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Neutrophils are a specific kind of white blood cell that help prevent and fight infections. The presence of abnormally low levels of neutrophils in the circulating blood is referred to as neutropenia.
When a doctor or nurse discusses your blood test results, you may hear them refer to the "absolute neutrophil count" (ANC) or the number of neutrophils in your blood. A "low white blood count" is another common term used to describe a low neutrophil level in the blood. Fortunately, having a low level of neutrophils can be corrected.
Recurrent infections typically occur with neutropenia, but neutropenia itself is not necessarily a disease.
Causes & Development
When discussing the consequences and management of neutropenia, it is important to distinguish between chemotherapy-induced neutropenia and neutropenia resulting from other causes.
The most common reason that cancer patients experience neutropenia is as a side-effect of chemotherapy. Chemotherapy-induced neutropenia typically occurs 3-7 days following administration of the chemotherapy drugs and continues for several days before recovering to normal levels. Infrequently, cancer patients may also experience neutropenia from other medications or as a consequence of their underlying cancer.
Signs & Symptoms
The clinical signs of neutropenia manifest as infections, most commonly of the mucous membranes. Skin is the second most common infection site, manifesting as ulcers, abscesses, rashes, and delays in wound healing. The genitalia and perirectum also are affected. Signs of infection, including warmth and swelling, may be absent.
Diagnosis & Tests
In a complete blood count (CBC) report, neutrophils may be referred to as polymorphonuclear cells (polys) or neutrophils. The absolute neutrophil count (ANC) is a measure of the total number of neutrophils present in the blood. When the ANC is less than 1,000, the risk of infection increases. The ANC can be calculated by multiplying the total WBC by the percent of polymorphonuclear cells.
Neutropenia is defined as a decrease in circulating neutrophils in the peripheral blood. The absolute neutrophil count (ANC) defines neutropenia. ANC is found by multiplying the percentage of bands and neutrophils on a differential by the total white blood cell count. An abnormal ANC is fewer than 1,500 cells per cubic mm.
African Americans have a lower normal ANC value of 1,000 cells per cubic mm but have a normal total neutrophil content.
The severity of neutropenia is categorized as mild with an ANC of 1,000-1,500 cells per cubic mm, moderate with an ANC of 500-1,000, and severe with an ANC of fewer than 500.
Treatment & Prevention
The Food and Drug Administration has now approved blood cell growth factors that increase the production of neutrophils, red blood cells, and platelets for the treatment of neutropenia, anemia, and thrombocytopenia, respectively. The blood cell growth factor that is approved by the Food and Drug Administration for the prevention of chemotherapy-induced neutropenia is Neupogen(R) (Filgrastim). Neupogen(R) has been extensively studied and used for the treatment of chemotherapy-induced neutropenia since 1991.
Complications
Neutrophils are a major component of antibacterial defense mechanisms. Neutropenia confers a substantial risk of life-threatening infection and the magnitude of risk is closely correlated with the severity and duration of neutropenia. As the neutrophil count falls, the frequency of life-threatening infection rises steeply. Patients developing fever during neutropenia require treatment with intravenous antibiotics and occasionally admission to the hospital until the neutrophil blood cells return to sufficient levels in the blood to fight the infection.
In prolonged severe neutropenia, life-threatening gastrointestinal and pulmonary infections occur, as does sepsis. However, patients with neutropenia are not at increased risk for parasitic and viral infections.
The risk of bacterial infection is related to the severity and duration of neutropenia.
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Recommendations and treatments for Neutropenia: | | | | | Drug |  Antibiotics | Patients developing fever during neutropenia require treatment with intravenous antibiotics and occasionally admission to the hospital until the neutrophil blood cells return to sufficient levels in the blood to fight the infection. |
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KEY | | May do some good |
GLOSSARY
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Furuncle, Furuncles, Cystic Acne, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Complete Blood Count (CBC)
A set of measurements that are generally determined by specially designed machines that analyze the different components of blood in less than a minute. The values generally included are:- White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter. This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 10^9 cells per liter.
- Automated white cell differential. A machine-generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.
- Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells per cubic millimeter. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 10^12 cells per liter.
- Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 gm/dl for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).
- Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.
- Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.
- Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.
- Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.
- Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.
- Platelet count. The number of platelets in a volume blood. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000 per cubic millimeter (150 - 400 x 10^9 per liter).
Gastrointestinal (GI, GI Tract)
Pertaining to the stomach, small and large intestines, colon, rectum, liver, pancreas, and gallbladder.
Lung (Lungs, Pulmonary)
Organ of the body, located in the chest cavity which is designed to bring oxygen from the air into the blood stream, while also expelling carbon dioxide and other waste gases out of the body. Pulmonary: Related to the lungs.
Millimeter (Millimeters, mm)
A metric unit of length equaling one thousandth of a meter, or one tenth of a centimeter. There are 25.4 millimeters in one inch.
Mucous Membranes (Mucosa, Mucous Membrane, Mucus Membranes)
The membranes, such as the mouth, nose, anus, and vagina, that line the cavities and canals of the body which communicate with the air.
Neutrophils (Neutrophil)
Another name for polymorphonuclear leukocytes, the most common type of blood-carried white blood cell, and the first mobile resistance cell to come to the rescue in injury.
Parasite (Parasites, Parasitic, Parasitical)
An organism living in or on another organism.
Platelets (Platelet)
Cells that help the blood to clot.
Red Blood Cell (Erythrocyte, Erythrocytes, RBC, Red Blood Cells)
Any of the hemoglobin-containing cells that carry oxygen to the tissues and are responsible for the red color of blood.
Sepsis (Blood Poisoning, Septicemia)
Like septicemia, an infection that has moved deeply into the body, involving the subcutaneous or submucosal layers, connective tissue, lymph system, or blood. Septicemia: The presence of pathogenic bacteria or other microbes in the blood stream - a serious business, since most defenses are focused outside the bloodstream and the infection has bypassed them either due to its virulence, the depth and severity of the original focal infection or the weakened state of the body's immunity and life energy. Blood poisoning.
Thrombocytopenia
Condition of abnormally small number of platelets circulating in the blood, characterized by inability to properly clot blood and easy bruising.
Ulcer (Ulceration, Ulcers)
Lesion on the skin or mucous membrane.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
Last updated: Nov 14, 2009
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