Neutropenia

What is neutropenia?

Neutropenia (noo-troh-PEE-nee-uh) refers to lower-than-normal levels of neutrophils in your blood. A neutrophil is a type of white blood cell that your bone marrow primarily makes. White blood cells in general, and neutrophils in particular, fight infections in your body. Neutrophils destroy germs that cause infections, like viruses and bacteria.

Not having enough neutrophils makes it harder for your body to fight germs and prevent infections. In severe cases, even bacteria that a healthy body typically tolerates (like the bacteria in your mouth and intestines) can make you sick.

What are normal neutrophil levels?

Neutropenia gets classified as mild, moderate, or severe, depending on the number of neutrophils in a blood sample. The lowest normal limit for adults is about 1,500 neutrophils per microliter of blood by many standards. (Some put the cut-off at 1,800 per microliter.) The range of neutrophil numbers is:

• Mild neutropenia: 1,000 – 1,500.
• Moderate neutropenia: 500 – 1,000.
• Severe neutropenia: Less than 500.

Neutropenia can also be classified as acute (temporary or short-lasting) or chronic (long-lasting), congenital (a condition you’re born with) or acquired (a condition that happens over time).

Who is affected by neutropenia?

Infections sometimes cause neutropenia, but it’s often a result of cancer treatments, like chemotherapy. Researchers estimate that 50% of people receiving chemotherapy will develop neutropenia.

Benign ethnic neutropenia (BEN) is a chronic (long-lasting) congenital (present from birth) form of neutropenia that’s most common in people of African, Middle Eastern and West Indian descent. Although neutrophil counts are below 1,500 with this type of neutropenia, people with BEN are not at increased risk of infection.

How does neutropenia affect my body?

Neutropenia’s effects vary depending on your neutrophil count. With mild neutropenia, you may not experience any symptoms. You may learn you have neutropenia incidentally during a blood test for another condition. Moderate to severe neutropenia may increase your risk of infection. Without treatment, severe neutropenia can be life-threatening.

What causes neutropenia?

Neutropenia happens when your bone marrow doesn’t make enough neutrophils, when your neutrophils break down too soon or when neutrophils get destroyed.

Any of the following can cause neutropenia.

• Genetic conditions: Genetic abnormalities that cause neutropenia can be passed from parents to their biological children. Types of inherited neutropenia include benign ethnic neutropenia (BEN), cyclic neutropenia and severe congenital neutropenia.
• Infections: Viral, bacterial and parasitic infections can cause neutropenia. Common causes include HIV, hepatitis, tuberculosis, sepsis, and Lyme disease, among other infections.
• Cancer: Cancer and other blood and/or bone marrow disorders, including leukemia and lymphoma, can prevent your body from making enough healthy white blood cells, causing neutropenia.
• Medications: Cancer treatments such as chemotherapy and radiation therapy can harm or destroy neutrophils and/or the bone marrow that makes neutrophils as a side effect. Medications for conditions unrelated to cancer may also cause low levels of neutrophils.
• Nutritional deficiencies: Not having enough vitamins or minerals such as vitamin B12, folate or copper in your diet can cause neutropenia.
• Autoimmune deficiencies: With certain autoimmune conditions, your body makes antibodies that destroy healthy neutrophils. Autoimmune conditions include Crohn's disease, lupus, and rheumatoid arthritis, among others.

Chronic idiopathic neutropenia is a specific type of neutropenia that doesn’t have a clear cause.

Why does cancer treatment cause neutropenia?

Cancer treatments, like chemotherapy, destroy cancer cells, but they may also destroy healthy neutrophils and the bone marrow that makes healthy white blood cells. Neutropenia is common during chemotherapy treatments. Neutrophil levels dip to their lowest numbers within the first two weeks following treatment before rising again.

It’s crucial to take extra precautions to avoid infections during this vulnerable time.

What are the symptoms of neutropenia?

Neutropenia doesn’t cause symptoms, but the infections that may result from having neutropenia can. Repeated infections may also be a sign of neutropenia.

Symptoms may include:

• Fever (febrile neutropenia).
• Fatigue.
• Sore throat (pharyngitis).
• Swollen lymph nodes.
• Ulcers in your mouth or around your anus.
• Pain, swelling and rash at an infection site.
• Diarrhea.
• Burning with urination or other urinary symptoms (urgency, frequency).

If you have mild neutropenia, your body may have enough neutrophils to fight infections. In that case, you may not notice or develop any symptoms.

How is neutropenia diagnosed?

The most common test is a simple blood test called a complete blood count (CBC) with differential. Your healthcare provider will likely perform this test regularly to monitor your neutrophil levels if you receive chemotherapy.

Your healthcare provider may order additional tests if they’re unsure what’s causing your neutropenia. For instance, they may take a sample of your bone marrow and examine the cells under a microscope. This test can help your provider tell if neutrophils are developing abnormally in your bone marrow or being destroyed after they’re produced. This information can help your provider establish a diagnosis.

What are the treatments for neutropenia?

Some types of neutropenia might not require treatment. Other treatment options depend on what’s causing your low neutrophil levels.

Treatments may include:

• Antibiotics: Antibiotic treatment can save your life if you have neutropenia with a fever (febrile neutropenia). Your provider will likely admit you to the hospital, where you’ll get antibiotics intravenously (through a vein) to fight your infection and undergo tests to identify a possible infection.
• Corticosteroids: Your provider might prescribe corticosteroids if you have an autoimmune condition. These drugs can suppress (lessen) your body’s immune response that’s causing the destruction of your neutrophils.
• Granulocyte colony-stimulating factor (G-CSF): Your provider may also prescribe drugs that promote the production of white blood cells in your bone marrow. You’ll likely receive G-CSF if you’re also receiving chemotherapy.

If your medicine is causing neutropenia, your provider might tell you to stop taking it, or they may adjust your dose.

How can you prevent neutropenia?

You can’t prevent the types of neutropenia you’re born with. If you’re receiving chemotherapy and your healthcare provider is worried about your low neutrophil levels, they may delay your next round of chemo or reduce your dose. They may also recommend getting injections of G-CSF to boost your white blood cell production, which increases neutrophils.

How can you prevent infections if you have neutropenia?

You can take precautions to prevent infections if you know your neutrophil levels are low.

• Wash your hands frequently with soap and water, or use an alcohol-based hand sanitizer.
• Stay up-to-date on all vaccines, including shots for the flu and COVID-19.
• Avoid people who are sick or crowds where you’re likely to come into contact with a sick person.
• Avoid injuries like scrapes, tears or cuts (including tattoos and piercings), and care for wounds immediately if your skin is damaged.
• Prevent the spread of germs by washing fruits and vegetables, keeping meats away from other foods, preparing meals in a clean kitchen and cooking foods to the proper temperature.
• Don’t share utensils, cups, food or drinks with others.
• Don’t share towels, razors or toothbrushes with others.
• Wear gloves if you’re gardening or working in the yard.
• Avoid picking up pet waste or changing a newborn’s diaper (use gloves and wash your hands afterward if you can’t avoid it).
• Avoid lakes, ponds, rivers and hot tubs.
• Take the prophylactic medications prescribed by your healthcare provider to help prevent infections.

Many of these tips apply to anyone who’s trying to keep from getting sick. If you have neutropenia, you’ll need to take extra care to avoid infection. Ask your provider about additional ways to prevent infection based on your lifestyle and health.

What is the prognosis (outlook) for people who have neutropenia?

Neutropenia can be treated, so the outlook is good for most people. It’s essential to prevent infections and (if you do get sick) treat infections promptly.

When should I see my healthcare provider?

If you’re receiving chemotherapy or have any condition that makes you vulnerable to neutropenia, see your healthcare provider immediately if you notice these symptoms or contact your provider immediately for instructions on what to do:

• A fever of 100.4 degrees Fahrenheit or 38 degrees Celsius.
• Sweating or chills.
• Trouble breathing.
• Stuffy nose.
• A sore throat or stiff neck.
• A new or worsening cough.
• Diarrhea and/or vomiting.
• Vaginal discharge or irritation.
• Soreness, redness or swelling in any part of your body.
• Changes in your pee (pain, burning, increased frequency).
• Any new pain, especially pain in your abdomen or rectum.
• Confusion or feeling mentally different than usual.
• Increased fatigue or feeling overall unwell.

A note from Cleveland Clinic

Your experience of neutropenia will depend on what’s causing your low neutrophil count. If your levels are low because of a recent infection, they’ll likely return to normal once your body has had time to recover. If your neutropenia results from a chronic condition or chemotherapy treatment, your provider may monitor your levels regularly to prevent complications from infections. Ask your provider if your neutropenia will require more frequent check-ups to ensure you remain infection-free and if you require medications to help prevent infections.