Neutropenia diagnosis

Bernini, J. C., Diagnosis and management of chronic neutropenia during childhood. Pediatr. Clin. North Am. 43, 773-792 (1996). 

To broaden the spectrum of antibacterial activity (1) in a known mixed infection, e.g. peritonitis following gut perforation or (2) where the infecting organism cannot be predicted but treatment is essential before a diagnosis has been reached, e.g. septicaemia complicating neutropenia or severe community-acquired pneumonia full doses of each drug are needed. 

A 36-year-old white woman with relapsing acute myeloid leukemia took ceftazidime (2 g tds) and aciclovir for febrile neutropenia and Herpes labialis. She developed an itchy rash and treatment was changed to imi-penem (500 mg qds for 5 days), vancomycin (1 g bd for 3 days), and gentamicin (2 mg/kg for 3 days) chemotherapy included idambicin, cytarabine, etoposide, ondansetron, and dexamethasone for 3 days. Within a few days the rash developed into blisters and erosions, affecting more than 80% of the skin. The diagnosis was confirmed histologically, and she subsequently died from shock (70). 

A number of laboratory abnormalities can be identified at the time of diagnosis. As stated above, lymphocytosis in the peripheral blood and lymphocytic infiltration of the bone marrow are usually seen at diagnosis. Anemia, thrombocytopenia, and neutropenia are frequently evident, either at the time of diagnosis or some time during... 

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