Neutropenia is a low level of neutrophils in the blood. Neutrophils are a type of white blood cell. They help to fight infection.
There are 2 types of neutropenia:
- Acquired—Appears anytime after birth. It can happen quickly or grow slowly over time.
- Congenital—Present at birth.
White Blood Cells
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The body is always making new neutrophils. They replace old or damaged cells. Neutropenia happens when this system is not balanced. One or more of the following may be present:
- Higher destruction of white blood cells than normal
- Body uses up white blood cells to fight an infection
- Failure of bone marrow to make enough white blood cells
Acquired neutropenia may be caused by:
- Underlying inflammatory condition
- Certain medicines
- Illegal drug use
- Immune system problems
- Certain toxins
- Poor nutrition—mainly low protein intake
Congenital neutropenia is caused by a problem in the genes.
Risk of neutropenia is higher with:
- Chemotherapy to treat cancer
- Certain medicines such as antidepressants or antihistamines
- An infection
- Exposure to certain chemicals or radiation
- Immune system problems
- Low levels of vitamin B-12 or folate
- Bone marrow diseases
- Family history of certain genetic problems
Most people won’t have symptoms. Neutropenia can lead to an infection. This may cause:
- Fever or chills—may come on quickly
- Lack of strength
- Sore throat
Yellowish skin or whites of the eyes—
- Mouth sores
- Bleeding gums
- Mild infections of skin, mouth, and nose
- Poor weight gain in children
The doctor will ask about symptoms and past health. A physical exam will be done. Blood tests will show levels of blood cells and possible causes. Other tests may be needed to look for other causes.
Care is based on the cause and how serious the condition is. It may involve:
- Treat infections—either the cause or result of neutropenia
- Prevent infections in people who are at high risk
- Help the body make more white blood cells
Medicine may need to be changed or avoided. Toxins may also need to be identified and removed.
Most cannot be prevented. Some may have a high risk neutropenia. Regular testing to look for changes in neutrophil counts may help. Medicines can be given early to boost white blood cells.
Boulton F, Cooper C, Hagenbeek A, Inskip H, Leufkens HG. Neutropenia and agranulocytosis in England and Wales: incidence and risk factors. Am J Hematol. 2003;72(4):248-254.
Gibson C, Berliner N. How we evaluate and treat neutropenia in adults. Blood. 2014 Aug 21;124(8):1251.
Neutropenia—approach to the patient. EBSCO DynaMed website. Available at:https://www.dynamed.com/approach-to/neutropenia-approach-to-the-patient-24. Updated November 25, 2019. Accessed March 18, 2020.
Neutropenia and risk of infections. Centers for Disease Control (CDC) website. Available at: https://www.cdc.gov/cancer/preventinfections/neutropenia.htm. Updated Novemeber 20, 2019. Accessed March 18, 2020.
Last reviewed March 2020 by
EBSCO Medical Review Board
Michael J. Fucci, DO, FACC
Last Updated: 3/18/2020