What constitutes a reasonable workup for neutropenia in an otherwise healthy young person? — Deboray Kay Lanius, FNP, Fredericksburg, Va.

Neutropenia is defined as a deficiency of circulating neutrophils or an absolute neutrophil count <1,500 µL. This condition can be attributable to a reduction in bone-marrow production or increased loss of bone marrow from the circulation. A thorough history is the best place to start in your evaluation of a healthy child with a low neutrophil count.

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A viral infection is the most common cause in children (not infants). The neutropenia develops during the illness and persists for up to one week after resolution. Measles, mumps and rubella vaccine as well as varicella vaccine can also trigger transient neutropenia. Another possible cause is bacterial infection.

Nutritional deficits in folic acid, vitamin B12 or copper can also lead to a drop in neutrophils. Lastly, look carefully at any drugs the patient is currently taking or may have recently finished taking. Herbal therapies and supplements also deserve evaluation. — Julee B. Waldrop, DNP (175-1)

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