Clinical spectrum of pediatric neutropenia: mostly benign, but not to be overlooked.

Background: Neutropenia is a common laboratory finding in children, therefore it is a common referral reason to pediatric hematology units. This study hypothesizes that most neutropenic children do not require pediatric hematology consultation, and that key clinical indicators can guide the need for referral.

Methods: Medical records of 180 patients who were admitted to a tertiary reference center, were evaluated in terms of demographical data, physical examination findings, laboratory findings, and outcome measures. The patients enrolled in the study had newly diagnosed or incidental neutropenia and did not meet the criteria for chronic neutropenia. Neutropenia was classified based on absolute neutrophil count (ANC) as follows: mild (1000–1499/mm³), moderate (500–999/mm³), severe (200–499/mm³), and very severe (<200/mm³).

Results: Of the 180 patients enrolled, 51.7% were male, with a mean age of 4.8 years (min-max: 1 week- 17 years). 12 patients (6.7%) were diagnosed with congenital neutropenia. The median age for patients diagnosed with congenital neutropenia was 12 months, whereas it was 47 months for those with post-infectious neutropenia (p=0.037). 64.4% of patients had no known prior disease, and 45% were incidentally found to have neutropenia. The average ANC was 732/mm³, with 26.1% having mild, 47.2% moderate, 19.4% severe, and 7.2% very severe neutropenia. Etiological causes included post-infectious (53.9%), idiopathic/immune (25.6%), congenital (6.7%), and drug-related (6.7%) neutropenia. The median ANC for congenital neutropenia patients was 200/mm³, and their infection rates were significantly higher than the other groups (p=0.001). The mean follow-up period was 10 months, with 69.4% of patients having normal ANC at the last follow-up.

Conclusions: Despite the increased frequency of neutropenia in childhood, a vast majority of the cases have a benign and transient clinical course.