Neutropenia definition and facts

Symptoms of Neutropenia
Symptoms of neutropenia are fever, skin abscesses, mouth sores, swollen gum, and skin infections.

  • Neutropenia is defined as an absolute neutrophil count (ANC) of less than 1500 per microliter (1500/microL); severe neutropenia is defined as an ANC of less than 500/microL.
  • Neutropenia may be caused by or associated with numerous medical conditions including congenital disorders of the bone marrow, cancer chemotherapy, infections, certain medications (drug-induced neutropenia), and autoimmune disorders.
  • Most infections that occur as complications of neutropenia are due to bacteria that are normally present on the skin or in the gastrointestinal or urinary tract.
  • Treatment depends upon the cause and severity of the condition as well as the underlying disease state responsible for neutropenia.

What is neutropenia?

Neutropenia is a condition in which the number of neutrophils in the bloodstream is decreased. Neutrophils are a type of white blood cell also known as polymorphonuclear leukocytes or PMNs. Neutropenia reduces the body's ability to fight off bacterial infections.

White blood cells are also known as leukocytes. There are five major types of circulating white blood cells:

  1. basophils,
  2. eosinophils,
  3. lymphocytes (T-cells and B-cells,
  4. monocytes, and
  5. neutrophils.

Some white blood cells, called granulocytes, are filled with microscopic granules that are little sacs containing enzymes (compounds that digest microorganisms). Neutrophils, eosinophils, and basophils are all granulocytes and are part of the innate immune system with somewhat nonspecific, broad-based activity. They do not respond exclusively to specific antigens, as do the lymphocytes (B-cells and T-cells).

Neutrophils contain enzymes that help the cell kill and digest microorganisms it has engulfed by a process known as phagocytosis. The mature neutrophil has a segmented nucleus (it is often called a 'seg' or 'poly'), while the immature neutrophil has a band-shape nucleus (it is called a band). Neutrophils are made in the bone marrow and released into the bloodstream. The neutrophil has a life-span of about three days.

What are the signs and symptoms of neutropenia?

Signs and symptoms suggestive of neutropenia include:

  • low-grade fever,
  • skin abscesses,
  • mouth sores,
  • swollen gums, and
  • symptoms suggestive of infections of the skin, perirectal area, mouth, or other areas of the body.

Pneumonia is an infection of the lungs that can occur in people with neutropenia.

What causes neutropenia?

Neutropenia can be present (though it is relatively uncommon) in normal healthy individuals, notably in some persons of African or Arabic descent and Yemenite Jews. Neutropenia may arise as a result of decreased production of neutrophils, destruction of neutrophils after they are produced, or pooling of neutrophils (accumulation of the neutrophils out of the circulation).

Neutropenia may arise as a result of numerous medical conditions:

  • Infections (more commonly viral infections, but also bacterial or parasitic infections). Examples include: HIV, tuberculosis, malaria, Epstein-Barr virus (EBV);
  • Medications that may damage the bone marrow or neutrophils, including cancer chemotherapy;
  • Vitamin deficiencies (megaloblastic anemia due to vitamin B12 or folate deficiency);
  • Diseases of the bone marrow such as leukemias, myelodysplastic syndrome, aplastic anemia, myelofibrosis;
  • Radiation therapy;
  • Congenital (inborn) disorders of bone marrow function or of neutrophil production, for example, Kostmann syndrome;
  • Autoimmune destruction of neutrophils (either as a primary condition or associated with another disease such as Felty's syndrome) or from drugs stimulating the immune system to attack the cells
  • Hypersplenism, which refers to the increased sequestration or destruction of blood cells by the spleen


Cancer: Guide to Leukemia See Slideshow

What are normal neutropenia levels and ranges?




  • severe if the ANC is below 500/microL.



Does neutropenia put a person at risk for bacterial infections?



How is neutropenia diagnosed?

Neutropenia is diagnosed by a blood cell count performed on a sample of blood removed from a vein. To determine the specific cause of neutropenia in a given situation, other tests may be required. Sometimes a bone marrow biopsy may be required to diagnose the specific cause of neutropenia.

What is the treatment for neutropenia?

Treatment of neutropenia is based upon the underlying cause, severity, and the presence of associated infections or symptoms as well as the overall health status of the patient. Obviously, treatment must also be directed toward any underlying disease process. Treatments that directly address neutropenia may include (note that all of these treatments may not be appropriate in a given setting):

  • antibiotic and/or antifungal medications to help fight infections;
  • administration of white blood cells growth factors (such as recombinant granulocyte colony-stimulating factor (G-CSF, filgrastim (Neupogen); sargramostim (Leukine);
  • a granulocyte-macrophage colony-stimulating factor (GM-CSF), or pegfilgrastim (Neulasta), a long-acting form of filgrastim) in some cases of severe neutropenia;
  • granulocyte transfusions; and
  • corcorticosteroid therapy or intravenous immune globulin for some cases of immune-mediated neutropenia.

Preventive measures may also be implemented in neutropenic patients to limit risk of infections. These measures might include strict attention to hand washing, use of private rooms, or in some cases, use of gloves, gowns, and/or face masks by caregivers.

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Medically Reviewed on 9/1/2020
REFERENCE: Braden, CD., MD. "Neutropenia." Medscape. Updated: Aug 02, 2017.