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986 Part VII: Neutrophils, Eosinophils, Basophils, and Mast Cells CHAPTER 64: Classification and Clinical Manifestations of Neutrophil Disorders 987
of differentiation (CD) 13 and CD15 phenotype with absent expression of the effect of cigarette usage. The oxidants, especially hypochlorous
of human leukocyte antigen-D related (HLA-DR) and CD34. acid and chloramines, released by the neutrophil are extremely short
lived and may play a role in tissue injury by inactivating several protease
QUALITATIVE NEUTROPHIL inhibitors in tissue fluids, permitting proteases, especially elastase, col-
lagenase, and gelatinase, to cause tissue injury. Thrombogenesis also has
ABNORMALITIES been ascribed to leukocyte products.
Neutrophil function depends on the ability of neutrophils to exit the REFERENCES
marrow, adhere to vascular endothelium, move, respond to chemotactic
gradients, ingest microorganisms, and kill ingested pathogens. Loss of 1. Pearson HA, Lobel JS, Kocoshis SA, et al: A new syndrome of refractory sideroblastic
any of these functions can predispose to infection (Chap. 66). Defects in anemia with vacuolization of marrow precursors and exocrine pancreatic dysfunction.
J Pediatr 95:976, 1979.
each step of the neutrophil’s participation in the inflammatory response 2. Jacobs LJ, Jongbloed RJ, Wijburg FA, et al: Pearson syndrome and the role of deletion
have been identified. Defects in adhesion molecules, cytoplasmic con- dimers and duplications in the mtDNA. J Inherit Metab Dis 27:47, 2004.
tractile proteins, granule synthesis or contents, or intracellular enzymes 3. Bagby GC Jr: Genetic basis of Fanconi anemia. Curr Opin Hematol 10:68, 2003.
may underlie a movement, ingestion, or killing defect. These defects 4. Taniguchi T, D’Andrea AD: Molecular pathogenesis of Fanconi anemia: Recent prog-
ress. Blood 107:4223, 2006.
may be inherited or acquired. Chronic granulomatous disease 113,114 and 5. Srinavin C, Trowbridge A: Dyskeratosis congenita: Clinical features and genetic
Chédiak-Higashi disease 145,146 are two examples of inherited defects. aspects. J Med Genet 12:339, 1975.
Among the acquired disorders are those extrinsic to the cell, as in the 6. Walne AJ, Dokal I: Dyskeratosis congenita: A historical perspective. Mech Ageing Dev
129:48, 2008.
movement, chemotactic, or phagocytic defects of diabetes mellitus, the 7. Tidwell T, Wechsler J, Nayak RC, et al. Neutropenia-associated ELANE mutations
effects of alcohol abuse, or glucocorticoid excess. Acquired intrinsic disrupting translation initiation produce novel neutrophil elastase isoforms. Blood
disorders usually are manifestations of clonal hematopoietic (myeloid) 123:562, 2014.
disorders such as acute myelogenous leukemia (Chap. 85). 8. Klein C, Grudzien M, Appaswamy G, et al. HAX1 deficiency causes autosomal recessive
severe congenital neutropenia (Kostmann disease). Nat Genet 39:86, 2007.
Severe defects in bacterial killing, as occur in chronic granulo- 9. Person RE, Li FQ, Duan Z, et al. Mutations in proto-oncogene GFI1 cause human neu-
matous disease, result in S. aureus, Klebsiella-Aerobacter, E. coli, and tropenia and target ELA2. Nat Genet 34:308, 2003.
other catalase-positive bacterial infections. Suppurative lymphadenitis, 10. Boztug K, Appaswamy G, Ashikov A, et al. A syndrome with congenital neutropenia
and mutations in G6PC3. N Engl J Med 360:32, 2009.
pneumonia, dermatitis, hepatic abscesses, osteomyelitis, and stomati- 11. Boztug K, Klein C. Genetics and pathophysiology of severe congenital neutropenia syn-
tis occur, and chronic granulomatous reactions in these sites give the dromes unrelated to neutrophil elastase. Hematol Oncol Clin North Am 27:43, 2013.
disease its name. Fatality rates have been high. Functional disorders 12. Donadieu J, Fenneteau O, Beaupain B, et al. Congenital neutropenia: Diagnosis, molec-
ular bases and patient management. Orphanet J Rare Dis 6:26, 2011
may be severe, as in chronic granulomatous disease. Mild functional 13. Bouma G, Ancliff PJ, Thrasher AJ, Burns SO. Recent advances in the understanding of
disorders predispose to infections that occur infrequently and respond genetic defects of neutrophil number and function. Br J Haematol 151:312, 2010.
readily to antibiotics. Severe functional disorders result in suppurative 14. Ward AC, Dale DC: Genetic and molecular diagnosis of severe congenital neutropenia.
Curr Opin Hematol 16:9, 2009.
lesions because neutrophil influx into inflammatory foci is not impaired, 15. Ishikawa N, Okada S, Miki M, et al: Neurodevelopmental abnormalities associated with
whereas agranulocytosis is associated with nonsuppurative lesions. severe congenital neutropenia due to the R86X mutation in the HAX1 gene. J Med
Genet 45:802, 2008.
16. Levinsky RJ, Tiedman K: Successful bone-marrow transplantation for reticular dysgen-
NEUTROPHIL-INDUCED VASCULAR OR TISSUE 17. Calhoun DA, Christensen RD: Recent advances in the pathogenesis and treatment of
esis. Lancet 1:671, 1983.
DAMAGE nonimmune neutropenias in the neonate. Curr Opin Hematol 5:37, 1998.
18. Shimamura A: Shwachman-Diamond syndrome. Semin Hematol 43:178, 2006.
An overabundance of neutrophils does not result in specific clinical 19. Lonsdale D, Doedhar SD, Mercer RD: Familial granulocytopenia associated with
manifestations. Neutrophils, however, can transiently occlude capillar- immunoglobulin abnormality. J Pediatr 71:760, 1967.
ies, as determined by supravital microscopy, and such occlusions may 20. Kozlowski C, Evans DIK: Neutropenia associated with X-linked agammaglobulinemia.
J Clin Pathol 44:388, 1991.
reduce local blood flow transiently and contribute to the development of 21. Lougaris V, Badolato R, Ferrari S, Plebani A: Hyper immunoglobulin M syndrome due
ischemia. Impairment of reperfusion of the coronary microcirculation to CD40 deficiency: Clinical, molecular, and immunological features. Immunol Rev
has been thought to be dependent, in part, on neutrophil plugging of 203:48, 2005.
myocardial capillaries, but these effects can occur at normal neutrophil 22. Lux SE, Johnston RB Jr, August CS, et al: Chronic neutropenia and abnormal cellular
immunity in cartilage-hair hypoplasia. N Engl J Med 282:231, 1970.
concentrations. An elevated neutrophil count is a feature of sickle cell 23. Trojak JE, Polmar SH, Winkelstein JA: Immunologic studies of cartilage-hair hypopla-
disease and is a prognostic variable, increasing the likelihood of vasooc- sia in the Amish. Johns Hopkins Med J 148:157, 1981.
clusive events. Neutrophil adhesion to the vascular wall is an intrinsic 24. Olivieri O, Lombardi S, Russo C, Corrocher R: Increased neutrophil adhesive capability
part of the vasoocclusive events and the salutary effect of hydroxyurea is in Cohen syndrome, an autosomal recessive disorder associated with granulocytopenia.
Haematologica 83:778, 1998.
related to the decrease in neutrophil concentration that accompanies its 25. Kolehmainen J, Black GC, Saarinen A, et al: Cohen syndrome is caused by mutations
use. 157,173 In patients with ischemic vascular disease, an increased neu- in a novel gene, COH1, encoding a transmembrane protein with a presumed role in
trophil count is associated with an increased probability of acute throm- vesicle-mediated sorting and intracellular protein transport. Am J Hum Genet 72:1359,
2003.
botic episodes and the severity of chronic atherosclerosis. 183 26. Barth PG, Scholte HR, Berden JA, et al: An X-linked mitochondrial disease affecting
Neutrophil products may contribute to the pathogenesis of inflam- cardiac muscle, skeletal muscle and neutrophil leukocytes. J Neurol Sci 62:327, 1983.
matory skin, bowel, synovial, glomerular, and bronchial and interstitial 27. Yen TY, Hwu WL, Chien YH, et al: Acute metabolic decompensation and sudden death
in Barth syndrome: Report of a family and a literature review. Eur J Pediatr 167:941,
pulmonary diseases (see Table 6 4–1). Diabetic retinopathy has been 2008.
ascribed in part to the effects of hyperadhesive neutrophils on retinal 28. Bassan R, Viero P, Minetti B, et al: Myelokathexis: A rare form of chronic benign neu-
157
capillaries. Neutrophils may act as mediators of tissue injury in stroke tropenia. Br J Haematol 58:115, 1984.
157
and myocardial infarction. Highly reactive oxygen products of neu- 29. Wetzler M, Talpaz M, Kellagher MJ, et al: Myelokathexis. JAMA 267:2179, 1992.
30. Beaussant Cohen S, Fenneteau O, Plouvier E, et al: Description and outcome of a cohort
trophils may be mutagens that increase the risk of neoplasia. This action of 8 patients with WHIM syndrome from the French Severe Chronic Neutropenia
may explain, for example, the development of carcinoma of the bowel in Registry. Orphanet J Rare Dis 7:71, 2012.
patients with chronic ulcerative colitis and the relationship between ele- 31. Balabanian K, Levoye A, Klemm L, et al: Leukocyte analysis from WHIM syndrome
patients reveals a pivotal role for GRK3 in CXCR4 signaling. J Clin Invest 118:1074,
vated leukocyte count and the occurrence of lung cancer, independent 2008.
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