How do you manage isolated and asymptomatic leukopenia or neutropenia? What tests do you perform?
Mark Crowther: The most important test in assessing for isolated neutropenia is history and physical examination. Most patients who have isolated neutropenia—it is a completely benign abnormality, and I do not do any testing. If I have a 64-year-old woman who has a neutrophil count of 0.8 × 109/L and I look back through her records and she had a neutrophil count of 1.2 × 109/L ten years ago, she has never had any infections, she has never been hospitalized with an infection, it is a benign variant. In our area we have a lot of people of African ethnic origin, and many people of African ethnic origin run neutrophil counts that are much lower than Caucasian neutrophil counts. You just need to be aware of the fact that in many patients who have neutropenia it is not clinically important.
There is also the large group of patients who have an autoimmune condition like lupus. If they have lupus and neutropenia, they have never had infections, we will usually attribute it to the lupus. Again, we do not do any specific investigations. For almost every patient with neutropenia, we basically reassure them.
If the patient has had recent infections or there is something to suggest that it is a progressive problem, so it is getting progressively lower, then we would do things like look for that underlying diagnosis of lupus if that has not been made before. Look at the rest of the complete blood cell count, see if there are abnormalities in the red cell count or the platelet count, and let our investigations be guided by the simple tests and the results of the history and physical examination.