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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

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.

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.

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).

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.

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/

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
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