Absolute Neutrophil Count (ANC) and Neutropenia

What is neutropenia?

Neutropenia refers to having a low number of neutrophils in the blood. Neutrophils are a type of white blood cell that fight infection. 

If your child has neutropenia, an infection can be life-threatening. 

What is the absolute neutrophil count (ANC)? 

An absolute neutrophil count (ANC) measures the number of neutrophils in the blood. The ANC is calculated as part of a complete blood count (CBC) test. 

The ANC gives an estimate of your child’s ability to fight infections. If your child’s ANC is low, they have a higher risk of infection. 

A normal ANC for a healthy child is greater than 1,500. Neutropenia can be classified by severity based on the ANC range:

• Mild neutropenia: 1000-1500
  
• Moderate neutropenia: 500-1000
  
• Severe neutropenia: less than 500
  
• Profound neutropenia: less than 100
  

Causes of neutropenia

Neutropenia can have several causes. These include:

• Cancers that affect the bone marrow, such as leukemia and lymphoma 
  
• Bone marrow disorders including aplastic anemia and myelodysplastic syndromes
  
• Autoimmune diseases, such as lupus or rheumatoid arthritis
  
• Infections, especially those caused by certain viruses
  
• Treatments including chemotherapy, radiation therapy, and certain medicines
  

Tests for neutropenia

A complete blood count (CBC) test with differential is a simple blood test that is used to monitor neutrophil counts. On most blood count test reports, the ANC is already calculated for you. 

Other tests may be used to learn more about the cause of neutropenia, such as a bone marrow aspiration and biopsy.  

Treatment of neutropenia

The treatment for neutropenia depends on the cause or if neutropenia is a result of an underlying health condition. 

Your care team may prescribe antibiotics to help prevent infection.

If your child’s ANC is too low, your care team may decide to delay chemotherapy or other treatments until their counts improve. In some cases, your child may have to be hospitalized. Each hospital has its own guidelines for patients with low ANCs.

How to manage neutropenia

If your child has neutropenia, they are at risk for infections, particularly bacterial and fungal infections. Even minor infections can become serious when the ANC is low. 

It is important to take steps to help prevent infection: wash hands often, limit exposure to germs, and get the vaccines recommended by your care team. 

The activities your child can do may depend on their neutrophil counts. When counts are low, your child may have to take extra precautions, such as avoiding public places, staying home from school, and wearing a face mask.    

Talk to your care team about your child’s risk of infection, signs to watch for, and when to seek medical care. 

Questions to ask your care team

• What is my child’s ANC and what do those values mean?
  
• What is the cause of my child’s neutropenia?
  
• How will my child’s counts be monitored? 
  
• Will my child need treatment for neutropenia?
  
• What signs and symptoms of infection should we watch for?
  
• What precautions are needed based on test results?
  

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