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Neutropenia is an abnormally low level of neutrophils in the blood. Neutrophils are white blood cells (WBCs) produced in the bone marrow that ingest bacteria. Neutropenia is sometimes called agranulocytosis or granulocytopenia because neutrophils make up about 60% of WBCs and have granules inside their cell walls. Neutropenia is a serious disorder because it makes the body vulnerable to bacterial and fungal infections.


The normal level of neutrophils in human blood varies slightly by age and race. Infants have lower counts than older children and adults, and African Americans have lower counts than Caucasians or Asians. The average adult level is 1500 cells/mm3 of blood. Neutrophil counts (in cells/mm3) are interpreted as follows:
  • greater than 1000. Normal protection against infection
  • 500-1000. Some increased risk of infection
  • 200-500. Great risk of severe infection
  • lower than 200. Risk of overwhelming infection; requires hospital treatment with antibiotics

Causes and symptoms


Neutropenia may result from three processes:
DECREASED WBC PRODUCTION. Lowered production of white blood cells is the most common cause of neutropenia. It can result from:
  • medications that affect the bone marrow, including cancer drugs, chloramphenicol (Chloromycetin), anticonvulsant medications, and antipsychotic drugs (Thorazine, Prolixin, and other phenothiazines)
  • hereditary and congenital disorders that affect the bone marrow, including familial neutropenia, cyclic neutropenia, and infantile agranulocytosis
  • cancer, including certain types of leukemia
  • radiation therapy
  • exposure to pesticides
  • vitamin B12 and folate (folic acid) deficiency
DESTRUCTION OF WBCS. WBCs are used up at a faster rate by:
SEQUESTRATION AND MARGINATION OF WBCS. Sequestration and margination are processes in which neutrophils are removed from the general blood circulation and redistributed within the body. These processes can occur because of:
  • hemodialysis
  • felty's syndrome or malaria, the neutrophils accumulate in the spleen
  • bacterial infections, the neutrophils remain in the infected tissues without returning to the bloodstream


Neutropenia has no specific symptoms except the severity of the patient's current infection. In severe neutropenia, the patient is likely to develop periodontal disease, oral and rectal ulcers, fever, and bacterial pneumonia. Fever recurring every 19-30 days suggests cyclical neutropenia.


Diagnosis is made on the basis of a white blood cell count and differential. The cause of neutropenia is often difficult to establish and depends on a combination of the patient's history, genetic evaluation, bone marrow biopsy, and repeated measurements of the WBC.


Treatment of neutropenia depends on the underlying cause.


Patients with fever and other signs of infection are treated for seven to 10 days with antibiotics. Nutritional deficiencies are corrected by green vegetables to supply folic acid, and by vitamin B supplements.
Medications known to cause neutropenia are stopped. Neutropenia related to pesticide exposure is treated by removing the patient from the contaminated environment.
Patients receiving chemotherapy for cancer may be given a blood growth factor called sargramostim (Leukine, Prokine) to stimulate WBC production.


Patients with Felty's syndrome who have repeated infections may have their spleens removed.


The prognosis for mild or chronic neutropenia is excellent. Recovery from acute neutropenia depends on the severity of the patient's infection and the promptness of treatment.



Linker, Charles A. "Blood." In Current Medical Diagnosisand Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton &Lange, 1997.

Key terms

Cyclical neutropenia — A rare genetic blood disorder in which the patient's neutrophil level drops below 500/mm3 for six to eight days every three weeks.
Differential — A blood cell count in which the percentages of cell types are calculated as well as the total number of cells.
Felty's syndrome — An autoimmune disorder in which neutropenia is associated with rheumatoid arthritis and an enlarged spleen.
Granulocyte — Any of several types of white blood cells that have granules in their cell substance. Neutrophils are the most common type of granulocyte.
Neutrophil — A granular white blood cell that ingests bacteria, dead tissue cells, and foreign matter.
Sargramostim — A medication made from yeast that stimulates WBC production. It is sold under the trade names Leukine and Prokine.
Sequestration and margination — The removal of neutrophils from circulating blood by cell changes that trap them in the lungs and spleen.


diminished numbers of neutrophils in the blood.
congenital neutropenia infantile genetic agranulocytosis.
cyclic neutropenia a chronic form marked by regular, periodic episodic recurrences, associated with malaise, fever, stomatitis, and various infections. Called also periodic neutropenia.
drug-induced neutropenia that caused by medications; the most common mechanisms are immunological (formation of antibodies destructive to neutrophils or of immune complexes that bind to neutrophils), followed by inhibition of granulopoiesis and direct damage to bone marrow or precursor cells of the granulocytic series.
idiopathic neutropenia agranulocytosis.
Kostmann's neutropenia infantile genetic agranulocytosis.
malignant neutropenia agranulocytosis.
neonatal neutropenia, alloimmune neutropenia in the newborn due to in utero incompatibility between its immunoglobulin G antigens and those of the mother's blood; the mother's blood produces antibodies that cross the placenta and sensitize fetal neutrophils. Affected infants may have fever, pneumonia, septicemia, and other infections that can be fatal. The condition eventually resolves as the infant's immunoglobulin replaces that from the mother.
periodic neutropenia cyclic neutropenia.


The presence of abnormally small numbers of neutrophils in the circulating blood.
[neutrophil + G. penia, poverty]


/neu·tro·pe·nia/ (noo″tro-pe´ne-ah) diminished number of neutrophils in the blood.


(no͞o′trə-pē′nē-ə, nyo͞o′-)
An abnormally low level of neutrophils in the circulating blood.

neu′tro·pen′ic (-pĕn′ĭk) adj.


Etymology: L, neuter, neither; Gk, penia, poverty
abnormal decrease in the neutrophil count associated with acute leukemia, chemotherapy, and idiosyncratic drug reactions, predisposing individuals to infection. Compare leukopenia. See also neutrophil.


Hematology An absolute ↓ in neutrophils–normal, 2,500-7,000/mm3; serious infections occur if < 500/mm3 See Congenital neutropenia, Cyclic neutropenia. Cf Neutrophilia.


Condition that occurs when neutrophil counts fall below the normal percentage in circulating blood.
[neutrophil + G. penia, poverty]


A reduction in the numbers of NEUTROPHIL POLYMORPHS (polymorphonuclear leucocytes) in the blood. This may prejudice the body's ability to resist infection.


abnormally low levels of neutrophils in circulating blood

neutropenia (nuˈ·trō·pēˑ·nē·),

n an atypical decrease in the number of neutrophils circulating within the blood. The condition is associated with infection, rheumatoid arthritis, acute leukemia, chronic splenomegaly, or a deficiency in vitamin B12.


The presence of abnormally small numbers of neutrophils in the circulating blood.
[neutrophil + G. penia, poverty]

neutropenia (noo´trōpē´nēə),

n a relative or absolute decrease in the normal number of neutrophils in the circulating blood. Various limits are given; e.g., absolute neutropenia may exist when the total is less than 1700 cells/mm3 regardless of the percentage, whereas relative neutropenia may exist when the total percentage of neutrophils is less than 38% and the total number is not less than 1500/mm3. It may be associated with viral infections, pernicious anemia, sprue, aplastic anemia, bone marrow, neoplasms, chronic intoxication with drugs or heavy metals, malnutrition, and nonpyogenic and overwhelming infections. See also neutrophil.
neutropenia, cyclic,
n a condition in which there is a depression in the number of circulating white cells, especially the neutrophils, at intervals of about 21 days. It lasts for approximately 10 days; during this time, gingival inflammation and aphthous ulcer occur.
Enlarge picture
Cyclic neutropenia.


a diminished number of neutrophils in the blood.

cyclic neutropenia
periodic neutropenia. See also canine cyclic hematopoiesis.
malignant neutropenia
periodic neutropenia
see canine cyclic hematopoiesis.
References in periodicals archive ?
The most common serious adverse reactions (>2%) of ONIVYDE were diarrhea, vomiting, neutropenic fever or neutropenic sepsis, nausea, pyrexia, sepsis, dehydration, septic shock, pneumonia, acute renal failure, and thrombocytopenia.
2] The side effects of greatest note are neutropenic events, diarrhea and fatigue/asthenia.
Microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in pediatric febrile neutropenic oncology patients: comparison between two consecutive time periods with use of different antibiotic treatment protocols.
3) There is a move to stratify patients into high-risk and low-risk groups even if they are neutropenic and have a fever.
Given the serious nature of neutropenic infections, it is vital that patients are provided with information about their risk of neutropenia and developing an infection, as a result of their chemotherapy.
Children receiving chemotherapy can mix with close family and friends but should be protected from individuals who are known to be unwell or infectious, particularly when the child is known to be neutropenic.
Pathologist Jan Lowe said death was caused by bronchopneumonia with chemotherapy and neutropenic sepsis as contributing factors.
In 2005 Pazos and others completed a study on the contribution of (1 [right arrow] 3)-[beta]-D-glucan for diagnosis and therapeutic monitoring of IA in neutropenic adults in comparison with serial screening for circulating galactomannan.
For example, in a previous study we completed an analysis of racial disparities in inpatient neutropenic cancer patients, a very small portion of neutropenic patients (coded as agranulocytosis ICD-9 288.
We're treating a lot of neutropenic sepsis in the outpatient setting.
She is neutropenic, which means she has a low white blood cell count and is unable to fight off infection.
The German Paul-Ehrlich-Gesellschaft (PEG) has developed an intervention strategy for the management of infections in neutropenic patients with underlying hematologic malignancies, which has gained international acceptance [9,11].