MedFriendly®
Neutrophil (Low and High Levels)
A neutrophil under the
microscope.
A neutrophil is a type of mature (developed) white blood cell
that is present in the blood. White blood cells help protect
the body against diseases and fight infections.
Neutrophils are essential in protecting the body against
disease and infections by removing and destroying some
types of bacteria, wastes, foreign substances, and other
cells.
Neutrophils accomplish this by eating these substances.
They are the main type of white blood cell that protect the
body in this way.
Neutrophils are also essential for a process known as proteolysis, in which water is added
to bonds that make up proteins so that they can be broken down into smaller substances.
Proteins are extremely complex, naturally occurring substances made of amino acids that
are essential to the body's structure and function.
WHAT DOES IT MEAN THAT A NEUTROPHIL IS MATURE?
When a neutrophil is described as mature, this means it is developed. Before a neutrophil
becomes a neutrophil, it develops in the following stages, from the earliest stage to the
latest stage: 1) myeloblasts, 2) promyelocytes, 3) myelocytes, 4) metamyelocytes, 5) band
forms, 6) neutrophils. The earlier developmental forms are sometimes called immature
neutrophils.
WHAT ARE SOME OTHER NEUTROPHIL
CHARACTERISTICS?
A main characteristic of neutrophils is that they
have 3 to 5 round sections within them called
lobes that are connected by thin threads known as
chromatin. These lobes can be seen in a picture of
a neutrophil below. Neutrophils stain easily when
exposed to neutral dyes. Dyes are colored stains
that are used in laboratories, often to tell cells
apart from one another. Neutral dyes are made up
of salts that do not have an electric charge.
This lack of an electric charge is why these dyes are called neutral. The nucleus (central structure) of a
neutrophil stains dark purple/blue when exposed to a neutral stain. Another characteristic of neutrophils is
that their cytoplasm (a gel-like substance that fills up a cell) is light pink and mostly made of thin, difficult to
see, pink or purplish-pink grain-like particles. The light pink cytoplasm provides a strong contrast with the
dark colored nucleus.
WHERE ARE NEUTROPHILS MADE?
Neutrophils are made by the bone marrow (a tissue that fills the openings inside of bones). Neutrophils are
sometimes made outside of the marrow as well. After the neutrophils are formed, they are released into
the circulating blood.
WHAT PERCENT OF WHITE BLOOD CELLS ARE NEUTROPHILS?
Approximately 50% to 70% of white blood cells are neutrophils. Neutrophils are the most common type of
white blood cell. The amount of neutrophils on blood work tests is known as the ANC (absolute neutrophil
count). On most blood work tests, the ANC will be presented in terms of the amount of neutrophils per mm3
(cubic millimeters) of blood. See the next section for a description of cubic millimeters. The normal range
for the neutrophil count is 1500 to 8000. It is important to keep in mind that the ranges mentioned above
will be different depending on the machine used to do the blood test. Always use the normal range printed
on the lab report to decide what range is normal.
WHAT ARE CUBIC MILLIMETERS?
Cubic millimeters (abbreviated mm3) are extremely small units of measurement that cannot be seen with
the naked eye. To get an idea of how small a cubic millimeter is, consider the following. It takes 1000
cubic millimeters to get one cubic centimeter. It takes 1000 cubic centimeters to get one liter. A liter is a
measurement of the amount of space that a liquid takes up in a container, which is equal to 1.056688
quarts. To understand this better, picture a gallon of milk. It takes 4 quarts of milk to make up one gallon of
milk. Since one liter is a little bit more than one quart, 4 liters of milk is a little bit more than one gallon of
milk.
WHAT CAN CAUSE THE LEVEL OF NEUTROPHILS TO BE TOO HIGH?
There are many possible causes for an abnormally high neutrophil count. A neutrophil level that is more
than 8000 is considered to be abnormally high. One basic cause of a high neutrophil count is when a high
level of stress is placed on the body. The stress can due to many factors such as nervousness, exercise,
or seizures (involuntary muscle movements due to overexcitement of nerve cells in the brain). Another
cause is a sudden infection from bacteria. Damage or inflammation of tissues can also lead to a high
neutrophil count. Examples would be burn injuries and a heart attack.
Sudden kidney failure can cause a high neutrophil count. The kidneys are two organs located on each side
of the spine, behind the stomach. The kidneys filter (remove) wastes from the blood. A condition known as
ketoacidosis can also cause a high neutrophil count. Ketoacidosis is a condition in which acids and
poisonous chemical substances known as ketones are produced by the body. Ketones are produced when
the body has a difficult time breaking down fats.
Another cause of a high neutrophil count is eclampsia. Eclampsia is a rare, but serious complication of
pregnancy characterized by an attack of convulsions (abnormal, severe, involuntary muscle movements)
that are not caused by other conditions of the brain, such as bleeding in the brain, in a woman with
moderate or severe (but not mild) preeclampsia. Preeclampsia is a severe condition that occurs in the 2nd
half of pregnancy, which is characterized by a sudden onset of high blood pressure with edema (a type of
swelling), and/or abnormal amounts of protein in the urine.
A high neutrophil count can be caused by cancer spreading in the body. Cancer is a group of diseases in
which symptoms are due to an abnormal and excessive growth of cells in one of the body organs or
tissues.
Hemolytic anemia can cause a high neutrophil count. Hemolytic anemia is a condition in which the red
blood cells are destroyed earlier than they should be. Red blood cells help carry oxygen to the blood.
Another cause of a high neutrophil count is polycythemia vera. Polycythemia vera is a condition of
unknown cause in which there is a long-term increase in red blood cells and other types of cells. Myeloid
metaplasia can cause a high neutrophil count. Myeloid metaplasia is a condition in which bone marrow (a
tissue that fills the openings of bones) grows in abnormal places in the body.
Certain medications can also lead to a high neutrophil count. One such medication is corticosteroids.
Corticosteroids are a group of drugs that act similarly to a natural chemical in the body known as
corticosteroid hormone. Corticosteroid hormones control the body's use of nutrients and the amount of
water and salts in the urine (pee). Another such medication that can raise the neutrophil count is lithium
carbonate. Lithium carbonate is a type of salt that is used as a drug to reduces mania (an abnormal,
overly excited state).
WHAT CAN CAUSE THE LEVEL OF NEUTROPHILS TO BE TOO LOW?
There are many possible causes for an abnormally low neutrophil count. When the number of neutrophils
are abnormally low (less than 1500), this condition is known as neutropenia. Neutropenia can be caused
by a decreased production of neutrophils. A decreased production of neutrophils can be caused by
leukemia. Leukemia is a type of cancer in the blood in which bone marrow (a tissue that fills the openings
of bones) is replaced by early forms of white blood cells. See the previous section for a description of
cancer.
In leukemia, the level of neutrophil production decreases because they are crowded out of the bone
marrow by the early forms of white blood cells. A condition that occurs before leukemia, known as
preleukemia, can also cause an abnormal decrease in neutrophils. Another cause of a decreased
neutrophil count is myelofibrosis, in which the normal bone marrow is replaced by fibrous tissue (the
connective tissue of the body).
Another cause of decreased neutrophil production is damage to the bone marrow. Such damage can be
caused by infections, medications, and radiation (a type of energy often used to treat cancer). Bone
marrow destruction occurs in aplastic anemia. Aplastic anemia is a condition in which the there is an
abnormal decrease in the cells that make up blood (such as white blood cells) because the bone marrow is
not working properly to make these cells.
Besides decreased neutrophil production, another cause of a decreased neutrophil count is an increase in
the destruction of neutrophils. Such destruction can be caused by a severe bacterial infection that causes
the formation of pus or leads to bacteria increasing in the blood. Pus is a yellow or green creamy
substance sometimes found at the site of infections.
The body can actually produce proteins known as antineutrophil antibodies that destroy neutrophils. These
proteins are produced in autoimmune diseases in which the body mistakenly attacks itself. An example of
an autoimmune disorder that can cause an abnormal decrease in neutrophils is systemic lupus
erythematosus (abbreviated SLE). SLE is a long-term disease in which the connective tissues throughout
the body are inflamed because the body's defense system attacks these tissues as if they were foreign
substances.
Another condition that can cause a decrease in neutrophils is hypersplenism. Hypersplenism is a condition
in which there is an abnormal enlargement of the spleen and an abnormal decrease in white blood cells.
The spleen is an organ near the stomach that helps fight infection and removes and destroys worn-out red
blood cells. In a condition known as Felty's syndrome, an abnormal decrease in neutrophils is found.
Felty's syndrome is a group of abnormal changes (such as an enlarged spleen, frequent infections, and a
decreased white blood cell count) that accompanies rheumatoid arthritis. Rheumatoid arthritis is another
example of an immune disorder (see last paragraph) in which the body's defense system attacks its own
tissues, causing inflammation of bone joints.
Certain medications can cause an abnormal decrease in the neutrophil account. One such type of
medication are phenothiazines drugs, which are used to treat psychosis, allergies, and vomiting.
Psychosis is a mental disorder characterize by an impairment in the ability to understand reality. Another
type of drug that can cause an abnormally low neutrophil count is phenylbutazone, which is a drug used to
reduce inflammation in conditions such as arthritis (inflammation of bone joints).
Another cause of a low neutrophil count is too little vitamin B12 or folic acid (a type of vitamin) in the body.
A vitamin is one of a group of substances made up partly of carbon (an element) that are essential in small
amounts for normal bodily functioning and chemical processes in the body to take place.
Cardipolumonary bypass can lead to low neutrophil count. Cardiopulmonary bypass is a procedure used
during heart surgery in which the flow of blood is moved away from the heart and the lungs with a pump
and returned to the aorta. The aorta is the largest artery of the body. An artery is a blood vessel that
carries blood away from the heart.
Dialysis can cause a low neutrophil count as well. Dialysis is a technique in which one is hooked up to a
machine that performs the functions of the kidneys, removing wastes and extra water from the blood. The
kidneys are two organs located on each side of the spine, behind the stomach. The kidneys filter (remove)
wastes from the blood.
A rare cause of a decreased neutrophil count is Chediak-Higashi syndrome. This is a disorder found at
birth characterized by a massive decrease in white blood cells, movement abnormalities, pale skin, a pale
appearance in the back of the eye, an abnormal sensitivity to light, reoccurring infections, and early death.
DOES NEUTROPHIL HAVE ANY OTHER MEANINGS?
Yes. The word "neutrophil" is sometimes used in a more general sense to describe any cell or tissue that
does not show a special attraction to acid or bases (the opposite of acids). Thus, these types of cells are
neutral - that is, they have an attraction to dyes that are between acids and bases. See the previous
section for a discussion of dyes.
Other conditions that can cause an abnormally high neutrophil count include mononucleosis, hepatitis,
toxoplasmosis, and cytomegalovirus. Mononucleosis is suddenly occurring virus infection that is
characterized by an abnormal increase in a type of white blood cell in the blood. Hepatitis is an infection of
the liver that causes liver inflammation. The liver is the largest organ in the body and is responsible for
filtering (removing) harmful chemical substances, producing important chemicals for the body, and other
important functions. Toxoplasmosis is a type of infection of birds, reptiles, and other animals that can also
occur in humans. Cytomegalovirus is a type of virus that usually causes infections in the eye and the
stomach area.
Certain medications can also lead to a high neutrophil count. Two such medications are Dilantin and
mephenytoin, which are both anti-seizure medications. Seizures are involuntary muscle movements and/or
decreased environmental awareness due to overexcitement of nerve cells in the brain. High neutrophil
levels also occur after blood transfusions. A blood transfusion is a procedure in medicine in which blood
(usually from another person) is introduced into someone's bloodstream.
WHAT ELSE ARE NEUTROPHILS CALLED?
Neutrophils are also known as neutrophiles and band cells. They are also sometimes called neutrophilic
leukocytes or neutrophilic granulocytes.
WHAT IS THE ORIGIN OF THE TERM, NEUTROPHIL?
Neutrophil comes from the Latin word "neuter" meaning "neither," and the Greek word "philein" meaning "to
love." Put the two words together and you have "love neither." This is a reference to the fact that
neutrophils stain easy with neutral dyes. Dyes are colored stains that are used in laboratories, often to tell
cells apart from one another. Neutral dyes are made up of salts that do not have an electric charge. This
lack of an electric charge is why these dyes are called neutral.
