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:

Infections
Underlying inflammatory condition
Chemotherapy
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 Factors

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

Symptoms

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— jaundice
Mouth sores
Bleeding gums
Mild infections of skin, mouth, and nose
Poor weight gain in children

Diagnosis

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.

Treatment

Care is based on the cause and how serious the condition is. It may involve:

Medicines to:

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.

Prevention

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.

RESOURCES:

Mouth Healthy—American Dental Association
https://www.mouthhealthy.org

NORD———National Organization for Rare Disorders
https://rarediseases.org

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca

The College of Family Physicians of Canada
http://www.cfpc.ca

REFERENCES:

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

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