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Neutrophil Count
Aka: Neutrophil Count, Neutrophil, Absolute Neutrophil Count, Neutrophilic Leukocyte, Polymorphonuclear Leukocyte, PMN, PMN Count, Neutrophilia, Stress Leukocytosis, Band Neutrophil, Left Shift, Demargination
- Definitions
- Left Shift
- Increased number of immature Neutrophils (band forms)
- Suggests acute inflammation
- Characteristics
- Forms in Bone Marrow from Myeloblasts as with other Granulocytes (Basophils, Eosinophils, Monocytes)
- Function: Primary defense against Bacterial Infection
- Phagocytizes and digests microorganisms
- Responds to several sources of chemotaxins
- Macrophage released Interleukin
- Basophil and Mast Cell released Histamine
- C-Reactive Protein Induced Complement Activation
- Morphology on Blood Smear
- Granulocyte with neutral staining on Wright Stain
- Nucleus with 3 to 5 lobes connected by thin chromatin
- Cytoplasm with fine granules
- Interpretation: Normal Count
- Range: 50-70% of White Blood Cells
- Bands: 2-6% of White Blood Cells
- Absolute Neutrophil Count (ANC) >1500 Neutrophils/mm3
- Causes: Decreased Neutrophils
- See Neutropenia
- Causes: Increased (Neutrophilia) - ANC > 7500/mm3
- Acute Bacterial Infection (and other infections)
- Reactive Neutrophilia (Physiologic Increase, Demargination)
- Release of cells in marginal pool
- Mediated by stress (Stress Leukocytosis)
- Exercise
- Seizures
- Anxiety
- Epinephrine
- Tobacco use
- Post-operative state
- Tissue Injury
- Myocardial Infarction
- Burn Injury
- Hypersensitivity Reaction
- Chronic Inflammation
- Rheumatic disease
- Inflammatory Bowel Disease
- Vasculitis
- Chronic Hepatitis
- Metabolic condition
- Acute Renal Failure
- Eclampsia
- Ketoacidosis
- Myeloproliferative disorder
- Myelocytic Leukemia
- Myeloid metaplasia
- Polycythemia Vera
- Miscellaneous causes
- Hemolytic Anemia
- Acute Hemorrhage
- Splenectomy (Leukocytosis may persist for months)
- Immune Thrombocytopenia
- Neoplasms
- Metastatic cancer
- Congenital
- Down Syndrome
- Leukocyte adhesion deficiency
- Medications
- Corticosteroids
- Lithium
- Beta agonists
- Epinephrine
- Colony-Stimulating Factors
- Evaluation: Neutrophilia (Neutrophils >7000/mm3)
- See Leukocytosis
- Consider history and potential causes
- Travel and contagious contacts
- Social history
- New medications
- Diagnostics (consider)
- Infection source evaluation
- Urinalysis
- Chest XRay
- Lumbar Puncture
- Blood Cultures (2 sets or if SBE suspected, 3 sets)
- Acute phase reactants
- Erythrocyte Sedimentation Rate (ESR)
- C-Reactive Protein (C-RP)
- Procalcitonin
- Other labs
- Rheumatologic studies (e.g. Antinuclear Antibody)
- References
- Wilson (1991) Harrison's Medicine, McGraw, p. 360-1
- Riley (2015) Am Fam Physician 92(11):1004-11 [PubMed]