Neutropenia refers to a lower-than-normal level of the white blood cells called neutrophils. Cyclic neutropenia means that these levels dip and then return to normal on a periodic basis. Low neutrophil levels put you at risk of infection. It can lead to symptoms like fever, fatigue and mouth sores, among others.
Cyclic neutropenia involves having lower-than-normal levels of neutrophils (a type of white blood cell) in your blood. But the low levels occur periodically, not all the time. Neutrophils are important because they help fight infection. A shortage of neutrophils, or neutropenia, makes it harder for your immune system to fight harmful bacteria or viruses that can make you sick.
Cyclic neutropenia differs from other forms of neutropenia in that neutrophil levels drop and then return to normal on a fairly consistent, predictable schedule. Neutrophil levels drop for about three to five days, return to normal and then drop again around every three weeks.
Other names for cyclic neutropenia include periodic neutropenia or cyclic hematopoiesis. “Cyclic hematopoiesis” isn’t used much, and it might be used to indicate period deficiency (or drop) in platelets.
Yes. Neutrophils help your immune system protect you from infection. During periods when your neutrophils are low, your immune system has a harder time fighting germs. The lower your neutrophil count, the harder it is for your immune system to protect you.
It’s rare. Researchers estimate that only about 1 in every 1 million people has cyclic neutropenia.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
With cyclic neutropenia, symptoms appear on a consistent schedule. Although the timeline may differ from person to person, you’ll likely experience neutropenia for about the same number of days and at the same intervals separating periods of normal and low neutrophil levels.
During periods when your neutrophils are low, you’re more susceptible to infection and may experience associated symptoms. Symptoms may include:
Symptoms and symptom severity can vary throughout your life. For many people, symptoms often get milder after puberty. Adolescents and young adults are more prone to mouth sores and dental issues. Adults more commonly report symptoms like headaches and sinus infections (sinusitis).
Cyclic neutropenia results from a genetic mutation (change) in the ELANE gene. You can inherit the mutation from a biological parent, or it can arise during development. The ELANE gene contains instructions for making an enzyme that helps neutrophils work. Problems with this gene prevent neutrophils from working as they should to protect you from infection.
Neutropenia symptoms result when:
Signs of cyclic neutropenia usually appear at birth. Healthcare providers diagnose most people in infancy. Your healthcare provider will consider various factors before making a diagnosis.
An important part of diagnosis involves distinguishing cyclic neutropenia from other types of neutropenia that cause similar symptoms. Other types of neutropenia include:
Neutropenia may also be a sign of a different condition. For example, certain types of cancer and cancer treatments, like chemotherapy, can cause low neutrophil levels. With these causes, even if your neutrophil levels fluctuate, they don’t often do so on a consistent cycle, as with cyclic neutropenia.
Treatment involves curing any infections and boosting your neutrophils to healthy levels to prevent future infections.
G-CSF side effects vary depending on the specific type of medicine you’re receiving and the dosage. Often, healthcare providers can manage cyclic neutropenia with low doses of G-CSF that only cause mild side effects.
Side effects may include:
Ask your healthcare provider about any side effects you should be aware of during treatment. It’s a good idea to be aware of any side effects requiring emergency medical attention.
While untreated neutropenia can cause life-threatening infections, medicines like G-CSF have greatly improved cyclic neutropenia outcomes. You may need regular blood work to monitor your neutrophil levels, but often, people with cyclic neutropenia can live normal lives thanks to current treatments.
A different type of neutropenia called congenital neutropenia is associated with an increased risk of developing cancers called myelodysplastic syndromes (MDS) or acute myeloid leukemia (AML) over time. But cyclic neutropenia doesn’t pose the same risks.
If you or your child has cyclic neutropenia, you should call your healthcare provider at once if you think an infection is developing. The signs include:
Protect yourself from infection — especially when you know that your body doesn’t always make enough healthy neutrophils to protect you. You can:
Follow your healthcare provider’s guidance about how often you’ll need blood tests to monitor your neutrophil levels. Take all medicines as prescribed.
A note from Cleveland Clinic
Low neutrophil levels make it harder for your immune system to fight germs and protect you from infection. With cyclic neutropenia, the moments when you’re most susceptible to infection happen on a predictable schedule. The predictability makes it easier to manage the condition. Take extra care to avoid injury and protect yourself from getting sick if you know you have cyclic neutropenia. Follow your provider’s advice about taking antibiotics or G-CSF to fight infections or boost your body’s immune defenses.
Last reviewed by a Cleveland Clinic medical professional on 01/18/2023.
Learn more about our editorial process.