The haematological emergency - Granulocytopenia - Calendar 2008 month 3

Author(s): H. Diem (1), R. Hinzmann, F. Forstreuter (2)
Institution(s): (1) Würmtal-Labor, 82131 Gauting; (2) Sysmex Europe GmbH, Norderstedt - Germany
References: The Sysmex Scientific Calendar 2008;
Photos and text: Heinz Diem, MD; text: Rolf Hinzmann, MD, PhD; Frauke Forstreuter, PhD
Last change of this image collection: 2008/01/01

Granulocytopenia is defined as a granulocyte count below the lower limit of the reference interval (2,000/µL for adults). If the values drop below 1,000/µL there is an imminent danger of infection, increasing significantly at values below 500/µL . Therefore, a granulocyte count below 500/µL always has to be reported immediately.

With granulocytes being a subpopulation of the leukocytes, a leukocyte count below 500/µL is equivalent to a granulocyte count below 500/µL. On the other hand, a normal or elevated leukocyte count does not exclude granulocytopenia. In this case the differential blood count always has to be the decisive factor.

When evaluating a cell population it is crucial to always consider its absolute cell count /µL and not the percentage. Shown here is leukopenia (400/µL) in combination with granulocytopenia (30/µL) in a patient after chemotherapy

Leukocytes 600/µL, granulocytes 10% (absolute: 60/µL), haemoglobin 6 g/dL and platelets 10,000/µL. Diagnosis: Severe aplastic anaemia. Monitoring before stem cell transplantation.

Leukocyte concentration 180,000/µL. Despite intensive search no granulocytes were detectable. Diagnosis: acute lymphocytic leukaemia (T-ALL).