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.
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.
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:
In some people, neutropenia can be caused by certain medications, such as:
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.
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:
For those with neutropenia, preventive measures should be taken to prevent infections:
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.
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.
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.
Neutropenia and neutrophil dysfunction has been shown to play a role in poor wound healing.
Recurrent infections typically occur with neutropenia.
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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