An absolute neutrophil count
less than normal range.
Caused by: Myelodysplastic
syndrome, megaloblastic anemia.
This is then referred to as being
"Dr. Raj, how in the world
are you telling me a megaloblastic
anemia causes neutropenia,
or even for that matter,
Because I find cells in my bone marrow.
In fact, I might actually find a
lot of cells in my bone marrow,
but yet you’re telling
Look at the name, please.
You must call this neutropenia,
because the type of cells that you’re going
to produce in your bone marrow with MDS,
which is more preleukemic in nature
are megaloblastic in which your patient
might be B12 or folate deficient.
You’re not going to form the proper
functioning cells that you require.
Therefore, it may result in neutropenia
or ineffective granulopoiesis.
Or bone marrow infiltration.
For example, leukemia, metastatic cancer,
storage diseases, myelofibrosis.
Once again, here,
it’s a space occupying lesion
within the bone marrow
Splenic sequestration with splenomegaly.
There’s every possibility that
the spleen itself may then
sequester the neutrophil
resulting in neutropenia.
But not just that, you could have
neutropenia, anemia, or even thrombocytopenia
when your splenomegaly look for those
types of symptoms in your patient.
Drugs that cause neutropenia.
These are important.
Remember, please, that chemotherapeutic
drugs do what to your bone marrow?
Shuts it down.
Bone marrow suppression.
In general, chemotherapeutic drugs
like to target what kind of cells?
What do you mean
what kind of cells?
or labile cells,
They love to go after cells that are
constantly dividing, dividing, dividing.
That’s what chemotherapy is.
Chemotherapy is trying to attack
those cells that are proliferating.
There’s every possibility that in
addition to attacking the cancer,
that might actually attack the bone marrow
because in the bone marrow, oh my goodness,
the amount of multiplication,
normally, is a lot, and so therefore, it
might shut it down bone marrow suppression.
tell me about the cells
on the top of your head.
Hair loss, right?
Because these are labile.
And what about the diarrhea?
Good, the intestinal cells,
which are also labile.
You knock out these three cells.
There are your symptoms for chemotherapy,
uncomfortable, very uncomfortable.
For this, every single month,
you’re thinking about doing
your proper granulocyte count
so that your patient is not, is
not susceptible to infection.
Sulfonamides and chloramphenicol,
all may then cause neutropenia.
Lymphopenia is my topic, not
neutropenia but lymphopenia.
Lymphopenia here will be,
perhaps, due to HIV.
If it’s less than 200,
automatically puts your patient
on prophylaxis for
Autoimmune diseases may shut down
your bone marrow lymphopenia.
Cytotoxic drugs, chemotherapy.
Let’s summarize real
Glucocorticoid given to your
patient looks like Cushing
looks like Cushing,
buffalo hump, so
on and so forth.
Glucocorticoid is then going to cause
demargination, neutrophilic leukocytosis.
Glucocorticoids may then cause
a decrease in lymphocytes,
and perhaps even eosinophils
due to apoptosis.
And glucocorticoids causes --
let’s say your patient comes in for
a face lift, a plastic surgeon.
You’re giving glucocorticoid
so that you can do --
well, slow down the wound
healing on purpose.