evaluated for enteric bacterial pathogens and Clostridium difficile toxins.
Radiography of the facial sinuses may be helpful if symptoms or signs of sinusitis (eg, headache, facial swelling, nasal discharge) are present.

In chronic neutropenia patients have White Blood Count and differential counts obtained three times a week for 6 weeks to evaluate the cyclic neutropenia.
Bone marrow aspirate and biopsy may aid in diagnosis.
Additional marrow should be obtained for patients with suspected malignancies.
Selection of further laboratory tests is determined by the duration and severity of the neutropenia and by findings on the physical examination.
Antineutrophil antibodies are associated with immune neutropenia. Various neutrophil antibody assays have been used to study patients with suspected autoimmune neutropenia; all assays directly measure antibody in the patient's neutrophils or indirectly measure antibody in the patient's serum. Their specificity and sensitivity are not well defined.
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Treatment
Using glucocorticoids, androgenic steroids, and vitamins to stimulate the bone marrow to produce more neutrophils has not proved successful. Cytokines are widely used to prevent fever and infections in patients with severe neutropenia, but they are expensive. In some cases saline or hydrogen peroxide gargles every few hours, chlorhexidine mouth rinse (1% solution) may relieve the discomfort associated with mouth ulcerations. Oral candidiasis is treated with nystatin mouthwash.

Conclusion
Talk to your doctor and tell her about your worries. She would be able to help you.


Links & Additional Contact Sites:
ThinkQuest
Merck
Neutropenia Support Assoc.