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Absolute Neutrophil Count and Neutropenia

The absolute neutrophil count (ANC) is an estimate of the body’s ability to fight infections, especially bacterial infections. These test results are often referred to as a patient’s “counts.”

An ANC measures the number of neutrophils in the blood. A neutrophil is a type of white blood cell that kills bacteria.

A lower than normal number of neutrophils (lower than 500) is called neutropenia (noo-truh-PEE-nee-uh).

Lower than 100 is severe neutropenia.

The lower a person’s ANC is, the higher the risk of getting an infection.

For a cancer patient, an infection can be life-threatening and requires immediate medical attention.

Causes of Neutropenia

Cancer treatments such as chemotherapy can reduce a patient’s ANC and cause neutropenia. It is a common side effect. Chemotherapy usually affects a patient’s ANC 7-14 days after it is received. The length of time it takes neutrophil counts to drop depends on the dose and type of medicine.

Cancers that affect the bone marrow, such as leukemia and lymphoma, can also cause a low level of neutrophils.

In some cases, radiation can cause a drop in neutrophils.

Calculating ANC

Neutrophils are counted as part of the complete blood count (CBC) test.

Risk of Infection ANC Value
Highest Lower than 500
Moderate 500-1,000
Lower More than 1,000

On most blood count reports, the ANC is already calculated. To determine the ANC, multiply the WBC (white blood cell count) by the percent of segmented neutrophils (shortened to “segs”) and bands.

One section of the lab report will state the total white blood cell (WBC) count and a "differential," in which each type of white blood cell is listed as a percentage of the total. For example, if the total WBC count is 1,500 mm3, the differential might appear as:

White blood cell type Percentage of total WBCs
Segmented neutrophils (also called polys or segs) 49%
Band neutrophils (also called bands) 1%
Basophils (also called basos) 1%
Eosinophils (also called eos) 1%
Lymphocytes (also called lymphs) 38%
Monocytes (also called monos) 10%


1,500 WBC
x .50 (49 segs + 1 bands = 50)
750 ANC

ANC and Daily Life

The activities of families of children with cancer can sometimes revolve around a patient’s ANC or “counts.”

If counts are low, patients may receive medicine called growth factors. These drugs are given to increase the number of white blood cells.

When patients have neutropenia, they may have to avoid public places such as schools. The care team may advise the patient to wear a face mask (particulate mask) to lower the risk of infection. In some cases, the patient may have to be hospitalized.

If ANC is too low, the doctor may decide to delay chemotherapy.

Each hospital has its own guidelines concerning activities for children with low ANCs.

Reviewed: June 2018

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