Some patients with neutropenia will show circulating large granular lymphocytes. These patients need to be evaluated in order to identify the underlying cause.

Large granular cells may be:

(1) cytotoxic T-cells (CD8+CD57+)

(2) cytotoxic NK cells (CD3-CD56+)


Patient evaluation may include:

(1) identification of large granular cell leukemia (monoclonal) vs benign LGL proliferations (usually polyclonal but can be monoclonal)

(2) presence of cyclic neutropenia

(3) responsiveness to corticosteroids

(4) presence of concurrent anemia

(5) presence of common variable immunodeficiency

(6) presence of autoimmune disorder (uveitis, ankylosing spondylitis, etc)

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