Core IM | Internal Medicine Podcast #185 Neutropenia: 5 Pearls Segment
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Aug 13, 2025 Join hematologists Jason Fried, Lauren Wirtz, and Eric Poe as they dive into the intricacies of neutropenia. They discuss when neutrophils recover and how to diagnose neutropenic fever quickly. Key insights include the importance of a thorough patient history over lab tests and strategies for managing febrile neutropenia effectively. Learn about the nuances of drug-induced neutropenia and dietary considerations for neutropenic patients. They also tackle timely antibiotic treatment and the complexities of recovery dynamics in cytotoxic therapy.
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Don't Rely On 1,500 ANC Rule
- The ANC threshold of 1,500 originated from 1980s chemo toxicity definitions and isn't universally applicable.
- Apply context and patient factors before treating every ANC <1,500 as high risk.
Duffy Null Explains Low ANC Without Immune Defect
- Duffy null genotype commonly lowers peripheral ANC but preserves immune function.
- Two-thirds of Black Americans may be Duffy null, so test selectively to avoid unnecessary workups.
When To Send Duffy Antigen Testing
- If isolated ANC 1,000–1,500 in patients of African or Middle Eastern ancestry, order Duffy antigen testing.
- If Duffy null, reassure and avoid further invasive testing.