Critical Care Medicine-Hematologic and Oncologic Disorders>>>>>White Blood Cell Disorders
Question 1#

A 57-year-old male with history of alcohol abuse is admitted to the intensive care unit after a fall from a ladder. He has sustained a left ankle fracture and several rib fractures. His white blood cell count is 1600/µL.

Initial workup for possible causes of leukopenia includes all of the following EXCEPT:

A. Obtain complete blood count (CBC) with differential
B. Review patient’s medications
C. Obtain screening studies for rheumatologic disorders
D. Review results of CBCs/differential counts from prior hospitalizations and the ambulatory setting

Correct Answer is C


Correct Answer: C

Leukopenia is a reduction in the circulating white blood cells below the normal range. It is often used interchangeably with neutropenia as the neutrophils are the most abundant white blood cells. The pathophysiology of neutropenia involves decreased production, increased destruction, or sequestration of neutrophils in the spleen or vascular endothelium. Medications, infection/inflammation, and genetics are more common causes of neutropenia. 

Initial workup for neutropenia includes obtaining a CBC including a differential to calculate the ANC. A history and physical examination should be performed looking for possible causes. This patient’s history of trauma may point to inflammation as a possible cause of neutropenia. Other possible causes based on his history include nutritional deficiencies or liver disease because of alcohol abuse. Reviewing results of CBCs/differential counts from prior hospitalizations and the ambulatory setting will help determine whether the neutropenia developed during hospitalization or is chronic. The patient’s medication list should be reviewed for medications that may cause neutropenia and should be stopped if the ANC <1000 cells/µL or continues to drop. Though rheumatological disorders can cause rarely cause leukopenia, it is unlikely in this patient presenting with trauma.


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  2. Dale D. How I diagnose and treat neutropenia. Curr Opin Hematol. 2016;23:1-4.