Benign ethnic neutropenia: What is a normal absolute neutrophil count?,☆☆

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Abstract

Approximately 25% to 50% of persons of African descent and some ethnic groups in the Middle East have benign ethnic neutropenia, with low leukocyte and neutrophil counts. It is important to recognize the existence of this condition, the most common form of neutropenia throughout the world, and thus avoid both under- and overevaluation. Although there is no scientific basis for an absolute neutrophil count of 1.5 × 109/L to be considered minimal, counts below this level are empirically regarded as inadequate in persons of all ethnic groups who are above the age of 1 year.1, 2, 3, 4 Many individuals, however, maintain consistently low absolute neutrophil counts without evidence of increased susceptibility to infection or any other adverse effect. The important determination is not how many neutrophils are present in the peripheral blood, but whether the bone marrow is able to produce enough normally functioning cells when needed.5, 6, 7, 8, 9 A description of benign ethnic neutropenia, as set forth in this review, suggests that the lower limit now considered acceptable for the absolute neutrophil count should be readjusted downward for all ethnic groups. (J Lab Clin Med 1999;133:15-22)

Section snippets

Definition

When neutropenia, defined by normative data in white populations, occurs in individuals of other ethnic groups who are otherwise healthy and who do not have repeated or severe infections, the condition may be referred to as benign ethnic neutropenia.27 Other descriptive terms include pseudoneutropenia,19, 20 nongenetic neutropenia,21 “benign” neutropenia of the black,25 familial neutropenia,31 benign hereditary neutropenia,34 benign familial leukopenia and neutropenia,35 and chronic benign

Standard values

Neutropenia is commonly defined for adults and children older than 1 year of age as a reduction in circulating polymorphonuclear and band form neutrophils with an absolute neutrophil count below 1.5 × 109/L,1, 2, 3, 4 although other definitions have been used. For example, Mason et al25 considered 2.0 × 109/L to be the lower limit of normal for adults. Neutrophil counts are generally higher in women and are further elevated during pregnancy.37 Newborns characteristically have elevated WBC and

Epidemiology of benign ethnic neutropenia

Benign ethnic neutropenia occurs in American and British children and adults of African descent.10, 12, 14, 19, 20, 23, 25, 26, 27, 28 Broun et al12 reported significant granulocytopenia in 25% of black patients admitted for elective surgery, and Karayalcin et al19, 20 found that 30% to 40% of 231 black hospital employees had low WBC values attributed to a significant decrease in granulocytes. Rippey13 reported that 50% of African and West Indian patients in a London hospital had WBC values of

Mechanism of benign ethnic neutropenia

Mintz and Sachs30 showed that neutropenic Yemenite Jews had a normal bone marrow pattern with adequate numbers of mature granulocytes and without evidence of degenerating hypersegmented mature granulocytes (“myelokathexis”) or increased numbers of immature granulocytes in the peripheral blood. Bone marrow cells from these patients with neutropenia formed approximately twice the number of granulocyte colonies as bone marrow cells from non-neutropenic persons, thus establishing that the

Diagnosis of benign ethnic neutropenia

If the ethnic background is appropriate, the diagnosis of benign ethnic neutropenia should not be difficult in a person who is physically normal and lacks a history of susceptibility to infection. It is important to confirm the presence of neutropenia by repeating the blood count, to rule out involvement of other blood cell lines, and to establish that morphologic characteristics of the blood cells are normal. By 2 months of age the neutropenias of infancy need no longer be considered. The

Conclusion

Benign ethnic neutropenia, the most common form of neutropenia seen throughout the world, appears to confer no clinical disadvantage and can be considered to be a variation of normal. Patients with an appropriate ethnic background who have no physical abnormalities and no history of increased frequency or severity of infections do not require extensive or invasive testing. A closer look at benign ethnic neutropenia would offer an opportunity to re-evaluate the normal range of the ANC for all

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