The evaluation and management of leukopenia

Leukopenia, defined as a white blood cell count of <4,000 cells per microliter, is a common diagnostic and therapeutic dilemma faced by the primary care physician. The history and physical examination usually point to the underlying etiology. Selective laboratory tests and, when indicated, a bone marrow biopsy may aid in the diagnostic process. Although leukopenia is frequently caused by benign and self-limited conditions, some circumstances necessitate aggressive management. One such entity is neutropenia with sepsis, where empiric broad-spectrum antibiotic therapy must be initiated, whereas a simultaneous investigation for the infectious agent is carried out. The acuity, severity, age of the patient, and presence of infection are important factors in the individualized approach to the leukopenic patient. The obstetrician/gynecologist, by following patients over time and being familiar with the effects of chemotherapeutic agents, is well positioned to evaluate and treat leukopenia.