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White blood cells (WBCs) help protect the body from infection. Neutrophils are a type of white blood cell. Their main job is to help the body fight bacterial and fungal infections. Neutropenia occurs when there are fewer neutrophils in the blood than normal. It can range from mild to severe. This depends on the number of neutrophils in the blood. Severe neutropenia puts a person at higher risk for having more infections. Bacterial and fungal infections are most common. Your doctor can tell you more about your condition and whether it needs to be treated.

Types and Causes of Neutropenia

There are two main types of neutropenia: congenital and acquired. Each type has many causes.

  • Congenital neutropenia. These are the types that are present at birth. They are caused by certain rare genetic conditions, such as Kostmann’s syndrome.

  • Acquired neutropenia. This type is not present at birth. Causes include:

    • Certain medications, such as antibiotics and chemotherapy drugs

    • Certain autoimmune conditions

    • Certain viral, bacterial, or parasitic infections

    • Too little folate or vitamin B12 in the diet

    • Other causes

Diagnosing Neutropenia

Your doctor may check for neutropenia if you have frequent infections. Your doctor may also check for neutropenia if you’re having certain treatments, such as chemotherapy, which is known to cause a lower neutrophil count. Tests will be done to confirm the problem. These may include:

  • A complete blood cell count (CBC). This test measures the amounts of the different types of cells in your blood. This includes the WBCs. The WBC count can be broken down further to find the number of neutrophils and immature neutrophils (bands) in your blood. This is called an absolute neutrophil count (ANC).

  • A blood smear. This test checks for the different types of blood cells in your blood and how they appear. A sample of your blood is spread on a glass slide and viewed under a microscope. A stain is used so the blood cells can be seen.

  • A bone marrow aspiration and biopsy. This test checks for problems with how your bone marrow makes blood cells. A needle is used to remove a sample of the bone marrow in your hip bone. The sample is then sent to a lab to be tested for problems.

Treating Neutropenia

  • If there is a clear cause of neutropenia, it is addressed. For instance, if a medication is the cause, it may be stopped or changed.

  • For mild cases, often no treatment is needed. Your doctor monitors your symptoms to see if they improve. Blood tests are also done to see if your neutrophil count returns to normal on its own.

  • For moderate to severe cases, treatment is likely needed. This may include:

    • G-CSF (granulocyte-colony stimulating factor). This is a special type of protein. It helps promote the growth and activity of neutrophils. G-CSF is given by injection.

    • Bone marrow transplant. This treatment replaces diseased bone marrow cells with healthy cells from a matched donor. This treatment is only done in specific severe cases.

Long-Term Outcome of Neutropenia

The outcome of neutropenia varies for each person. For some people, neutropenia may resolve after a few weeks or months. For other people, neutropenia may be long-lasting. In these cases, it may require ongoing care and treatment. Your doctor will talk to you more about what to expect from your condition.

When to Call the Doctor

Call your doctor right away if you have any of the following:

  • Fever of 100.4°F or higher (call 911—this is especially important if you have severe neutropenia, which puts you at higher risk for life-threatening infection)

  • Cold sweat or chills

  • Chest pain or trouble breathing

  • Sore throat

  • Extreme tiredness or fatigue

  • Nausea and vomiting

  • Redness, warmth, or drainage from any open cuts or wounds

  • Pain or burning with urination; frequent urination

  • Pain, burning, or bleeding in the rectum

  • Severe constipation or diarrhea

  • Bloody stool or urine 

Reference: Cancer section on Better Medicine

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Your neutrophil counts generally start to drop about a week after each round of chemotherapy begins and usually reach a low point about 7 to 14 days after treatment.