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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-
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               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
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                                                                        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
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                                                                         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.
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                                                                         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,
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               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,
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          Kaushansky_chapter 64_p0983-0990.indd   986                                                                   9/17/15   3:28 PM
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