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Diagnostic laboratory evaluation for neutropenia

Diagnostic laboratory evaluation for neutropenia
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.
ANA: antinuclear antibodies.
Graphic 51687 Version 6.0

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