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other causes of neutropenia should be considered including the use of drugs associated with neutropenia (see Table 93.7 ), as well as other underlying disorders Genetic testing for congenital neutropenias should be pursued in infants, usually at follow-up with a pediatric hematologist Consider underlying disorders such as malignancies or nutritional disturbances (folate and vitamin B12 ) If the etiology is suspected to be viral suppression and neutrophil count has resolved on repeat testing, no further evaluation may be required If no etiology is identified and neutropenia persists on repeat follow-up testing, additional evaluation should be performed in consultation with a pediatric hematologist Workup for patients with unexplained neutropenia should include CBC with differential and peripheral smear review, nutritional studies (such as folate and vitamin B12 ), and may include antineutrophil antibodies, bone marrow aspiration and biopsy (if neutropenia is persistent and without clear etiology), serum immunoglobulins, and virology screen Patients with some forms of chronic neutropenia may be treated with granulocyte colony-stimulating factor (G-CSF), especially in the setting of recurrent infections Neonatal alloimmune neutropenia may be treated with IVIG and eventually resolves as the maternal antibody titer wanes Clinical Indications for Discharge or Admission The afebrile neutropenic patient who is well appearing and has no other significant comorbidities may be evaluated on an outpatient basis in consultation with hematology For febrile but well-appearing neutropenic patients with good marrow function (e.g., noncancer or bone marrow failure patients), outpatient management is typically reasonable after blood cultures are obtained and antibiotics administered If severe neutropenia is present (ANC