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Differential Diagnosis: Neutropenia

Julie Allen, BVMS, MS, MRCVS, DACVIM (SAIM), DACVP, Cornell University

Internal Medicine

|May 2019|Peer Reviewed

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Differential Diagnosis: Neutropenia

Following are differential diagnoses, listed in order of likelihood, for patients presented with neutropenia.

  • Increased migration into tissue due to severe inflammation (eg, pneumonia, peritonitis) or acute endotoxemia due to increased margination; can occur within an hour of endotoxin release by gram-negative bacteria
  • Decreased bone marrow production (often in association with other cytopenias) resulting from:
    • Chemotherapeutics
    • Estrogen toxicity (endogenous [eg, Sertoli cell tumor] vs exogenous)
    • Other drugs (eg, potentiated sulfonamides)
    • Myelophthisis
      • Myelofibrosis
      • Neoplasia (eg, lymphoblastic leukemia, multiple myeloma)
    • Bone marrow necrosis (eg, from sepsis, heatstroke, or drugs [eg, phenobarbital, carprofen, metronidazole, cyclophosphamide, colchicine, fenbendazole])
    • Canine parvovirus and feline panleukopenia virus
    • FeLV and FIV
    • Tick-borne disease (eg, Ehrlichia canis, E ewingii, Anaplasma phagocytophilum, babesiosis)
    • Gray collie syndrome (ie, cyclic hematopoiesis)
    • Trapped neutrophil syndrome of border collies
  • Increased neutrophil destruction resulting from:
    • Immune-mediated neutropenia (primary or secondary [eg, to drugs or infection])
    • Hemophagocytic syndrome, often with other cytopenias
    • Histiocytic sarcoma, often with other cytopenias
    • Drugs
    • Toxins
    • Viruses
  • Vitamin B12 deficiency, particularly in border collies, Australian shepherd dogs, giant schnauzers, and beagles
  • Breed-associated cause of unknown mechanism, particularly in Belgian Tervurens and Australian shepherd dogs
  • Idiopathic neutropenia (cats)


For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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