LEUKOPENIA

The mnemonic VINDICATE is most useful in developing a list of possible causes of leukopenia.

LEUKOPENIA

1. V—Vascular disorders are not usually associated with leukopenia.
2. I—Inflammation will help recall viral infections, typhoid fever, tularemia, brucellosis and miliary tuberculosis which are associated with leukopenia. Malaria and various rickettsial infections are also associated with leukopenia.
3. N—Neoplasms and nutritional: Neoplasms that invade the bone marrow may cause leukopenia. Aleukemic leukemia is also a cause of leukopenia. Nutritional disorders include B12 and folate deficiencies.
4. D—Degenerative disorders are not usually associated with leukopenia.
5. I—Intoxication and Idiopathic will call to mind the leukopenia (agranulocytosis) of benzene, chemotherapy, sulfonamides, anticonvulsants, antibiotics, and many other drugs. It should also prompt the recall of aplastic anemia, myelofibrosis, and benign familial neutropenia.
6. C—Congenital should bring to mind the reticuloendothelioses such as Gaucher disease.
7. A—Autoimmune: Collagen vascular disorders such as lupus erythematosus and autoimmune neutropenia should be remembered by this classification.
8. T—Trauma mechanism is not usually a cause of leukopenia with the exception of radiation.
9. E—Endocrine disorders are not usually associated with a leukopenia. Addison disease is a noteable exception. Unfortunately, this method of recalling the possibilities would leave out the leukopenia that occurs with splenomegaly of many causes.

Approach to the Diagnosis

The history may disclose the use of various drugs and exposure to radiation and other toxins. If there are associated anemia and thrombocytopenia, the possibility of aplastic anemia should be considered. An enlarged spleen suggests hypersplenism is the cause. The initial laboratory workup includes a CBC, urinalysis, sedimentation rate, differential count, chemistry panel, febrile agglutinins, ANA, platelet count, serum B12 and folic acid levels, and serum protein electrophoresis. A bone marrow examination and hematology consult is next in line.

Other Useful Tests

1. Donath–Landsteiner test (paroxysmal cold hemoglobinuria)
2. Liver–spleen scan (splenomegaly)
3. CT scan of the abdomen (splenomegaly, liver disease, neoplasm)
4. Bone scan (metastatic neoplasm)
5. Skeletal survey (metastatic neoplasm)
6. Lymph node biopsy (Hodgkin disease, metastasis)

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Leukopenia

Read excerpts from these other book chapters:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8