Patient cost and physician medical liability in a population with high prevalence of benign neutropenia

Introduction
Benign neutropenia (BN), i.e., neutropenia not associated with an increased risk of infection, is common in many Arab countries. Confusing BN with secondary neutropenia, i.e., disease and drug related neutropenia, and vice-versa, has far reaching consequences. We aimed to identify the risks associated with misdiagnosis of benign and secondary neutropenia.

Methods
The experience is limited to a solo hematology clinic in the United Arab Emirates (BN prevalence 11%). A total of 31 cases of neutropenia were analyzed. In addition, attitudes and opinions of five hematologists were solicited.

Results
A physician’s approach to neutropenia followed two broad categories: 1. Neutropenia not investigated due to the belief that it is “very common” and “benign.” 2. Neutropenia referred to hematologist for investigation/opinion due to the belief that it is pathologic. In healthy subjects, the specialist encountered mostly subjects with a more pronounced neutropenia; mild cases were less often referred for consultation. In sick subjects (i.e., with intercurrent disease), the specialist encountered multiple problems: delayed surgery and discharge; increased follow-up and admission to hospital; reduced drug dose and delayed treatment; and an increased number of tests (including bone marrow biopsy).

Discussion
In a population with a high prevalence of BN, population screening for BN should be considered. No guideline on approaching neutropenia may result in i) inferior quality of service provided to those with BN; ii) increased medical liability of physician; iii) increased costs for the patient and for health-care. Physicians should be better educated about BN and proper diagnostic guidelines need to be developed.