Neutropenia in Children

Neutropenia, a decrease in the number of circulating neutrophilic leukocytes, often provides a diagnostic challenge to the pediatrician. When the pediatrician is unable to ascertain the cause of the neutropenia, pediatric hematologists are also frequently frustrated in their attempts to uncover a satisfactory explanation for the finding.The total white cell count and the absolute granulocyte count vary as a function of age as depicted in Table 1. The while blood cell count and the absolute granulocyte count are characteristically increased in the normal newborn and both rapidly decrease during the first week of life. After the first year of life, the normal neutrophil count generally ranges between 1,500 to 8,000/cu mm. Although neutropenia is conventionally defined as the presence of an absolute granulocyte count (neutrophilic leukocytes and band forms) of less than 1,500 cu mm, an increase in the incidence of infections is rarely observed until the absolute granulocyte count remains persistently below 1,000/cu mm.The black population and possibly Yemenite Jews characteristically have lower total white cell counts than age-matched control subjects. Approximately 30% to 40% of black male adults have a total white blood cell count of less than 5,000/cu mm as compared with only 7% of white males.2 Presumably the same difference in distribution of white cell counts exists in the pediatric population as well.