Neutrophils blood test: what high or low neutrophils mean

Percent vs absolute count

Neutrophils usually make up about half to two thirds of your white cells. The percent tells you their share. The absolute neutrophil count (ANC) is the actual number: your total WBC multiplied by the neutrophil percent.

The two can disagree. A neutrophil percent of 45% sounds fine, but with a low total WBC the absolute count can still be low. Always read the absolute number, and see the WBC differential lab guide and WBC guide.

What high neutrophils can mean

An absolute count above about 7,000 per microliter is called neutrophilia, the most common reason for a high WBC. Causes include:

• Bacterial infection and other infections
• Physical or emotional stress: surgery, injury, burns, hard exercise
• Smoking and obesity
• Inflammatory conditions such as rheumatoid arthritis or inflammatory bowel disease
• Medicines: corticosteroids, lithium, beta agonist inhalers and epinephrine
• Less common: blood disorders and leukemias, especially with abnormal red cells or platelets or immature cells on a smear

What low neutrophils can mean

An absolute count below about 1,500 per microliter is called neutropenia. Clinicians grade it as mild (1,000 to 1,500), moderate (500 to 1,000) or severe (below 500). Causes include:

• Medicines, one of the most common causes: chemotherapy, and some antibiotics, antithyroid drugs and psychiatric drugs such as clozapine
• Viral infections, which can lower counts for a short time, and severe infection (sepsis)
• Low vitamin B12 or folate and severe undernutrition
• Autoimmune conditions such as lupus, and HIV
• An enlarged spleen that holds on to cells
• Bone marrow conditions such as leukemia, myelodysplasia or aplastic anemia

Benign ethnic neutropenia is a lower normal count seen in some people of African, Middle Eastern or Jewish ancestry, sometimes tied to the Duffy blood group. It does not raise infection risk, and recognizing it can save you from repeated workups.

Gabriel's optimal ranges

Typical lab ranges vary, but many run about 40% to 74% and 1.4 to 7.0 thousand per microliter. Gabriel's optimal range is 50% to 60% and an absolute count of 1.5 to 3.0. A steadily high neutrophil count, especially with low lymphocytes, often fits the stress and inflammation pattern; see lymphocytes.

What to do with an abnormal result

1. Read the absolute count first, then the total WBC and the other cell types.
2. Think about the last few weeks. A cold, a hard workout, a steroid course or a stressful event can all move neutrophils.
3. Bring your medication list, including supplements. Several common drugs lower or raise the count.
4. Ask about B12 and folate if your count is low, and about a repeat CBC. Counts swing, so one value is rarely the whole story.
5. If you have a report in hand, you can upload it to Gabriel for a plain-words read of every marker, then take your questions to your clinician.

A fever when your neutrophils are low can be an emergency: call your clinician or seek care the same day. Also see a clinician promptly for mouth sores, repeated infections, sores that won't heal, night sweats, unexplained weight loss, or easy bruising.