Neutrophil is a type of white
blood cells, an important part of the immune system. They are produced in bone
marrow, and fight against bacteria and fungi thanks to their enzymes after
entering the blood circulation. In case of an infection, they're the primary
cells to migrate the infection site to kill the microbes. High or low
neutrophil count might be an indication of a serious illness or infection. Low
neutrophil level is a common side effect in patients with leukemia or
individuals receiving chemotherapy for cancer. Vitamin deficiencies, smoking,
excessive stress and poor nutrition may affect neutrophil production. If there
is an underlying cause for abnormal neutrophil counts, the treatment is based
on this cause.
Table of Contents
1. What is neutrophil?
2. Diseases related to
neutrophils
3. What is the normal
neutrophil count?
4. What is Neutropenia (Low
neutrophil count)?
5. Neutropenia causes
6. Symptoms of neutropenia
7. Neutropenia treatment
8. What is neutrophilia (High
neutrophil level)?
9. Treatment of neutrophilia
What is neutrophil?
Neutrophils are a type of white blood cells which fight against
infections caused by bacteria and fungi. They are produced in bone marrow and
make up the majority (50-75%) of white blood cells. With chemical stimulation
in case of inflammation, injury or infection, they migrate to the site of
condition. The ones that do not encounter with microbes undergo programmed cell
death and are cleared by liver and spleen. Due to rapid consumption of
short-lived neutrophil, there's an outsized reserve in bone marrow.
Majority of neutrophils are in bone marrow, and the rest are in
tissues and blood vessels. An adult produce 100,000,000 neutrophils a day; they
have a life time of approximately 3-7 days in bone marrow and 6 hours in
circulation.
What is the role of neutrophils?
Neutrophils have the function of killing as many microbes as
possible. They can damage the microbes thanks to antimicrobial proteins which
are the natural antibiotics of our body. With the help of other immune cells,
they work for days or weeks until the immune system steps in. Each neutrophil
only lives for a few hours and there is a continuous production of new
neutrophils in bone marrow. Neutrophils determine their route supported the
localization of infection or tissue injury.
Contrary to the other white blood cells, neutrophils are not
restricted with a certain circulation area. They can move freely from vascular
walls to body tissues to immediately attack all antigens.
Diseases related to neutrophils
Neutrophil and cancer
Cancer treatments (chemotherapy, radiation, surgery, stem cell
or bone marrow transplantation) or the cancer itself decrease the count of
white blood cells and prevent them from functioning properly by weakening the
immune system. This is called immune suppression. The risk of infection is high
when there is not sufficient amount of neutrophils to kill the microbes.
The timing of the decrease in neutrophil levels is associated
with the chemotherapy dose. The levels start to decrease approximately one week
after the chemotherapy cycle. When the production in the bone marrow starts
again after the session, neutrophil levels start to increase, however, it takes
3-4 weeks to restore the normal levels.
Neutrophil and infection
Neutrophils are a crucial line of defense against many sorts of
infection; neutrophil count is studied to know the danger of infection.
Neutropenia increases the susceptibility to fungal and bacterial infections.
The risk level is based on the cause, severity, underlying medical condition, and
the presence or absence of bone marrow reserve.
Neutrophil and heart diseases
Low neutrophil levels contribute to the vascular occlusion
process, and being a risk factor for cardiovascular diseases, may result in
heart attack.
Neutrophil and cystic fibrosis
It is a genetic disease affecting the secretory glands of many
organs, leading to dysfunction starting from birth. It affects the lungs,
pancreas, liver, bowels, sinuses and reproductive organs. The abundant amount
of DNA released when the neutrophils which accumulated in airways due to
infection and inflammation are broken down may result in stickier, thickened
secretions, bronchial obstruction and permanent lung damage.
What is the normal neutrophil count?
What is the normal blood neutrophil count?
The normal range of neutrophil count differs in adults and
children by age. Reference ranges are in microliter (mcL), and only give
approximate values. Under normal conditions, neutrophil count is between 1500
and 8000 in adults and 1000 and 8000 in children.
What is the normal neutrophil count in babies?
At-risk pregnancies and delivery stress increase the strain
hormone in mothers, thereby, causing the newborn inclined to neutrophilia,
however, the amount become closer to normal within 1 week. Neutrophil counts in
babies:
• Newborn: 6000-26,000 mcL
• 1-week: 1000-10,000 mcL
• 6-month: 1000-8500 mcL
The reasons for requesting a neutrophil count test
Absolute neutrophil count provides important clues about health.
ANC is typically listed as a part of differential complete blood count (CBC).
It is performed to help with a diagnosis of an illness, or to monitor a disease
or the effect of chemotherapy. If the results are abnormal, the blood test is
repeated weekly and the changes in neutrophil count is monitored. In some
cases, bone marrow biopsy or additional tests may be necessary to diagnose a
specific cause.
The results may differ between laboratories, also following
factors may affect the results:
• Having an infection
• Chemotherapy, or radiation or corticosteroid treatment
• Recent history of operation
• HIV
• Pregnancy
• Age
• Sex
•
Genetic inheritance
What is Neutropenia (Low neutrophil count)?
It means abnormally low neutrophil level. It can be mild,
moderate or severe based on the neutrophil count; acute or chronic based on the
duration; and acquired or congenital based on the cause. Neutropenia decreases
the body’s ability to fight against infections and increases risk of
life-threatening infections. It can be originating from cancer or illnesses
damaging the bone marrow including genetic disorders affecting immune system,
or by some medications. It is the most common or even an expected result of
chemotherapy.
Neutropenia values
A neutrophil count less than 1500/mcL is considered as neutropenia,
and it is classified as following:
• Mild
neutropenia:1000-1500mcL
• Moderate
neutropenia: 500-1000mcL
• Severe
neutropenia: <500mcL
Neutropenia causes
• Problem with
neutrophil production in bone marrow
• Extramedullary
destruction of neutrophils
• Bone marrow
deficiency
• Congenital bone
marrow function disorders (Kostmann syndrome)
• Chemotherapy,
radiation therapy
• Cancers
affecting the bone marrow such as leukemia, lymphoma, multiple myeloma
• Antibiotics,
blood pressure, epilepsy, psychiatry medications
• Poor nutrition,
vitamin deficiencies
• Lyme disease
• Anemia, blood
poisoning
• Autoimmune
diseases such as rheumatoid arthritis, Crohn’s or lupus
Viral or bacterial infections causing neutropenia:
• Tuberculosis
• Dandy fever
• Epstein-Barr virus,
HIV, Hepatitis A, B, C, salmonella, malaria
Problems caused by neutropenia
Any condition impairing the neutrophil production may lead to
neutropenia, and this weakens the immune system. If severe neutropenia is
prolonged, the risk of serious infection increases. Majority of the infections
like ulcer, urticaria seen as a complication of neutropenia is caused by
bacteria that are already present in skin, or gastrointestinal or genitourinary
tract.
Symptoms of neutropenia
• Infections in
mucosal membranes (e.g., intraoral or skin)
• Infection-related
fever
• Skin abscess
• Mouth sores
• Swollen gingiva
• Fatigue
• Sweating
• Sore throat,
abdominal pain
• Pain, burning
sensation with urination
• Unusual vaginal
discharge, itching
Neutropenia might be asymptomatic and usually noticed after a
blood test performed for diagnosing a disease. For neutropenia patients, even a
small infection can rapidly become serious. If you have any of these symptoms,
consult with a physician as soon as possible.
Neutropenia treatment
Treatment is based on the underlying condition as well as the
cause and severity of neutropenia. Treatment may not be necessary in mild
cases. Therapeutic approaches are as following:
• Fever caused by
infection is treated using antibiotics.
• Granulocyte
colony stimulating factor (G-CSF) treatment stimulates the bone marrow to
produce white blood cells.
• Granulocyte
transfusion may be administered, though it is extremely rare.
• In drug-induced
cases, the treatment is changed if possible.
• Stem cell
transplants might be useful in the treatment of severe neutropenia caused by
bone marrow problems.
• Corticosteroid
treatment is used in cases of immune deficiency.
Neutropenia in babies
Neutropenia is one of the important problems seen in children.
It can be congenital or acquired. The most common cause of acquired neutropenia
is viral infections. Congenital neutropenia is usually diagnosed after
occurrence of acute, life-threatening bacterial and fungal infections.
Congenital neutropenia may be accompanied by immune system disorders.
How to increase low neutrophil counts in babies?
If there is an infection, the source should be identified and
treated. In many cases, neutropenia improves spontaneously when the bone marrow
develops and starts to produce sufficient amount of white blood cells. In rare
cases of life-threatening neutropenia, medications to stimulate white blood
cell production can be used.
Foods increasing the neutrophil levels
In periods of neutropenia, vitamins A, B, C, E, carotenes, iron,
zinc and selenium are highly important to support the immune system. You can
balance your body’s neutrophil count by eating foods which contain omega-3 and
antioxidant.
In general, high-calorie
foods rich in protein should be preferred.
• Red meat,
chicken, turkey, fish, egg, milk and dairy products are important sources of
vitamin B12, vitamin A, iron and protein. They should be well-cooked to
consume.
• Cheese and
yoghurt are rich zinc sources.
• Fish oil, flax
seed, walnut, salmon, spinach and soy are foods containing high omega-3 fatty
acid.
• Sea products
and organ meat are foods containing selenium.
• Green-leafy
vegetables, red-, orange-, yellow-colored vegetables are beta-carotene sources.
• Fruits and
vegetables like orange, green pepper, parsley, broccoli, kiwi, strawberry,
cherry, carrot, watermelon and melon which are rich in antioxidants, help
cellular structure and are important vitamin C sources should be consumed in
plenty amounts.
• Legumes are
important folic acid sources.
• Oily seeds such
as sesame, almond and peanut are rich in vitamin E.
• Green tea
contains antioxidants which boost immunity and help fight against infections.
• You should also drink plenty of
boiled and cooled water.
What is neutrophilia (High neutrophil level)?
It is the abnormally high neutrophil level and suggests that you
have an infection. However, it can also be caused chronic myelogenous leukemia,
a cancer of blood-producing tissues. Normal neutrophil count in the blood
should be around 1500. If it increases above 8000, it is considered as
neutrophilia, and this might be an indication of diseases such as cancer,
hemolytic anemia, kidney disease, thyroid inflammation, rheumatoid arthritis
and hepatitis. Neutrophil level might be increased during pregnancy or in
newborns for the first 3 days of life, however, this is transient.
Neutrophilia causes
• Bacterial, viral, fungal infections
• Inflammation
• Injury
• Smoking or tobacco products use
• Stress
• Excessive exercise
• Steroid use
• Heart attack
• Chronic myeloid leukemia
• Surgical intervention, blood transfusion
Symptoms of neutrophilia
Neutrophilia is an asymptomatic disorder that means the symptoms
are based on the underlying condition. Symptoms such as shortness of breath,
fatigue, palpitation, chest-joint pain, fever and constipation may be seen
based on the underlying condition. Regular complete blood count is helpful for
early diagnosis of neutrophilia and also other illnesses.
Treatment of neutrophilia
Neutrophilia is typically caused by stress or infection,
however, there may different causes. Therefore, additional tests are used to
identify the underlying condition, and proper treatment can be recommended.
• Managing your everyday stress may help restore normal
neutrophil levels.
• If it is caused by infection, antibiotics or antiviral
medications are used.
• In case of inflammation, anti-inflammatories are preferred.
• Corticosteroids and immune-modulator medications might be part
of the treatment.
• If neutrophilia is caused by cancer, operation, chemotherapy
and radiotherapy options are considered based on the type of cancer.
Recommendations for neutrophilia patients
• In severe cases, use private room and make sure that
caregivers use gloves, gown and face mask.
• To reduce the risk of infection, take care of your personal
hygiene; frequently wash your hands and brush your teeth.
• Avoid contact with ill people.
• Immediately clean the cuts and scratches, and put on bandage.
• Do not take very hot baths.
• Definitely avoid using alcohol, tobacco and other tobacco
products.
• Do not eat undercooked meat and raw vegetables or eat all raw
foods after you keep them in water mixed with vinegar for 30 minutes.
• Prefer eating fruits which can be peeled if possible.
• Avoid very hot, cold, spicy and sour foods.
• Avoid unpasteurized dairy products.
• Exercise and try to avoid stress.
