1. Neutropenia observed on Complete blood count (CBC)
Neutropenia: diagnostic approach
Neutropenia observed on Complete blood count (CBC)
Severe if Absolute neutrophil count (ANC) < 500/mm3
Mild if ANC between 500 and 1500/mm3
Frequent etiology: Bacterial infections like strept B, gravidic toxemia and prematurity
Rare etiology Maternofetal alloimmunisation - Neutrophil antigens and allo-antibodies
Severe combined immunodeficiency  immunophenotype lymphocytes
Viral fetopathy  cytomegalovirus…
Congenital neutropenia with early expression
Situation 1
New Born
Situation 2
Mild neutropenia
« Incidental » neutropenia
No other blood abnormalities
No infection – No recurrent aphthosis No gingivitis
No associated pathology
Monthly clinical follow-up for as long as the neutropenia persists (except ethnic)
No work up
CBC monthly (max) for a year and then according to outcome
Emergency consultation if fever
Ethnic neutropenia: to be considered if black skin
Situation 3
Severe neutropenia
or mild with severe infection or stomatologic infections
or with other blood count anomalies
or hepatomegaly/splenomegaly
Bone marrow cytology : without delay if other blood anomalies
Or organomegaly: malignant hemopathy has to be ruled out
Immune deficiency like agammaglobulinemia
Immunoglobulin assay (Ig GAM)
Lymphocyte immunophenotyping
Antibodies against neutrophil membrane antigen
Autoimmune neutropenia
Initial Work up: no etiology: Clinical and hematological follow up
Recovery from neutropenia : probable post viral neutropenia
Neutropenia persists or is recurrent
Probable congenital neutropenia
Bone marrow cytology and cytogenetics
Situation 4
Neutropenia in multisystemic disease or
dysmorphic syndrome
Genetic study depending on context (see table 2)