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