Neutropenia in children: clinical masks and therapeutic approach

S.I. Ilchenko, O.S. Koreniuk, A.A. Fialkovskaya


Neutropenic syndrome is quite common in pediatric practice. Its nature is diverse, and every case of neutropenia needs thorough differential diagnosis to determine the patient’s management. Only a differentiated approach to patients with neutropenia can prevent the development of severe complications of infectious processes. To illustratу this point, we present a clinical case of severe chronic bronchopulmonary disease in a 4-year-old child, who was examined and treated in children’s city pulmonology center. The child was admitted to the hospital with the complaints of persistent non-productive cough, episodic distal rales, loss of hearing. From the history of the disease it was found that from one month of age, the child had repeated otitis, relapsing bronchitis with bronchial obstructive syndrome, repeated pneumonia of different localization. A comprehensive examination including, in addition to standard laboratory tests, diagnostic and diagnostic bronchoscopy, computed tomography of the thoracic organs, revealed a bilateral diffuse catarrhal-purulent endobronchitis, computed tomography signs of diffuse interstitial changes in the lungs and bronchomalacia. A thorough dynamic analysis of hemograms from the outpatient card made it possible to suspect a congenital neutropenia in the patient. Multiple occurrence of neutropenic crises with a decrease in the number of neutrophils to 1,000 cells/μl and lower during the first year of the child’s life and their periodicity of 3–4 weeks confirmed the cyclical nature of neutropenia. The sternal puncture performed with the evaluation of the myelogram revealed no significant changes in the granulocyte number that was probably due to the period of remission of cyclic neutropenia at the time of examination. Thus, severe chronic respiratory disease in this child was clinical mask of cyclic neutropenia, which required a thorough diagnosis. Neutropenia in children should be considered by the practicing physician as a laboratory symptom, which requires understanding, comparison with clinical manifestations and obligatory dynamic analysis.


neutropenia; cyclic neutropenia; children


Rumiantsev AG, Samochatova EV, editors. Vol 4. Hematology / oncology of childhood. In: Kokolina VF, Rumiantsev AG, editors. Prakticheskoe rukovodstvo po detskim bolezniam [Practical Guide to Childhood Illnesses]. Moscow: Medpraktika; 2004. 792 p. (in Russian).

Yudina NB, Brezhneva NV. Isolated neutropenia in children: from the pediatrician to a hematologist (literature review). Rossiiskii zhurnal detskoi gematologii i onkologii. 2015;(1):75-80. (in Russian).

Newburger PE, Dale DC. Evaluation and management of patients with isolated neutropenia. Semin Hematol. 2013 Jul;50(3):198-206. doi: 10.1053/j.seminhematol.2013.06.010.

Kazakova LM. Granulocytopenia at children. Mother and baby in Kuzbass. 2010;(40):3-6. (in Russian).

Ozhegov AM. Neutropenia at children. Practical medicine. 2009;(39):92-94. (in Russian).

Ratmanova GA, Rusova TV, Kuznetsova OV, et al. Neutropenia in pediatric practice. Pediatric diagnostics. 2009;(2):69-72. (in Russian).

Deordieva EA, Shcherbina AYu. Neutropenia in pediatric hematology/oncology practice. Onkogematologiya. 2015;(1):46-52. (in Russian).

Husain EH, Mullah-Ali A, Al-Sharidah S, Azab AF, Adekile A. Infectious etiologies of transient neutropenia in previously healthy children. Pediatr Infect Dis J. 2012 Jun;31(6):575-7. doi: 10.1097/INF.0b013e318250084a.

Autrel-Moignet A, Lamy T. Autoimmune neutropenia. Presse Med. 2014 Apr;43(4 Pt 2):e105-18. doi: 10.1016/j.lpm.2014.02.007.

Inoue S, Wolfe LC, Windle ML, Crouch GD, Jones G. Pediatric Autoimmune and Chronic Benign Neutropenia Differential Diagnoses. Available from: Accessed: November 28, 2017.

Ruda VI, Mys'ko LV, Mys'ko JuL, Jurchyshena EV, Jurchyshen OM. Genetic neutropenia in children. Zdorovʹe rebenka. 2010;(27):92-93. (in Ukrainian).

Boztug K, Klein С. Genetic etiologies of severe congenital neutropenia. Curr Opin Pediatr. 2011 Feb;23(1):21-6. doi: 10.1097/MOP.0b013e32834262f8.

Prilutskiy AS, Gomozova EA. A case of cyclic neutropenia. Clinical and laboratory signs of disease. Imunologija ta alergologija: nauka i praktyka. 2011;(3):72-75. (in Russian).

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