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For Physicians and Dentists

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Consult a Neutropenia Specialist

Neutropenia Specialists are Available for Consultation

Contact SCNIR-dl@childrens.harvard.edu to talk to our providers

Dosing Guidelines

Dosing Guidelines

Congenital Neutropenia

  • Starting dose ~5 mcg/kg/day subcutaneously daily. IV is also acceptable but may be less effective.

  • Assess response after 7-10 days to allow time for maturation from promyelocyte arrest. Blood counts should be obtained at least 18 hours after last dose.

  • Titrate dose to maintain ANC >1000 cells/μL. Higher doses may be necessary if clinical symptoms (e.g. severe stomatitis) persist.

  • If the response warrants, administration may be switched to alternate day or Mon-Wed-Fri, but less frequent administration may lead to more bone pain and less efficacy. Check ANC in two weeks at nadir before a dose.

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Cyclic Neutropenia

  • Starting dose ~2 mcg/kg/day subcutaneously daily. Alternate day or Mon-Wed-Fri administration is usually effective, but daily may be necessary

  • Monitoring ANC response is difficult, requiring CBCs three times per week for 3 weeks. Doses may also be adjusted based on elimination of symptoms (e.g. mouth sores, fevers, malaise)

  • We do NOT recommend trying to time the nadirs with intermittent administration, as the cycling period is diminished and may be irregular with G-CSF treatment.

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Idiopathic/Autoimmune Neutropenia

  • Starting dose 1-2 mcg/kg/day subcutaneously daily.

  • Assess response after 7-10 days. Blood counts should be obtained at least 18 hours after last dose.

  • Titrate dose to maintain ANC >1000 cells/μL. Higher doses may be necessary if clinical symptoms (e.g. severe stomatitis) persist.

  • If the response warrants, administration may be switched to alternate day or Mon-Wed-Fri, but less frequent administration may lead to more bone pain and less efficacy. Check ANC at nadir after 2-3 doses. If dosing Mon-Wed-Fri, then check the nadir before the Monday dose (3-day nadir).

  • If infections are infrequent, administration can be restricted to times of infection, as response is usually very rapid (within hours or days).

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For Dentists

For Dentists

Individuals with a diagnosis of neutropenia but absolute neutrophil counts (ANCs) >1000 (e.g. on therapy with G-CSF) do not require any treatment precautions beyond those for normal patients.

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For those with neutropenia

  • More frequent cleaning may be required

  • When possible, perform invasive procedures when ANC>1000. Confirm blood counts with patient's hematologist or PCP and consider initiation or dose adjustment of G-CSF therapy.

  • No prophylactic antibiotics are needed

  • Epi/lidocaine may be used

  • Consider the possibility of low bone density if planning implants

  • Use lowest impact orthodontic appliances to avoid trauma to buccal mucosa

For Physicians

Approach to the diagnosis of neutropenia:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10065839/

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Approach to genetic testing for neutropenia (includes whom to test and which test(s) to send:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380907/

For Physicians
Doctors Writing Notes

Letter of Medical Necessity for Genetic Tests

The SCNIR has prepared a template letter of medical necessity to assist patients and providers in requesting essential diagnostic genetic testing for their neutropenia condition. This template is designed for patients to share with their healthcare provider. Additionally, providers can use the templated language as a guide when ordering genetic tests for their patients.

Click the attachment icon below to download a copy of the template.

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Letter of Medical Necessity
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