What is a normal level of neutrophils

• Normal Neutrophil Count
  • What Are Neutrophils?
• Neutrophilia Conditions
  • What Does It Mean When Your Neutrophils Are High?
• Guide
  • What Does It Mean When Your Neutrophils Are High? Topic Guide

What Are Neutrophils?

A high neutrophil count or white blood cell count can indicate a variety of diverse conditions, no all of which are harmful. The test must be done in conjunction with other diagnostic measures to determine a diagnosis.

Neutrophils are a type of white blood cell that helps the body fight infections and heal injured tissues. 

Neutrophils are produced in the bone marrow, and they make up 55 to 70 percent of the total white blood cell count.

What Is a Normal Neutrophil Count?

An absolute neutrophil count (ANC) blood test may be ordered along with a complete blood count (CBC) test with differential. 

• Low levels of neutrophils are below 1.5 mcL or less than 45 percent of total white blood cells
  • If levels are between 1.0 to 1.5 mcL, it is considered mild
  • If levels are between 0.5 and 1.0 mcL, it is considered moderately low 
  • Levels of less than 0.5 mcL are considered severe low levels of neutrophils 
• Normal adult levels of neutrophils are about 1,500 to 8,000 or 1.5 to 8.0 neutrophils per microliters (mcL)
• High levels of neutrophils are more than 8000 neutrophils per mcL or 8.0 mcL

What Does It Mean When Your Neutrophils Are High?

High levels of neutrophils in the blood are called neutrophilic leukocytosis or neutrophilia.

Causes of high levels of neutrophils in the blood (neutrophilia) include:

• Infections
  • Bacterial
  • Viral
  • Fungal
• Inflammatory conditions 
  • Rheumatoid arthritis
  • Inflammatory bowel disease (IBD) - Crohn's disease, ulcerative colitis
  • Chronic hepatitis
  • Vasculitis
  • Kawasaki disease 
  • Adult Still's disease
  • Granulomatous infections
  • Bronchiectasis
• Certain medications
  • Catecholamines
  • Glucocorticoids
  • Myeloid growth factors
  • Plerixafor
  • Lithium
  • ATRA
  • Beta-2-agonists
  • Epinephrine
• Smoking tobacco
• Stress 
  • Exercise
  • Heat stroke
  • Surgery
  • Seizures
  • Emotional stress
• Obesity
• Seizures
• Endocrine disorders 
  • Thyroid storm
  • Hypercortisolism
• Pregnancy-associated conditions
  • Eclampsia
  • Post-partum state
• Certain cancers
  • Chronic myeloid leukemia (CML) 
  • Juvenile myelomonocytic leukemia (JMML) 
  • Other myeloproliferative neoplasms — polycythemia vera, essential thrombocythemia, chronic myelomonocytic leukemia, and chronic neutrophilic leukemia
  • Nonhematologic malignancy
• Genetic conditions 
  • Down syndrome
  • Leukocyte adhesion deficiency (LAD)
  • Chronic neutrophilic leukemia (CNL)
  • Cryopyrin-associated periodic syndromes 
• Injuries
• Accidents
• Surgical removal of the spleen

QUESTION

References

Medscape Medical Reference

Description

Differential blood count can be performed by the following 2 methods:

• Automated differential blood count: Automated hematology instruments using multiple parameters and methods (such as fluorescence flow cytometry and impedance) are used to count and identify the 5 major white blood cell types in blood (so-called 5-part differential count): neutrophils, lymphocytes, monocytes, eosinophils and basophils. [4, 5]

• Manual differential blood count: This is performed by visual examination of peripheral blood smear (blood films) by trained personnel. [4]

The automated differential blood count is less time-consuming and less expensive than routine examination of blood smear. With the automated technique, thousands of white blood cells can be examined, whereas typically 100-200 white blood cells are examined by visual examination. [6]

Indications/Applications

Differential blood count is primarily needed in the 2 following reasons. [2]

• To look for quantitative abnormalities in morphologically normal WBC population such as in the diagnosis of infectious or allergic diseases and for therapeutic monitoring of cytotoxic or myelotoxic drugs (This requires a high level of precision and accuracy [ie, ability to provide consistent and correct results]).

• To look for morphologic abnormalities of white blood cells (eg, when circulating abnormal white blood cell population such as immature or atypical cells are suspected for diagnostic or monitoring reasons; this requires a high level of clinical sensitivity, [ie, ability to identify all patients who have circulating abnormal WBCs]).

Considerations

Accuracy, precision, and clinical sensitivity

The automated differential blood count provides a high level of accuracy and precision (correct and consistent results) for quantification and identification of normal white blood cells; however, this method is not sensitive at identifying abnormal or immature cells and is not able to accurately identifying and classifying all types of white blood cells. To overcome this problem, most automated analyzers will flag samples with possible abnormal white blood cell populations, indicating the need for peripheral smear examination to be examined by trained personnels to identify abnormal cells. [6, 2]

Monocyte count and basophil count are the most difficult population to count and have a low level of precision and accuracy. Moreover, automated analyzers tend to underestimate the basophil count during true basophilia. [2]

False negative

Both automated and manual methods may not detect small numbers of abnormal cells. The false negative rate for detection of abnormal cells varies from 1-20%, depending on the instrument and the detection limit desired (1-5% abnormal cells). The most difficult for both automated instruments and visual examination by human is identification of lymphoma cells and reactive lymphocytes. [5]

Band neutrophils and immature granulocytes (IGs)

The value of reporting band neutrophils is questionable. The measurement of the immature cells of the myeloid lineages, specifically “band,” has been considered clinically useful in the diagnosis of infections, especially neonatal sepsis. [7]

However, band neutrophils cannot be enumerated by automated analyzers and are reported together with segmented neutrophils as absolute neutrophil counts (ANC), which are used to defined neutropenia or neutrophilia. Identification of band neutrophils by visual examination (manual differential blood count) is neither precise nor consistent, as a high variability of morphologic classification or quantification of band neutrophils exists due to interobserver variability.

Some, therefore, advocated ceasing quantitative reporting of band neutrophils. [5, 2] The extended differential count includes reporting immature granulocytes (IG) can be used alternatively to help diagnosis neonatal sepsis. [2] For further reading, see Interpretation.

What does higher than normal neutrophils mean?

What percent of lymphocytes is normal?

What level of neutrophils is high?

What is a normal monocyte count?