TỔNG HỢP KIẾN THỨC VỀ Neutropenia

Is it all in the time of day Joy Tippett, Taranaki Medlab 15.5.2010 ` ` ` ` ` 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 ...` ` ` ` ` Persistent Neutropenia Always sampled with fasting glucose and lipids Fit and well GP unconcerned Patient worried... 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