Neutrophils are white blood cells (WBC).
A high neutrophil count may be due to many physiological conditions and diseases.

Neutrophils are white blood cells (WBC), which are cells that fight infections in the body. A high neutrophil count may be due to many physiological conditions and diseases.

In most cases, a high neutrophil count is commonly associated with an active bacterial infection in the body. In rare cases, the high neutrophil count may also result from blood cancer or leukemia.

What are the 2 types of neutrophilia?

Neutrophilia is a condition of a high neutrophil count, which is categorized into two types:

  • True neutrophilia: True neutrophilia is usually related to bacterial infections. Abscess, boils, pneumonia, cough, and fever can cause neutrophilia by stimulating the bone marrow.
  • Shift neutrophilia: The increase in neutrophil count may be due to the shift of cells from capillaries and organs to the blood. This may be seen even when there is no disease. Shift neutrophilia is usually transient and may occur during vigorous exercise, in case of an anxiety attack, during pregnancy, after a seizure, and after meals.

What are the signs and symptoms of neutrophilia?

The symptoms of neutrophilia vary depending on the underlying cause.

Patients with bacterial infections, for instance, may experience symptoms such as:

For cancer patients the symptoms may include:

Other signs and symptoms of neutrophilia include:

Because neutrophilia can be a symptom of underlying medical issues, doctors will usually perform a physical exam to search for signs of infection, inflammation, or blood disorders. A complete blood count (CBC) is one of the tests that may be performed. This test, among other things, determines your overall white blood cell count and the proportion of those white blood cells that are neutrophils.

What are the common causes of high neutrophil count?

The following are the common causes of neutrophilia (high neutrophil count):

  • True neutrophilia is usually related to bacterial infections including abscesses, boils, pneumonia, cough, and fever.
  • Shift neutrophilia is usually transient and may occur during vigorous exercise, in case of an anxiety attack, during pregnancy, after a seizure, and after meals.
  • Conditions such as heart attack, a bone fracture, septic arthritis, wounds, burns, accidents, and appendicitis can also cause high neutrophil count.
  • An increased concentration of cortisol and adrenaline hormones and the ingestion of some drugs, such as prednisone, can cause more neutrophils to enter the bloodstream.
  • Neutrophilia may be observed because of malignancy, such as leukemia.
  • Surgical procedures, including splenectomy and appendicitis, are also known to increase neutrophil count.

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What are neutrophils?

Neutrophils comprise most of the white blood cells, which make up about 56% of the total cell count.

Neutrophils are the soldiers that fight infections. They recognize the foreign proteins over an infectious particle (tissue irritation) and move in to fight the infection. They may either eat the infectious particle or release chemicals that kill the particle.

On the lab sheet, polymorphonuclears or PMNs are mature neutrophils, and band forms are young white blood cells. Band forms are commonly seen in the blood of a child.

  • Neutrophils, like all other blood cells, are formed from the stem cells in the bone marrow.
  • They circulate in the bloodstream for 7 to 10 hours.
  • They migrate into the tissues, where they have a lifespan of only a few days after which the spleen destroys them.

Neutrophils have a short lifespan. New neutrophils are then produced continuously in the bone marrow. The number of neutrophils in the blood might differ with each individual because it is affected by various factors, such as age and environment.

However, the following is considered to be the normal range of neutrophil count:

Table. The normal range of neutrophil count
Normal range of neutrophil count Cell count Percentage of white blood cells (WBC)
Absolute neutrophil count (ANC) 1500-800 cells/mm3 40-45%
Mature/segmented neutrophils 2500-6000 cells/mm3 40-60%
Immature neutrophils 0-5000 cells/mm3 0-5%

What is neutropenia and what are the levels?

When the level of neutrophil is less than 1500 cells/mm3 of the blood volume, it is considered a low neutrophil level or neutropenia.

The three neutropenia levels can be seen below:

Table. Three neutropenia levels
Neutropenia (low neutrophil level) levels Cell count
Mild 1000-1500 cells/mm3
Moderate 500-100 cells/mm3
Severe <500 cells/mm3

What are the causes of neutropenia?

Neutropenia is a condition in which the number of neutrophils in the bloodstream is decreased, affecting the body’s ability to fight off infection and is often observed in viral infections. However, it can also be a sign of some other factors or illness.

The causes of neutropenia may include:

  • The most important cause of low neutrophil count is the intake of medicines, especially those taken during chemotherapy.
  • A suppressed immune system due to some underlying diseases, such as acquired immunodeficiency syndrome (AIDS), tuberculosis, and hepatitis, also causes low levels of neutrophils.
  • Similarly, other conditions, such as cancer and related bone marrow diseases, also result in low neutrophils count.
  • Another cause of neutropenia is the deficiency of vitamin B12 and other minerals.
  • Autoimmune diseases, such as Crohn’s disease, lupus, and rheumatoid arthritis, cause a decrease in the count of neutrophils as well.
  • Congenital disorders of bone marrow function such as Kostmann syndrome.
  • Hypersplenism (overactive spleen)

Neutrophilia and neutropenia need a meticulous clinical examination followed by relevant investigations so that appropriate treatment can be instituted. Though it may not be an emergency condition, proper physician advice is always recommended.

What are the signs and symptoms of neutropenia?

Neutropenia itself does not have any specific symptoms. It is usually detected when there is an infection.

Infections with neutropenia may have the following symptoms: 

Patients may only know about the condition after the results of a blood test, which is usually performed before each chemotherapy treatment, or if doctors suspect infection. Most patients with neutropenia will have recurring infections (ulcers, abscesses, and rashes), fever, and other signs and symptoms related to the underlying illness.

In terms of neutropenia treatment, most mild instances recover spontaneously, whereas severe cases require a doctor's proper diagnosis for individualized treatment based on the underlying reason.

An infection in a person with neutropenia is a medical emergency that can be fatal. Even a simple infection can suddenly turn dangerous if you have neutropenia. Seek immediate medical attention if your temperature exceeds 100.4 degrees Fahrenheit or you have any of the above symptoms.

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Medically Reviewed on 3/3/2022
References
Nader ND. Neutrophilia. Medscape. https://emedicine.medscape.com/article/208576- overview

Low blood cell counts: Side effect of cancer treatment. https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-treatment/art-20046192

Low white blood cell count. https://www.mayoclinic.org/symptoms/low-white-blood-cell-count/basics/causes/sym-20050615#