Neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation are an important component of the immune system Immune system The body's defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components. Primary Lymphatic Organs and play a significant role in the eradication of infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease. Low numbers of circulating neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation, referred to as neutropenia, predispose the body to recurrent infections Recurrent infections Common Variable Immunodeficiency (CVID) or sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock, though patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship can also be asymptomatic. Most causes of neutropenia are acquired, including neutropenia that is secondary to infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease, bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types marrow disorders, and/or adverse effects of many drugs. The diagnosis is made using CBC and peripheral blood smears. Management is aimed at preventing and treating infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease.
Last updated: 14 Sep, 2021
Neutropenia is a decrease in the number of circulating neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation in the blood, which is typically defined as an absolute neutrophil count (ANC) of:
Neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation are the most common of all the leukocytes Leukocytes White blood cells. These include granular leukocytes (basophils; eosinophils; and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). White Myeloid Cells: Histology. Leukocytes Leukocytes White blood cells. These include granular leukocytes (basophils; eosinophils; and neutrophils) as well as non-granular leukocytes (lymphocytes and monocytes). White Myeloid Cells: Histology are WBCs and are a major component of the immune system Immune system The body’s defense mechanism against foreign organisms or substances and deviant native cells. It includes the humoral immune response and the cell-mediated response and consists of a complex of interrelated cellular, molecular, and genetic components. Primary Lymphatic Organs.
Age group | Normal range (cells/µL) | Percent of WBCs that are neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation |
---|---|---|
At 1 day of life | 5000–21,000 | Approximately 60% |
At 1 month of life | 1000–9000 | Approximately 35% |
≥ 1 year of age | 1500‒8500 | Approximately 31% |
≥ 10 years of age | 1500–8000 | Approximately 40%–70% |
Scanning electron microscope images at different magnifications to demonstrate neutrophil extracellular traps (NETs):
The sections are from
Candida
Candida
Candida is a genus of dimorphic, opportunistic fungi. Candida albicans is part of the normal human flora and is the most common cause of candidiasis. The clinical presentation varies and can include localized mucocutaneous infections (e.g., oropharyngeal, esophageal, intertriginous, and vulvovaginal candidiasis) and invasive disease (e.g., candidemia, intraabdominal abscess, pericarditis, and meningitis).
Candida/Candidiasis albicans–infected mouse
lungs
Lungs
Lungs are the main organs of the respiratory system. Lungs are paired viscera located in the thoracic cavity and are composed of spongy tissue. The primary function of the lungs is to oxygenate blood and eliminate CO2.
Lungs: Anatomy 24 hours after intranasal challenge.
A: A bronchiole (b) colonized with C. albicans and infiltrated by host immune cells
B: High-resolution image of boxed area from panel A shows respiratory
epithelium
Epithelium
The epithelium is a complex of specialized cellular organizations arranged into sheets and lining cavities and covering the surfaces of the body. The cells exhibit polarity, having an apical and a basal pole. Structures important for the epithelial integrity and function involve the basement membrane, the semipermeable sheet on which the cells rest, and interdigitations, as well as cellular junctions.
Surface Epithelium: Histology of the bronchiole colonized with C. albicans
yeast
Yeast
A general term for single-celled rounded fungi that reproduce by budding. Brewers’ and bakers’ yeasts are saccharomyces cerevisiae; therapeutic dried yeast is yeast, dried.
Mycology forms (arrow) and
hyphae
Hyphae
Microscopic threadlike filaments in fungi that are filled with a layer of protoplasm. Collectively, the hyphae make up the mycelium.
Mycology (arrowhead).
C: High-resolution image of boxed area from panel B shows NETs covering fungal surfaces (arrow).
Scale
Scale
Dermatologic Examination bar in A = 100 µm, in B = 10 µm, and in C = 2 µm
Wright stain of a
peripheral blood smear
Peripheral Blood Smear
Anemia: Overview and Types showing 5 normal, mature
neutrophils
Neutrophils
Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Innate Immunity: Phagocytes and Antigen Presentation (polymorphonuclear cells):
Note that each neutrophil has a dense
nucleus
Nucleus
Within a eukaryotic cell, a membrane-limited body which contains chromosomes and one or more nucleoli (cell nucleolus). The nuclear membrane consists of a double unit-type membrane which is perforated by a number of pores; the outermost membrane is continuous with the endoplasmic reticulum. A cell may contain more than one nucleus.
The Cell: Organelles arranged into 2–5 lobes and pale pink-blue cytoplasm. The fine granularity of the cytoplasm can only be appreciated at higher magnification. The life span of
neutrophils
Neutrophils
Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Innate Immunity: Phagocytes and Antigen Presentation in the blood is 6–10 hours.
Prevalence Prevalence The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. Measures of Disease Frequency:
Neutropenia may occur as an isolated feature or in association with other hematologic abnormalities and/or bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types marrow defects (e.g., megaloblastic anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types or leukemia).
Mature
neutrophils
Neutrophils
Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Innate Immunity: Phagocytes and Antigen Presentation are produced by precursors in the
bone
Bone
Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy.
Bones: Structure and Types marrow.
Neutrophils
Neutrophils
Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Innate Immunity: Phagocytes and Antigen Presentation can be found in three compartments:
Neutropenia is most commonly acquired, often after infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease or as a side effect of a number of different medications. Rarely, neutropenia may be “primary” or congenitally inherited as part of a less common syndrome.
Some medications, including many chemotherapy Chemotherapy Osteosarcoma agents, produce predictable dose-dependent myelosuppression Myelosuppression Oxazolidinones. Many other medications are associated with severe isolated neutropenia (known as idiosyncratic drug reactions (IDRs)), typically occurring within 3 months after starting the medication.
Medications associated with myelosuppression Myelosuppression Oxazolidinones (partial list, includes many chemotherapy Chemotherapy Osteosarcoma and immunosuppressive agents):
Medications associated with IDR neutropenia (partial list, most common are in bold):
Neutropenia is associated with multiple rare syndromes. Examples include:
Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with neutropenia will either be asymptomatic, present with infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease, or present with symptoms associated with the underlying cause of their neutropenia.
The primary symptoms related directly to neutropenia involve infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease. Viral infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease may cause neutropenia, while patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with moderate to severe neutropenia are more likely to develop a bacterial or fungal infection. Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship with neutropenia may present with:
Most common organisms causing recurrent, opportunistic, and/or serious infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease:
Clinical findings will depend on the location of infection and causative organism and most commonly may include:
Note: Patients Patients Individuals participating in the health care system for the purpose of receiving therapeutic, diagnostic, or preventive procedures. Clinician–Patient Relationship are not at increased risk for viral or parasitic infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease, as these infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease are not neutralized by neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation.
Peripheral blood smear Peripheral Blood Smear Anemia: Overview and Types for a patient with systemic lupus erythematosus Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus ( SLE SLE Systemic lupus erythematosus (SLE) is a chronic autoimmune, inflammatory condition that causes immune-complex deposition in organs, resulting in systemic manifestations. Women, particularly those of African American descent, are more commonly affected. Systemic Lupus Erythematosus) showing a paucity of neutrophils Neutrophils Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes. Innate Immunity: Phagocytes and Antigen Presentation
Image: “ Peripheral blood smear Peripheral Blood Smear Anemia: Overview and Types” by Melissa Zhao. License: CC BY 4.0Other tests to consider based on clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor include:
Management depends on the cause and degree of the neutropenia.
Neutropenic fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever is the most common life-threatening complication of cancer therapy.