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How to Approach the Neutropenic Patient
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There are lots of potential causes for neutropenia yet it is not a very common finding. It is important to understand the major categories of disease resulting in neutropenia as it can be an indicator of severe, life threatening disease. First it is important to understand the basic physiology of neutrophil production and turnover in order to assess the causes of this laboratory finding.
Neutrophils are produced by the bone marrow and are part of the myeloid series of haematopoietic precursors. Early neutrophil progenitors are stimulated to proliferate via the production of granulocyte colony stimulating factor (G-CSF) which is produced by endothelial cells and activated macrophages1. As a result more neutrophil precursors (metamyelocytes and myelocytes) develop into mature neutrophils and, also as a further function of G-CSF, are allowed to leave the bone marrow. In times of significantly increased demand for neutrophils (high levels of G-CSF) earlier, non-mature, forms of neutrophil are released from the bone marrow. These cells are structurally different from mature neutrophils and are said to demonstrate “toxic” change e.g. Dohle bodies, band-nuclei, cytoplasmic vacuolation; however, these changes are not directly due to toxaemia but the result of a marked increase in the rate of neutrophil development and maturation abnormalities. [...]
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Affiliation of the authors at the time of publication
University or Company: Bristol Vet Specialists
Department: Internal Medicine Address: Bristol Vet Specialists, 615 Wells Road, Bristol, BS14 9BE United Kingdom
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