Test | Comments |
Serial complete blood counts with differential | Observation over time of the complete blood count and absolute neutrophil count is often the best approach. |
Sedimentation rate (ESR), C-reactive protein (CRP) | Elevations of the ESR and/or CRP in the absence of any overt infection may suggest underlying inflammation due to neutropenia or presence of autoimmune disease. |
ANA, C3, C4, anti-DNA | Screening tests for the presence of collagen vascular disease. |
B12, methylmalonic acid, homocysteine, copper, ceruloplasmin, pyridoxine | Indicate abnormality in micronutrients that can be associated with marrow failure. High methylmalonic acid and/or homocysteine suggest B12 or folate deficiency even if serum levels are normal. Low ceruloplasmin is associated with neutropenia or pancytopenia and corrects with copper replacement. |
Bone marrow aspirate and biopsy with cytogenetics | Testing to address possibility of underlying hematologic malignancy, myelodysplastic syndrome, maturation arrest. |
CD3/CD16,56,57, immunoglobulins, tetanus titers | Natural killer cells/cytotoxic T cell subsets. A clone of >20 percent suggests large granular lymphocyte disease; immunodeficiency can present with neutropenia. |
Genetic testing | Specific gene tests are available for several of the congenital neutropenias. |
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