These can provide clues for diagnosis and allow the results of the complete blood count to be interpreted in context. Although the total white count may provide a useful summary, the absolute count of each of the cell types is more useful than the total. The total white count may be misleading; e. As a result the total white count should not be considered in isolation.
The normal concentration range of neutrophils is 2. The average half-life of a non-activated neutrophil in the circulation is about hours.
Upon migration, outside the circulation, neutrophils will survive for days. Neutropenia is potentially associated with life threatening infection. It is most significant when the total neutrophil count is less than 0. When the neutropenia is due to increased peripheral destruction or margination e. These patients rarely have problems with significant bacterial infection despite quite low neutrophil counts. In routine clinical practice the most frequent cause of a low neutrophil count is overt or occult viral infection, including viral hepatitis.
Acute changes are often noted within one to two days of infection and may persist for several weeks. The neutrophil count seldom decreases enough to pose a risk of infection. A low neutrophil count is often discovered in some people as an incidental finding in the CBC result.
The patient is generally asymptomatic and the clinical examination is unremarkable. The count is usually stable on follow-up. This is likely to be idiopathic although in some cases a neutropenia may be associated with splenomegaly or an autoimmune disease such as lupus. The presentation of a haematological malignancy with only an isolated neutropenia is a rare finding. Although relatively rare, drug therapy may cause an acquired neutropenia in some people.
The drugs most likely to be associated with moderate neutropenia are chemotherapy and immunosuppressive drugs, antithyroid medications, antibiotics, antirheumatics, antipsychotics and anticonvulsants.
For a more comprehensive list see Neutropenia, drug induced. Many drugs may cause a chronic mild neutropenia e. The history and clinical features are important for providing the clues for diagnosis and allowing the results to be interpreted in context.
The risk of significant bacterial infection rises as the neutrophil count drops below 1. Patients who are febrile but otherwise well should at least be discussed with a Haematologist. If the patient is well and afebrile, they need to be advised to seek medical attention promptly if their condition deteriorates or they become febrile. Well patients should have follow up blood counts within 48 hours, and if the neutropenia persists at this level or progresses they should be discussed with a Haematologist.
If an isolated abnormality follow up blood counts are indicated, with frequency dependent on the severity of the neutropenia but usually within weeks. If the neutropenia persists for more than 6 weeks further investigation is indicated.
If it is progressive or other abnormalities develop a haematology referral, or discussion with a Haematologist, is indicated. There are specific protocols for management of clozapine induced neutropenia. Otherwise, if a drug cause is suspected and the neutropenia is moderate or severe, Haematology referral, or discussion with a Haematologist is indicated. Neutrophils are the primary white blood cells that respond to a bacterial infection. The most common cause of marked neutrophilia is a bacterial infection.
Neutrophils react within an hour of tissue injury and are the hallmark of acute inflammation. Neutrophils generally exhibit characteristic changes in response to infection. The neutrophils tend to be more immature, as they are being released earlier. This is called a left shift Figure 2. Neutrophils will frequently be increased in any acute inflammation, therefore will often be raised after a heart attack, or other infarct and necrosis.
Any stressor, from heavy exercise to cigarette smoking, can elevate the neutrophil count. A number of drugs have been demonstrated to increase the neutrophil count, including steroids, lithium, clozapine and adrenalin. Even nervousness may very slightly raise the neutrophil count because of the effect of steroid release.
Pregnancy is associated with a slight increase in total neutrophil count demonstrating a left shift. Most laboratories provide pregnancy specific reference ranges. Persistent elevation of neutrophils may be a sign of chronic myeloid leukaemia CML.
Chronic mild neutrophilia without left shift is very unlikely to be due to CML. CML occurs in all age groups but most commonly in the middle aged and elderly. The annual incidence is estimated at 1 - 2 cases per , The normal concentration of lymphocytes is between 1. There are two broad morphologic categories of lymphocytes which can be distinguished under the light microscope, large granular lymphocytes and small lymphocytes. Steroid administration may reduce lymphocyte counts.
More rarely lymphocytopenia may be caused by some types of chemotherapy or malignancies. People exposed to large doses of radiation, such as those involved with situations like Chernobyl, can have severe lymphocytopenia. Increases in the absolute lymphocyte count are usually due to acute infections, such as Epstein-Barr virus infection and viral hepatitis.
Less commonly, increased lymphocytes may be the result of pertussis and toxoplasmosis or rarely chronic intracellular bacterial infections such as tuberculosis or brucellosis. Chronic lymphocytic leukaemia CLL and other lymphoproliferative disorders should be considered in patients with a persistent lymphocytosis. In some cases lymphocyte surface markers may be recommended for differentiating between reactive lymphocytosis and lymphoproliferative disorders.
They circulate in the bloodstream for about one to three days and then typically move into tissues approx 8 - 12 hours to sites of infection. The normal concentration of monocytes is between 0 - 1. Monocytes which migrate from the bloodstream to other tissues are called macrophages. Macrophages have a role in specific immunity and phagocytosis. Most often, elevated monocyte counts are associated with infection and inflammatory processes and will be seen in conjunction with other blood count changes.
Isolated increases in the monocyte count, not accompanied by other changes in the blood count, are uncommon but may be associated with:. If levels are persistently elevated i. Basophils are the least common of the white cells, representing about 0. The normal concentration of basophils is 0 - 0. The function of basophils is not fully understood, but it is known that they are capable of phagocytosis and producing histamine.
The basophil count will only very rarely be significantly raised. When present, it may indicate a myeloproliferative disorder, or other more obscure causes. A repeat CBC a week or two later may help.
The normal concentration of eosinophils is 0 - 0. Eosinophils persist in the circulation for 8 - 12 hours, and can survive in tissue for an additional 8 - 12 days in the absence of stimulation.
Eosinopenia is difficult to demonstrate in practice because of the low frequency of eosinophils in most healthy people. As a result a low eosinophil count should not be a cause for concern. In developed countries the most common causes are allergic diseases such as asthma and hay fever, but worldwide the main cause of increased eosinophils is parasitic infection. Haematology assessment is appropriate for patients with persistent more than six months moderate eosinophilia, or marked or increasing eosinophilia.
Platelets are produced by budding off from megakaryocytes in the bone marrow. Each megakaryocyte produces between 5, to 10, platelets. Platelets circulate for approximately one to two weeks and are destroyed by the spleen and liver.
Some people have naturally lower levels of white blood cells and neutrophils than other people due to a range of factors, including congenital conditions. If neutrophil or white blood cell levels are significantly altered for no apparent reason or remain raised or lowered, a doctor will order more tests to determine the cause. Severely high or low levels of white blood cells often require emergency care and monitoring.
People with severe neutropenia will have an inadequate defense against infection. People with severe neutrophilia typically have a life-threatening type of infection or other inflammatory illness that requires treatment, such as cancer. Antibiotics can treat bacterial infections, while antifungal medicine treats fungal infections. People can treat certain viral infections with medications that slow viral activity.
Otherwise, supportive therapies, such as fluids and rest, may be part of the treatment plan. People with altered neutrophil levels caused by medications or procedures may need to stop or adjust treatments. People with chronic conditions that disrupt adequate neutrophil production or maturation may need to take drugs that allow the body to raise neutrophil production, such as:.
People with severely low levels of neutrophils often require monitoring, antibiotic therapy, and hospitalization to reduce the risk of severe infection. This period of intensive care helps keep people with weakened immune systems away from potentially harmful microorganisms. It also supports the body, giving it time to produce more white blood cells. One of the causes of low neutrophil blood levels is a vitamin B deficiency. Eating foods rich in B may help improve low neutrophil blood levels.
Examples of foods rich in vitamin B include:. To help reduce the risk of high or low neutrophil levels, people may want to try the following tips:. However, people with only minor or mild changes in their neutrophil blood levels often show no symptoms and do not require any treatment.
Having a healthy number of neutrophils in the blood and bone marrow is crucial to the correct working of the immune system. When neutrophil levels are higher or lower than usual for more than a short period, a doctor will order several tests to work out the underlying cause.
People with significantly altered neutrophil levels may also require hospitalization to prevent infection and treat life-threatening conditions. Anyone with concerns about their neutrophil count or any medical condition should talk to their doctor who will be able to answer questions they may have.
Antibiotics include a range of powerful drugs that kill bacteria or slow their growth. They treat bacterial infections, not viruses. If used…. Short-term inflammation is essential for healing, but long-term inflammation is a factor in various diseases.
Learn more about inflammation here. Bone marrow is a soft, gelatinous tissue inside some bones. This article covers bone marrow in detail, including what happens if it does not function…. The differential blood test tells doctors how many of each type of white blood cell are in the body. Therefore, doctors focus on treating the condition or disorder that caused the number of neutrophils to increase. Merck and Co. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world.
The Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Hyperviscosity syndrome. White Blood Cell Disorders. Test your knowledge. Neutropenia is the term for an abnormally low number of neutrophils, a type of white blood cell in the blood.
Which of the following is often the first indication that a person has neutropenia? More Content. Click here for the Professional Version. The normal response of the body to an infection.
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