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GENERAL CONSIDERATIONS

  • Normal neutrophil concentration values are significantly lower for certain ethnic groups (eg, African ancestry, Yemeni Jewish ancestry) than for persons of European ancestry. This difference is an important distinction to avoid unnecessary evaluations in these individuals. Men of African ancestry may have a “normal” absolute neutrophil count of 1.3 to 6.6 × 109/L.

  • In this classification, diseases resulting from neutrophil abnormalities in which the neutrophil is either the only cell type affected or is the dominant cell type affected are considered (Table 29–1).

  • Neutropenia or neutrophilia occurs as part of disorders that affect multiple blood cell lineages (eg, aplastic anemia [see Chap. 3], myelodysplastic syndrome [see Chap. 45], acute and chronic myelogenous leukemias [see Chaps. 46 and 47], chronic myeloproliferative diseases [see Chaps. 42, 43, and 48]).

  • A strict pathophysiologic classification of neutrophil disorders has proved elusive because:

    — The low concentration of blood neutrophils in neutropenic states makes measuring the circulatory kinetics of autologous cells technically difficult.

    — The two compartments of neutrophils in the blood (the circulating compartment measured by the absolute neutrophil count and the marginated neutrophil compartment sequestered in small vessel beds and not counted in the neutrophil count), the random disappearance of neutrophils from the circulation, the extremely short circulation time of neutrophils (t1/2 = ~6 hours), the absence of facile techniques to measure the size of the tissue neutrophil compartment, and the disappearance of neutrophils by apoptosis or gastrointestinal excretion from the tissue compartment make multicompartment kinetic analysis difficult.

  • Thus, the classification of neutrophil disorders is partly pathophysiologic and partly descriptive (see Table 29–1).

TABLE 29–1CLASSIFICATION OF NEUTROPHIL DISORDERS

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