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Posted by Dr. Monica Wonnacott | March 20, 2018

Neutropenia: One Reason Your Kid May Be Sick All The Time

If your child is frequently ill, it may be due to a condition called neutropenia. Neutropenia is when your body doesn’t have enough of a certain type of blood cell that helps fight infection.

The 30 second science lesson…

In the blood, there are different kinds of cells, including white blood cells. The white blood cells are the ones that help fight infection, essentially the body’s defense. When you get sick, the number of white cells goes up, trying to defend the body. Within the broad term of white blood cells, there are different subtypes of cells. One of those is called the neutrophil. Generally speaking, the neutrophil helps fight bacteria. Neutropenia is simply low levels of this particular type of white cell, the neutrophil. So if your neutrophil count is low, you won’t be able to fight off infection.

Why does it happen?

Neutropenia can happen when:

  1. The body uses up or destroys all the neutrophils it makes.
    1. Example: Your child gets one really bad infection and has to use all of the neutrophils to fight it, thereby making him/her more susceptible to other infections.
    2. Example: Your child’s cells are destroyed during chemotherapy or radiation, or;
  2. The body simply doesn’t make enough to start with.
    1. Example: Your child has an underlying autoimmune disorder.
    2. Example: Your child has an underlying bone marrow diseases like aplastic anemia, cancer, or leukemia.

Signs and symptoms of neutropenia

  1. Fever
  2. Frequent infections essentially anywhere:
    1. Ear infections
    2. Sore throats
    3. Sinus infections
    4. Pneumonia
    5. Urinary tract infections
    6. Skin infections, etc.

How is neutropenia diagnosed?

The only way to diagnose neutropenia is by doing a blood test, specifically a CBC (or complete blood count) with a differential. The “differential” component means that the doctor is looking specifically at the various types of cells. You cannot look at a person and surmise that he/she has neutropenia.

What is an ANC?

The ANC is the “absolute neutrophil count.” If your child has neutropenia, this number is one you will become very familiar with. This tells you how many of the actual little neutrophils your child has circulating in the blood stream. In medicine, we measure how severe the neutropenia by the sheer number in the body. The fewer neutrophils there are (i.e., the lower the ANC), the more severe the neutropenia.

What do I do once diagnosed?

There isn’t a specific treatment for just neutropenia (it’s not like you can take a pill or get a transfusion of just neutrophils to boost the numbers). There are a few basics though.

  1. Assess the clinical situation. If the condition was picked up incidentally, you may just wait and watch (allowing the body time to recover on its own). If there are serious other factors (e.g., life threatening infections or cancers), you may be much more aggressive.
  2. Treat any symptoms or complications that result from neutropenia. For example, give an antibiotic for pneumonia or a urinary tract infection.
  3. Evaluate for underlying causes. For example, there may be a problem with the immune system in general or the bone marrow (which is responsible for making blood).
  4. Prevent complications and/or further infections. A child who has a weakened defense system needs to be kept out of the line of fire. Don’t allow the child with neutropenia to be around sick people. Depending on the severity of the neutropenia (and what underlying conditions exist), it may be appropriate to keep your child home from preschool/school, daycare, and public places (like grocery stores, etc.)

Should I be worried?

Yes and No. While freaking out never helped anyone, having a healthy respect for the serious nature of an illness is appropriate. Neutropenia can leave your child very vulnerable. While most children recover without any serious complications/problems, there are kids who get very serious life threatening illnesses.

If you are worried that your child may have neutropenia , talk to your doctor. He/she can easily test for it and let you know if there is something worth worrying about.