Patient education: Neutropenia (The Basics)

What is neutropenia? — Neutropenia is a condition that happens when your blood does not have enough "neutrophils." Neutrophils are a type of white blood cell. They help your body fight infections.

Blood is made up of different types of cells. These cells are made in the center of your bones, in a part called the bone marrow. Neutropenia can happen if:

●Your bone marrow doesn't make enough neutrophils.

●Something in your body destroys some of your neutrophils – This can be related to a medicine you took, or a problem with your immune system.

Some people with neutropenia have no symptoms. But people with severe neutropenia can get fevers or have frequent or severe infections.

What causes neutropenia? — Many different things can cause neutropenia.

●Infections – Many different infections can cause neutropenia, including:

•Typhoid fever

•Tuberculosis

•Hepatitis B

•HIV, the virus that causes AIDS

●Medicines – Many medicines can cause neutropenia. Some examples include:

•Medicines used to treat cancer, such as cyclophosphamide (brand name: Cytoxan) and doxorubicin (brand name: Adriamycin)

•Clozapine (sample brand names: Clozaril, FazaClo)

•Sulfasalazine (brand name: Azulfidine)

●Vitamin deficiencies – Some vitamins help the body make neutrophils. Folic acid, vitamin B12, and copper are examples. You could have low levels of these vitamins if you are a strict vegetarian or have weight reduction surgery and do not take supplements.

●Immune system problems – The immune system is the body's infection-fighting system. Normally, the immune system kills germs. But sometimes, it attacks healthy cells, including white blood cells. This condition is known as "autoimmune neutropenia." It can happen with certain diseases like lupus or rheumatoid arthritis.

●Problems related to the bone marrow – Some conditions that involve the blood cells made in the bone marrow can cause neutropenia. Examples include certain inherited conditions, myelodysplastic syndrome ("MDS"), and certain types of leukemia or anemia.

Some people have something called "Duffy-null associated neutrophil count" ("DANC"). This means that they have a neutrophil count that is lower than what some labs consider "normal." But DANC is not a health problem, and people with it don't have a higher risk for infections or other conditions. DANC happens because there is a slight difference, or "variant," in the DNA of a gene called ACKR1. In the past, DANC was called "benign ethnic neutropenia" or "constitutional neutropenia."

Is there a test for neutropenia? — Yes. A blood test called a "complete blood count with white blood cell differential" looks at all the different types of white blood cells in your blood. It can show if you have neutropenia. Doctors also call this test a "CBC with diff." The important number is the number of neutrophils, or "neutrophil count," not the percentage.

Your doctor or nurse will decide if you need other tests, too. This depends on your age, other symptoms, and individual situation. Some of the things doctors use to find the cause of neutropenia:

●CBC results – Sometimes, there are other clues from the CBC, such as the sizes or numbers of other blood cells.

●Other lab tests – Sometimes, other lab tests can be helpful, such as the level of vitamin B12 or tests for lupus.

●Bone marrow biopsy – During this test, a doctor will take a very small sample of the bone marrow from your hip bone. Then, the cells are examined under a microscope. Only some people need this test. You are most likely to get this test if you have a very low neutrophil count or other abnormal blood cells.

How is neutropenia treated? — The treatment depends on what caused your neutropenia.

If your neutropenia was caused by a medicine you took, your doctor might have you stop taking the medicine. They might be able to switch you to a different medicine that is less likely to cause the problem.

Your doctor might also prescribe medicines that help your bone marrow make white blood cells. These medicines are given as a shot. They include:

●Filgrastim (brand name: Neupogen)

●Sargramostim (brand name: Leukine)

Am I at increased risk for blood cancer? — Some causes of neutropenia, such as MDS or leukemias, are forms of cancer. For other causes of neutropenia, there is little or no increased risk of getting cancer.

What problems should I watch for? — Your doctor will tell you how concerned you need to be about serious infections.

●If you are at risk for serious infections, get to a doctor or hospital right away if you get a fever or other symptoms of infection.

●For people who have neutropenia from chemotherapy and get a fever, it is very important to get to the hospital right away to be treated for infection.

More on this topic

Patient education: Complete blood count (CBC) (The Basics)
Patient education: Neutropenia and fever in people being treated for cancer (The Basics)
Patient education: Bone marrow aspiration and biopsy (The Basics)