Absolute neutrophil count

Neutropenia associated with interferon or pegylated interferon therapy is defined as an absolute neutrophil count (ANC) of less than 1000 cells/mm3 in rare cases, an ANC less than 500 cells/mm3 maybe observed. The neutropenia is more common and in some cases more severe with pegylated interferon than with unmodified interferon. Neutropenia usually occurs within the first 2 weeks after initiating either formulation of interferon, with the WBC count stabilizing by week four or six. The neutropenia is reversible upon discontinuing therapy. Granulocyte colony-stimulating factor has been used as an adjunctive therapy for interferon-induced neutropenia in hepatitis patients.44... 

Absolute neutrophil count less than 1.5 x 103/mm3 (less than 1.5 x 103/pL or less than 1.5x109/L)... 

TABLE 34-11. Monitoring of White Blood Cell Count and Absolute Neutrophil Count during Clozapine Treatment... 

ANC, absolute neutrophil count WBC, white blood cell. 

One month later, GD is back for a follow-up visit. She notes that her thyrotoxic symptoms are gone, and overall, she feels great. She is receiving propylthiouracil 100 mg three times daily. Her most recentTSH was 0.9 milliunit/L (normal 0.5-2.5 milliunits/L), and her free T4 was 1.6 ng/dL (20.6 pmol/L normal 0.7-1.9 ng/dL, or 9.0-24.5 pmol/L). However, over the past few days she has developed a sore throat and feels achy. She wonders if she has the flu. Her vital signs show a pulse of 92 beats/minute and a temperature of 38.3°C (101 °F). A complete blood count reveals a total white blood cell count of 1 00/mm3 or 0.1 x 1 09/L (normal 4000-10,000/mm3 or 4-10 x 1 09/L) with 15 neutrophils (absolute neutrophil count 150). 

Closely monitor patients for efficacy and toxicity while they are receiving hydroxyurea. Monitor mean corpuscular volume (MCV) because it increases as the level of HbF increases. If the MCV does not increase with hydroxyurea use, the marrow may be unable to respond, the dose may not be adequate, or the patient may be noncompliant.27 HbF levels also can be monitored to assess response. Assess blood counts every 2 weeks during dose titration and then every 4 to 6 weeks once the dose is stabilized. Temporary discontinuation of therapy is warranted if the hemoglobin level is less than 5 g/dL (50 g/L or 3.1 mmol/L), the absolute neutrophil count is less than 2000/mm3 (2 x 109/L), platelets are less than 80,000/mm3 (80 x 109/L), or reticulocytes are less than 80,000/mm3 (80 x 109/L) if the hemoglobin is less than 9 g/dL (90 g/L or 5.6 mmol/L). Monitor for increases in serum creatinine and transaminases. Once the patient has recovered, hydroxyurea may be restarted with a dose that is 2.5 to 5 mg/kg less than the dose associated with the patient s toxicity. Doses then may be increased by 2.5 to 5 mg/kg daily after 12 weeks with no toxicity. 

Vinorelbine 25-30 mg/m2 per week IV Repeat cycles every 7 days (adjust dose based on absolute neutrophil count see product information)"... 

Laboratory monitoring is performed before initiating therapy and before each cycle of chemotherapy. A complete blood count should be obtained prior to each course of chemotherapy to ensure that hematologic values are adequate. In particular, white blood cell counts and absolute neutrophil counts can be decreased in patients receiving chemotherapy such as irinote-can and 5-FU and increase the risk of infection. Baseline liver function tests and an assessment of renal function should be done prior to and periodically during therapy. Other selected laboratory tests include checking for the presence of protein in the urine in patients receiving oxaliplatin and bevacizumab. 

Engraftment is the reestablishment of functional hematopoiesis. It is commonly defined as the point at which a patient can maintain a sustained absolute neutrophil count (ANC) of greater than 500 cells/mm3 (0.5 x 109/L) and a sustained platelet count of greater 20,000/mm3 (20 x 109/L) lasting for 3 or more consecutive days without transfusions. 

The success of the treatment of febrile neutropenia hinges on the adequate recovery of the absolute neutrophil count and either optimal antimicrobial coverage of identified organisms or empirical coverage of unidentified organisms. 

Neutropenia is defined as an absolute neutrophil count (ANC) of less than 0.5 x 10 3/ J.L (0.5 x 109/L) cells or an ANC of less than 1.0 x 103/ J.L (1.0 x 109/L) cells with a predicted decrease to less than 0.5 x 103/ J.L (0.5 x 109/L) cells. The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils (segmented neutrophils plus bands). Fever is defined as a single oral temperature of 38.3°C (101°F) or greater or a temperature of 38.0°C (100.4°F) or greater for at least 1 hour. The combination of these two factors defines febrile neutropenia.5 The risk of infection during the period of neutropenia depends primarily on two factors ... 

If the white blood cell (WBC) count is less than 3,000/mm3 or the absolute neutrophil count (ANC) is less than 1,000/mm3, the antipsychotic should be discontinued, and the WBC count monitored closely until it returns to normal. 

GM-CSF was approved in 1991 by the United States Food and Drag Administration (FDA) to support transplant associated neutropenia and mobilize stem cells. In Europe, it is also approved for prophylactic treatment following dose intensive chemotherapy. However, the rate of absolute neutrophil count (ANC) recovery in response to treatment with GM-CSF in patients receiving myelosuppressive chemotherapy or in the... 

Ticlopidine can cause life-threatening hematological adverse reactions, including neutropenia/agranulocytosis and thrombotic thrombocytopenic purpura (TTP). Neutropenia/agranulocytosis Neutropenia defined as an absolute neutrophil count (ANC) less than 1,200 neutrophils/mm occurred in 50 of 2048 (2.4%) stroke patients who received ticlopidine in clinical trials. Neutropenia is calculated as follows ANC = WBC x % neutrophils. In 17 patients (0.8%) the neutrophil count was less than 450/mm. ... 

Laboratory monitoring includes complete blood count, especially the absolute neutrophil count, platelet count, and the appearance of the peripheral smear. Thrombocytopenia induced by ticlopidine is occasionally unrelated to TTP. Further investigate for a diagnosis of TTP with the occurrence of any acute, unexplained reduction in hemoglobin or platelet count. Discontinue ticlopidine if there are laboratory signs of TTP or the neutrophil count is less than 1200/mm. ... 

Lead exposure Not a substitute for effective abatement of lead exposure. Neutropenia Mild to moderate neutropenia has been observed in some patients receiving succimer. While a causal relationship to succimer has not been definitely established, neutropenia has been reported with other drugs in the same chemical class. Obtain a complete blood count with white blood cell differential and direct platelet counts prior to and weekly during treatment. Withhold or discontinue therapy if the absolute neutrophil count (ANC) is below 1200/mcL and follow the patient closely to document recovery of the ANC to above 1500/mcL or to the patient s baseline neutrophil count. There is limited experience with reexposure in patients who have developed neutropenia. Therefore, rechallenge such patients only if the benefit of succimer therapy clearly outweighs the potential risk of another episode of... 

Lab test abnormalities Discontinue the drug in any patient whose white blood cell count or absolute neutrophil count falls below normal levels. White blood cell and differential counts are recommended for patients who develop fever and sore throat (or other signs of infection) during therapy. 

Monitoring Patients must have a blood sample drawn for a WBC count before initiation of treatment with clozapine and must have subsequent WBC counts done at least weekly for the first 6 months of continuous treatment. If WBC counts remain acceptable (WBC at least 3,000/mm, absolute neutrophil count [ANC] at least 1,500/mm ) during this period, WBC counts may be monitored every other week thereafter. After the discontinuation of clozapine, continue weekly WBC counts for an additional 4 weeks. 

Hematology Decreased absolute neutrophil counts (ANC) less than 500 to 1500/mcL have been reported rarely. The total clinical experience in more than 12,000 patients does not indicate a clear association between tacrine treatment and serious white blood cell abnormalities. 

Statistically significant risk factors associated with seizures were low baseline absolute neutrophil count (ANC), impaired baseline renal function, and low total serum calcium. Several cases of seizures were associated with death. 

Monitoring Perform blood tests at least twice a week during therapy to assess the following parameters Hematology (absolute neutrophil counts [ANC], platelets) renal function (serum creatinine, BUN) hepatic function (AST, ALT, alkaline phosphatase). 

Neutropenia - If neutropenia develops (absolute neutrophil count [ANC] less than 1.3 x 10 /mcL), interrupt dosing or reduce the dosage. 

Peginterferon alfa-2a Dose reduction to 135 meg peginterferon alfa-2a is recommended if the neutrophil count is less than 750 cells/mm. For patients with absolute neutrophil count (ANC) values below 500 cells/mm, suspend treatment until ANC values return to more than 1000 cells/mm. Initially reinstitute therapy at 90 meg peginterferon alfa-2a, and monitor the neutrophil count. 

AMS acute myocardial syndrome ANC absolute neutrophil count ANS autonomic nervous system APACHE Acute Physiologic and Chronic Health Evaluation ICU illness severity scoring system APAP acetaminophen [N-acetyl-p-aminof enol] aPTT activated partial thromboplastin time ARB angiotensin 11 receptor blocker ARDS adult respiratory distress syndrome... 

Contraindications Absolute neutrophil count less than 500/mm, platelet count less than 25,000/mm, hypersensitivitytoacyclovir or ganciclovir, immunocompetent patients, patients with congenital CMV disease... 

Baseline tests CBC, hepatic function, pregnancy test, TSH, renal function, uric acid, HCVRNA level. Exclusions to treatment platelet count <90,000 cells/mm (as low as 75,000 cells/mm in patients with cirrhosis) absolute neutrophil count < 1,500 cells/mm serum creatinine concentration > 1.5 X upperlimit of normal abnormal thyroid function... 

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