Neutropenia

Neutropenia: Overview

Alternative Names: Neutrophiles, band cells, neutrophilic leukocytes, neutrophilic granulocytes.

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, which is not a disease as such.

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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.

Causes and Development

There are many possible causes for an abnormally low neutrophil count.  When discussing the consequences and management of neutropenia, it is important to distinguish between chemotherapy-induced neutropenia and neutropenia resulting from other causes.

In addition to those listed below, other causes include:

Infections that can cause neutropenia include:

Increased destruction of neutrophils can be due to the body's immune system targeting neutrophils for destruction.  This may be related to having an autoimmune condition, such as:

In some people, neutropenia can be caused by certain medications, such as:

  • Medications that cause damage to the bone marrow
  • Certain medications such as the phenothiazines drugs, which are used to treat psychosis, allergies, and vomiting
  • Antibiotics
  • Blood pressure drugs
  • Psychiatric drugs
  • Epilepsy drugs

Diagnosis and 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.  The normal range for the neutrophil count is 1,500 to 8,000 cells per cubic mm; 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.

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.

African Americans have a lower normal ANC value of 1,000 cells per cubic mm but have a normal total neutrophil content.

Treatment and 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® (Filgrastim).  Neupogen® has been extensively studied and used for the treatment of chemotherapy-induced neutropenia since 1991.

Other approaches for treating neutropenia include:

  • Antibiotics for underlying bacterial infections
  • Drugs to suppress the immune system
  • Granulocyte Colony-Stimulating Factor (G-CSF), which stimulates bone marrow production of white blood cells.  Used for several types of neutropenia, this treatment can be life-saving.
  • Changing medications, if possible, in cases of drug-induced neutropenia
  • Stem cell transplants for treating some types of severe neutropenia, for example those caused by bone marrow problems.

For those with neutropenia, preventive measures should be taken to prevent infections:

  • Improved hygiene: hand washing, good dental care
  • Avoiding contact with sick people
  • Proper wound hygiene: Cleaning all cuts and scrapes, and bandaging them
  • Using an electric shaver, which is less likely to cause cuts than a razor
  • Avoiding fecal matter (for example animal waste, changing diapers)
  • Avoiding uncooked foods such as unpasteurized dairy products, undercooked meat, and raw fruits, vegetables, grains, nuts
  • Staying out of shared/hot tubs, ponds, and rivers

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.

Signs, symptoms & indicators of Neutropenia:

Lab Values - Cells

Symptoms - Immune System

Regular/frequent infections

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, and rashes.  The genitalia and perirectum also are affected.  Signs of infection, including warmth and swelling, may be absent.

Conditions that suggest Neutropenia:

Circulation

Poor/Slow Wound Healing

Neutropenia and neutrophil dysfunction has been shown to play a role in poor wound healing.

Infections

Chronic / Hidden Infection

Recurrent infections typically occur with neutropenia.

Risk factors for Neutropenia:

Autoimmune

Autoimmune Tendency

Autoimmune disease can cause chronic neutropenia.

Circulation

Aplastic Anemia

Aplastic anemia reduces the bone marrow's ability to produce white blood cells.

Drug Side-Effect

Chemotherapy Side-Effects

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.

Environment / Toxicity

Radiation Poisoning

Radiation therapy or exposure can damage the bone marrow.

Immunity

Infections

Sepsis

Neutropenia can be caused by widespread, severe bacterial infection that causes pus formation or bacteria in the blood, which in turn leads to increased destruction of neutrophils.

Nutrients

Organ Health

Tumors, Malignant

Leukemia

Leukemia causes decreased production of neutrophils because they are crowded out of the bone marrow by the early forms of white blood cells.

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Neutropenia suggests the following may be present:

Circulation

Environment / Toxicity

Radiation Poisoning

Radiation therapy or exposure can damage the bone marrow.

Immunity

Tumors, Malignant

Neutropenia can lead to:

Circulation

Poor/Slow Wound Healing

Neutropenia and neutrophil dysfunction has been shown to play a role in poor wound healing.

Infections

Chronic / Hidden Infection

Recurrent infections typically occur with neutropenia.

Recommendations 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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