If the neutrophil count is over 7500/mm3 in the complete blood count, it is called neutrophilia. Neutrophils are one of the white blood cells (leukocytes) in the blood. The most frequently increased cells of leukocytosis, which is expressed as an increase in leukocytes, are neutrophils.

Increase in the number of neutrophils in the blood, Neutrophilia

If the neutrophil count is over 7500/mm3 in the complete blood count, it is called neutrophilia. Neutrophils are one of the white blood cells (leukocytes) in the blood. The most frequently increased cells of leukocytosis, which is expressed as an increase in leukocytes, are neutrophils. Neutrophils are also sometimes called granulocytes. An increase in the number of neutrophils in the blood is most often a finding that develops in response to inflammation. The neutrophil count in a complete blood count is simply the number of neutrophils in the bloodstream. Whereas, neutrophils accumulate in the bone marrow, blood, tissues, and margination sites, which are the transition stage from blood to tissues.



The increase in the number of neutrophils can occur at any stage of production and use. These stages are:

  • Increased production in the bone marrow
  • acceleration of release from the bone marrow
  • Remaining in high amounts in the blood as a result of decreased transfer from blood to tissues
  • Passage of neutrophils in the tissues and marginal pool into the blood

Neutrophils develop by differentiating from the same progenitor cell with cells of erythrocytes, megakaryocytes, eosinophils, basophils and monocytes in the blood. Progenitor cell proliferation is stimulated by IL-3 and GM-CSF proteins. The G-CSF protein initiates and accelerates their maturation. Each cell in the blood has different proteins that coordinate which to increase and which to decrease.



Neutrophil production increases in the presence of inflammatory stimuli. If needed, the number of neutrophils in the circulation can increase 2-3 times in 4-5 hours with the release of the depot in the bone marrow.

The reasons for an increase in the number of neutrophils in the blood may be increased production (reactive increase, myeloproliferative increase), decreased secretion (ethioholanolone, endotoxin), decreased margination to tissues (epinephrine) or decreased passage from blood to tissues (adrenal steroids, prednisolone).

The most common causes of neutrophilia are:

  • False increase
    • Platelet aggregation
    • Cryoglobulinemia
  • Primary increase
    • Hereditary neutrophilia
    • Chronic idiopathic neutrophilia
    • Myeloproliferative diseases (such as CML, CNL, PV)
    • Familial myeloproliferative diseases
    • Congenital anomalies and leucomoid reaction
    • Down Syndrome
    • Lack of Leukocyte Adhesion
  • Secondary increases
    • Infection, inflammation
    • Poisonings
    • Hypoxia
    • Stress (physical, emotional, heavy exercise, post-surgery, trauma, electric shock, etc.)
    • Myocardial infarction
    • Cigarette
    • Medicines
      • Steroids
      • Eepinephrine
      • Lithium
      • ATRA
      • G-CSF
      • GMCSF
    • Solid Tumors
    • Heat stroke
    • Bone marrow stimulation (such as hemolysis)
    • Past spleen surgeries (Asplenia and hyposplenia)
    • Having a new vaccine
    • Snake bite
    • Pregnancy or birth

In patients with increased neutrophils, peripheral smear is definitely confirmed and pseudoleukocytosis is ruled out. Because, sometimes during laboratory studies, aggregation of platelets during the waiting period of blood can be perceived as an increase in neutrophils in devices. Sometimes, an increase may be detected due to device-related reasons. For these reasons, the blood sample should be examined with a microscope and counted again.



The increase in neutrophils is evaluated together with other accompanying symptoms. For example, signs of infection may become symptomatic or aggravated. At the same time, the increase or decrease of other cells in the blood will also be evaluated together as it will affect the interpretations about the reasons for the increase in neutrophils. Since medical intervention may be required as a result of these evaluations, if there is such an increase in your hemogram test, you should definitely consult your doctor.

Decreased neutrophil count in blood, Neutropenia

Neutropenia is the most common type of leukopenia. It is also referred to as granulocytopenia. It is when the neutrophil count in the blood is below 1500/mm3. Under normal conditions, the production of neutrophils in the bone marrow is very rapid. More than 100 billion neuforils are produced per day. However, the lifespan of neutrophils is very short, 6-8 hours. Infections and inflammation, extreme stress, vigorous exercise, high levels of adrenaline and epinephrine accelerate neutrophil production.

The body’s resistance is directly related to the number of neutrophils in the blood. Body resistance is normal when the neutrophil count in the blood is more than 1500/mm3. In the presence of blood neutrophil count between 1000-1500, body resistance is slightly impaired. In the presence of 500-1000 neutrophil counts, body resistance is moderately impaired. In the presence of less than 500 neutrophils, body resistance is severely impaired.



Neutropenia increases the body’s susceptibility to infections. The symptoms that occur in the defense of the body that encounters the infection occur less frequently. Diseases such as meningitis or pyuria that develop suddenly in the patient may occur by passing the stage of symptoms quickly.

Neutropenia is a health emergency and requires prompt medical attention. The most common clinical picture in patients with neutropenia may be aplastic anemia, acute leukemia or drug-induced agranulocytosis.

Neutropenia is often seen with low levels of other blood cells. Anemia and thrombocytopenia are common. Their coexistence is called pancytopenia. Pancytopenia may also develop in cases of aplastic anemia or acute leukemia. These situations occur due to interrelated mechanisms.

What are the causes of neutropenia?

  • Disturbances in the proliferation of neutrophils
    • Damages and conditions affecting the bone marrow
      • Radiation
      • Medicines
        • Anticancer drugs
        • Antiviral drugs
        • Corticosteroids
        • Phenothiazines
        • Ampicillin
        • Methicillin
        • Sulfonamides
        • Procainamide
        • Antithyroid agents
      • Paroxysmal nocturnal hemoglobinuria
      • Hepatitis
      • Chemicals
        • Benzene
        • DDT
        • Arsenic
        • Bismuth
      • Inflammatory states of the bone marrow
        • Infections
          • Hepatitis
          • Parvovirus infection
          • AIDS
          • Tuberculosis
          • Mycoplasmas
        • Acute and chronic leukemias
        • Cancer and its metastases
        • Fibrosis of the bone marrow
        • Agnogenic myeloid metaplasia
        • Late polycythemia vera
        • Granulomatous infiltrates
        • Tuberculosis
      • Defects in maturation of neutrophils
        • Vitamin B12 deficiency
        • Folate deficiency
      • Disturbances in the distribution of neutrophils
        • Endotoxins (after severe bacterial infections)
        • Severe protein-energy malnutrition
        • Complement-mediated leukoagglutination in the lungs
      • Hereditary conditions
        • Cyclic neutropenia
        • Severe congenital neutropenia (Kostman syndrome)
        • Shwachman-diamond syndrome
      • Rapid destruction of neutrophils
        • Severe sepsis
        • Excessive use of neutrophils with anaphylaxis
        • Medicines
          • Phenylbutazone
          • Sulfonamides
          • Chlorpromazine
          • Chlorpromazides
        • Autoimmune diseases (for example Felty syndrome)
        • Diseases that cause excessive destruction of the spleen

 

 


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