Neutropenia in adults is usually due to either decreased granulocyte production (in the bone marrow) or increased destruction (in the periphery).

Decreased Granulocyte production caused by bone marrow disorders

  • Drug-induced neutropenia. Common culprits are antithyroid drugs (e.g. Methimazole), sulfasalazine, Bactrim (trimethoprim-sulfamethoxazole), dipyrone combined with analgesics, clomipramine, and carbimazole.
  • Chemotherapy
  • Aplastic anemia
  • Cyclic neutropenia
  • Pure white cell aplasia
  • “Chronic benign neutropenia” in African-American and other populations
  • Congenital (rare)

Increased destruction caused by peripheral disorders

  • Autoimmune disease leading to immune destruction, eg, systemic lupus erythematosus (SLE)
  • Hypersplenism
  • Sepsis
  • Felty’s syndrome (with rheumatoid arthritis and splenomegaly)
  • HIV infection
  • Acute viral infection
  • Large granular lymphocytosis

**One of the first things you must do in a patient with neutropenia is to check medications they are taken, have recently taken and stopped. Make sure you ask for OTC meds and any supplements.

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