TỔNG HỢP KIẾN THỨC VỀ Neutropenia

Is it all in the time of day.

Joy Tippett, Taranaki Medlab.
15.5.2010


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Persistent Neutropenia
Always sampled with fasting glucose and
lipids
Fit and well
GP unconcerned
Patient worried


3.8

NEUTROPHIL COUNT


Lipex
¾ Quinapril
¾ Glucosamine
¾ Panadol
¾ Cartia

¾


1995 By pass surgery
¾ 2008 Thyrotoxicosis
¾ Fit and well now
¾


PM/NF

1305

1218

1810

1537

1250
900/NF

1251

F

F
814/F
AM
934

1040/F
1140/NF

F

836/F
AM

827/F


ALL NEUTROPHIL COUNTS 28/12/09-27/4/10




28.12.2009 – 27.4.2010
¾ Neutrophil counts 1.5 or less
¾ Total 234 or 1.36% Patient visits
¾ Exclude
¾

¾Haematology Patients
¾Oncology Patients
¾Children
¾Viral Infections

¾

102 Patient visits








Time

Fasting /Non fasting

Neutrophil count

0833

F

1.1

0856

F

1.8

0835

F

1.5

0820

NF

1.5

0836

NF

2.5

0822

F

1.2

0810

NF

2.3



Fasting Patient

¾ Diabetes
¾ Hyperlipidaemia/cholesterolaemia
¾ Older age group
¾ Females
¾


“measured the biological variation in healthy
normal subjects and reported a diurnal
variation of as high as 50%”


The WBC and neutrophil count are higher in
the afternoon than in the morning.
¾ WBC, neutrophil count and monocyte count
fall steeply during menstruation.
¾ Menopause – The WBC and neutrophil count
fall.
¾


Diurnal variation – 10% for neutrophils
¾ Total leucocyte minimum counts in the
morning with the subject at rest.
¾ Random exercise may raise the count slightly.
¾ Strenous exercise causes rises of up to 30 x
10^9/L.
¾ The effect of ingestion of food is uncertain.
¾

Risperidone-induced morning
pseudoneutropenia
¾ Circadian rhythm of white blood cells during
clozapine treatment
¾


Jilma et al. Br J Haematology 1999; 106:368-370


Under-estimated.
¾ Consider time of collections in neutropenic
patients.
¾ Result in unnecessary repeats and
investigations.
¾ Some drugs may enhance it.
¾