Neutropenia: What it, Types, Causes and Treatment

Learn about neutropenia, its types, causes & treatments. GetWellGo guides international patients to expert care with trusted hospitals & specialists.

Neutropenia: What it, Types, Causes and Treatment

  • Category

    General

  • Published By

    GetWellGo Team

  • Updated on

    13-Jun-2025

What is neutropenia?

Neutropenia is an abnormally low count of neutrophils, a type of white blood cell that has a major role to play in combating bacterial and fungal infections. Neutrophils are components of the immune system and are vital in protecting the body from pathogens.

Normal Neutrophil Count

  • A normal absolute neutrophil count (ANC) is: 1,500 to 8,000 cells per microliter (µL) of blood.

Neutropenia is typically defined as:

  • Mild: ANC 1,000–1,500/µL
  • Moderate: ANC 500–1,000/µL
  • Severe: ANC <500/µL

Neutropenia causes

Bone marrow problems

  • Aplastic anemia
  • Leukemia or myelodysplastic syndromes

Cancer treatments

  • Chemotherapy or radiation therapy

Autoimmune diseases

  • Lupus, rheumatoid arthritis

Infections

  • Viral infections (e.g., hepatitis, HIV, influenza)

Medications

  • Antibiotics (e.g., penicillin, sulfa drugs)
  • Antipsychotics, anticonvulsants

Nutritional deficiencies

  • Vitamin B12, folate, or copper deficiency

Congenital (inherited) disorders

  • Kostmann syndrome
  • Cyclic neutropenia

Types of neutropenia

Types of Neutropenia are divided by cause, duration, and severity. Knowing the type directs diagnosis and treatment.

Congenital Neutropenia (Inherited)

  • Present at birth due to genetic defects in the production or survival of neutrophils.

Severe Congenital Neutropenia (SCN):

  • Example: Kostmann syndrome
  • ANC <200/μL, with early onset of infections
  • Increased risk of leukemia

Cyclic Neutropenia:

  • Neutrophil level falls every ~21 days, then recovers
  • Symptoms: recurring fevers, mouth ulcers, infections

Shwachman-Diamond Syndrome:

  • Involves bone marrow, pancreas, and skeletal system
  • Related to neutropenia and other cytopenias

Acquired Neutropenia

  • Develops later in life due to external causes or illnesses.

Drug-Induced Neutropenia:

  • Due to antibiotics (e.g., sulfa drugs), antipsychotics, anticonvulsants, or chemotherapy
  • Reversible upon discontinuation of the drug

Infection-Related Neutropenia:

  • Viral infections (e.g., HIV, hepatitis, EBV, CMV, influenza) suppress bone marrow
  • Typically transient (transient neutropenia)

Autoimmune Neutropenia:

  • Body produces antibodies against neutrophils
  • Found in systemic lupus erythematosus (SLE), rheumatoid arthritis
  • Can be chronic (particularly in children) or secondary to autoimmune diseases

Idiopathic Neutropenia:

  • Cause unknown despite extensive workup
  • Often chronic but stable, particularly in adults

Febrile Neutropenia

  • Medical emergency: neutropenia + fever (>100.4°F / 38°C)
  • Prevalent in cancer patients undergoing chemotherapy
  • High risk of severe infection
  • Needs immediate antibiotics and hospitalization

Chronic vs Acute Neutropenia

Acute Neutropenia:

  • Duration days to weeks
  • Mostly due to infections or medications

Chronic Neutropenia:

  • Remains >3 months
  • May be congenital, autoimmune, or idiopathic

Ethnic/Benign Neutropenia

  • Prevalent among individuals of African, Middle Eastern, or Caribbean ancestry
  • Mild chronic neutropenia (ANC 1,000–1,500/μL)
  • Not linked with elevated risk of infection

Neutropenia symptoms

Neutropenia by itself will not necessarily create direct symptoms, but it causes an impaired immune system, predisposing the body to infection. The symptoms are primarily caused by these infections, particularly when neutrophil counts decrease drastically.

Common Symptoms

These tend to indicate that an infection has occurred as a result of neutropenia:

  • Fever (≥100.4°F / 38°C) — most critical indication
  • Chills or perspiration
  • Sore throat
  • Sores in the mouth or sore gums
  • Swollen lymph nodes
  • Skin infection or rashes
  • Burning or discomfort upon urination
  • Shortness of breath or cough
  • Abdominal pain or diarrhea
  • Weakness and fatigue

Neutropenia treatment

Neutropenia management overview

Treatment for neutropenia is based on:

  • Severity (mild, moderate, or severe)
  • Cause (drug-induced, congenital, cancer-related, autoimmune, etc.)
  • Infection or fever status
  • Duration (acute vs. chronic)

Treat the Underlying Cause

  • Discontinue the offending drug (in drug-induced neutropenia)
  • Treat infection (antivirals, antibiotics, antifungals if infection-related)
  • Correct nutritional deficiencies (e.g., Vitamin B12, folate, copper)
  • Treat autoimmune disease (e.g., corticosteroids or immunosuppressants in lupus)

Medications to Stimulate Neutrophil Production

  • G-CSF (Granulocyte Colony-Stimulating Factor)
  • Examples: Filgrastim (Neupogen), Pegfilgrastim (Neulasta)
  • Used particularly in chemotherapy-induced or congenital neutropenia
  • Stimulates the bone marrow to form neutrophils
  • Usually administered as injections

Antibiotics and Antifungals

  • Empirical broad-spectrum antibiotics are initiated immediately in febrile neutropenia
  • Antifungal drugs if fever continues after 4–7 days and neutropenia is prolonged
  • Prophylactic antibiotics can be employed in chronic or chemotherapy-induced cases

Bone Marrow or Stem Cell Transplant

  • Reserved for severe congenital neutropenia or myelodysplastic syndromes
  • Also used if neutropenia turns into leukemia or fails to improve with G-CSF

Immunoglobulin Therapy (IVIG)

  • Occasionally used in autoimmune neutropenia or recurrently infecting patients

Supportive Care

  • Prevent raw foods, crowds, or ill individuals
  • Good hand washing, oral hygiene, skin hygiene
  • Protected isolation in the hospital during times of crisis
  • Vaccines (non-live vaccines if indicated)

Neutropenia in cancer patients

Neutropenia is a frequent and dangerous side effect of cancer and its treatment, notably chemotherapy. It renders patients highly susceptible to life-threatening infections, and it is an important aspect of cancer care to control it.

Why Does It Happen?

  • Chemotherapy medications destroy quickly growing cells — including cells that make neutrophils in bone marrow.
  • Radiation treatment, particularly to the pelvis, chest, or whole body, can also dampen bone marrow.
  • Cancer itself, such as leukemia or lymphoma, may invade the bone marrow and compromise neutrophil production.

Effects of Neutropenia in Cancer Patients

  • Febrile Neutropenia (FN): Neutropenia + fever (≥38°C / 100.4°F)
  • Emergency situation.
  • May indicate severe underlying infection with minimal observable symptoms.

Treatment delay or dose reduction:

  • In order to enable recovery of neutrophil levels, resulting in potential less than optimal efficacy of cancer treatment.

Neutropenia diagnosis

Diagnosis of neutropenia consists of assessing a patient's white blood cell (WBC) count—more precisely, the absolute neutrophil count (ANC)—and determining the etiology. 

Blood Tests

  • Complete Blood Count (CBC) with Differential
  • Most critical initial test.

Measures:

  • Total WBC count
  • Neutrophil percentage (and other white cells)

Other Blood Tests (dependent on suspected cause)

Peripheral blood smear

  • To inspect the shape, maturity, and type of white cells.

Vitamin and mineral levels

  • (e.g., Vitamin B12, folate, copper)

Viral serologies

  • To identify viruses such as HIV, EBV, CMV, hepatitis

Autoimmune markers

  • (e.g., ANA, RF) in case of suspected autoimmune neutropenia

Bone marrow biopsy

Indicated if:

  • Chronic or unexplained neutropenia
  • Suspected leukemia, myelodysplasia, or aplastic anemia
  • Evaluates marrow cellularity and precursors to neutrophils

Genetic testing

  • In case of congenital neutropenia (e.g., Kostmann syndrome)
  • Particularly in children or chronic unexplained neutropenia

Blood cultures / infection work-up

  • If patient presents with fever or infection
  • Comprises urine, throat, sputum, or wound cultures

Neutropenia in chemotherapy

Chemotherapy-induced neutropenia is the most frequent and severe side effect of cancer treatment. Neutropenia increases the risk of infection and may delay or reduce chemotherapy doses, affecting outcomes in cancer.

Why Does Chemotherapy Induce Neutropenia?

  • Chemotherapy attacks rapidly growing cells — cancer cells and normal cells in the bone marrow.
  • Neutrophils, which have a short life span (~6–8 hours in blood), are hit especially hard.
  • Thus, Absolute Neutrophil Count (ANC) decreases, usually 7–14 days after chemo.

Clinical Implications

Febrile Neutropenia (FN)

  • Fever ≥38.3°C (101°F) once or ≥38.0°C (100.4°F) for ≥1 hour
  • ANC <500 cells/µL (or projected to decrease <500 within 48 hours)
  • Requires immediate IV antibiotics
  • Can cause sepsis, hospitalization, or death

Treatment Dose Reductions or Delays

  • Can undermine cancer treatment effectiveness (e.g., in curative-intent therapies)

Factors Affecting Neutropenia infection risk

  • Severity of neutropenia
  • Duration of neutropenia
  • Disruption of barriers
  • Comorbid conditions
  • Hospital vs community
  • Use of immunosuppressants

How to increase neutrophils?

Raising neutrophil levels is based on the etiology of neutropenia. Measures involve medical therapy, lifestyle support, and treatment of causative factors.

Drugs to Promote Neutrophil Production

  • Granulocyte Colony-Stimulating Factors (G-CSFs)
  • They are the standard of care in drug- or chemotherapy-induced neutropenia.

Treat Underlying Conditions

  • Vitamin deficiencies: Correct B12, folate, copper deficiency
  • Infections: Treat HIV, TB, hepatitis, EBV
  • Drug-induced neutropenia: Stop offending agents (e.g., clozapine, carbimazole)
  • Autoimmune neutropenia: Try steroids or immunosuppressive drugs
  • Bone marrow failure (e.g., aplastic anemia): May need bone marrow transplant or immunotherapy

Nutrition Support

No single food directly increases neutrophils appreciably, but overall good nutrition maintains immune status.

  • Vitamin B12: Meat, eggs, dairy
  • Folate: Leafy greens, beans, citrus fruits
  • Copper & Zinc: Nuts, seeds, shellfish, whole grains
  • Protein: Lean meat, legumes, tofu

Lifestyle and Prevention

  • Avoid alcohol & smoking: They suppress bone marrow
  • Regular sleep & stress reduction: Chronic stress and fatigue reduce immunity
  • Prevent infections: Vaccination, hygiene, avoiding ill contacts

Experimental or Specialized Therapies

  • Eltrombopag: In certain marrow failure syndromes
  • Immunoglobulins (IVIG): In autoimmune neutropenia (exceptional cases)
  • Stem cell transplant: In severe congenital or marrow-failure neutropenia

Why Choose GetWellGo for Neutropenia Treatment?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

  • Complete transparency
  • Fair costs.
  • 24 hour availability.
  • Medical E-visas
  • Online consultation from recognized Indian experts.
  • Assistance in selecting India's top hospitals for neutropenia treatment.
  • Expert haematologist with a strong track record of success
  • Assistance during and after the course of treatment.
  • Language Support
  • Travel and Accommodation Services
  • Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
  • Local SIM Cards
  • Currency Exchange
  • Arranging Patient’s local food
     

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