The European Guidelines on Diagnosis and Management of Neutropenia in Adults and Children: A Consensus Between the European Hematology Association and the EuNet-INNOCHRON COST Action

Abstract

Neutropenia, as an isolated blood cell deficiency, is a feature of a wide spectrum of acquired or congenital, benign or premalignant disorders with a predisposition to develop myelodysplastic neoplasms/acute myeloid leukemia that may arise at any age. In recent years, advances in diagnostic methodologies, particularly in the field of genomics, have revealed novel genes and mechanisms responsible for etiology and disease evolution and opened new perspectives for tailored treatment. Despite the research and diagnostic advances in the field, real world evidence, arising from international neutropenia patient registries and scientific networks, has shown that the diagnosis and management of neutropenic patients is mostly based on the physicians' experience and local practices. Therefore, experts participating in the European Network for the Innovative Diagnosis and Treatment of Chronic Neutropenias have collaborated under the auspices of the European Hematology Association to produce recommendations for the diagnosis and management of patients across the whole spectrum of chronic neutropenias. In the present article, we describe evidence- and consensus-based guidelines for the definition and classification, diagnosis, and follow-up of patients with chronic neutropenias including special entities such as pregnancy and the neonatal period. We particularly emphasize the importance of combining the clinical findings with classical and novel laboratory testing, and advanced germline and/or somatic mutational analyses, for the characterization, risk stratification, and monitoring of the entire spectrum of neutropenia patients. We believe that the wide clinical use of these practical recommendations will be particularly beneficial for patients, families, and treating physicians.

Figure 1.

Flowchart for the basic evaluation of a patient with chronic neutropenia.

Figure 2.

Flowchart for the investigation of isolated neutropenia in neonates. The flowchart is recommended in cases of isolated neutropenia without a phenotype suggestive of any specific disease/syndrome. *The neutropenia is defined as true if absolute neutrophil counts are out of range for the corresponding gestational age and there is no a prenatal growth retardation. AIN = autoimmune neutropenia; HDN = Rh-hemolytic disease of the newborn; HNA = human neutrophil antigens; IN = idiopathic neutropenia; NAN = neonatal alloimmune neutropenia; NEC = necrotizing enterocolitis; SGA = small for gestational age; TTTS = twin-twin transfusion syndrome.