What Does an Abnormal Absolute Neutrophil Count (ANC) Mean?

Have you ever looked at the lab report from bloodwork and wondered what an absolute neutrophil count (ANC) is? If so, you’re not alone. The ANC is a test that measures important components of your blood that play a key role for your overall well-being. An absolute neutrophil count tells your doctor how many neutrophils are in your blood. When the ANC is abnormal, it may be an indicator of certain health issues. 

What is an absolute neutrophil count (ANC)? 

The absolute neutrophil count (ANC) is the exact number of neutrophils present in your white blood cells (WBCs). Neutrophils are the largest number of white blood cells in a healthy normal immune system. 

Neutrophils play an important role in fighting bacterial infections. They kill infectious organisms by swallowing and releasing chemicals to break down the bacteria.

A normal ANC count will range from 2,500 to 7,000 cells per microliter of blood.

What does it mean if you have an abnormal ANC?

An abnormal ANC signals that you have higher or lower than the average amount of neutrophils for people your age. Abnormalities in ANC levels can be due to issues with production of your neutrophils or destruction of the neutrophils. Let’s take a closer look at what it means to have a high or low ANC and what could be causing the abnormal lab results.

High ANC

Leukocytosis is a term that indicates that your overall white blood cell numbers are too high. A higher than normal ANC means that your neutrophil white blood cells are elevated. This typically means you have greater than 7,700 cells per microliter. This is a condition known as neutrophilia. This is usually the result of an overproduction of neutrophils.

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Causes of a high ANC include:

• Infections

• Certain cancers

• Traumatic injuries, such as burns and crush injuries

• Inflammatory conditions like rheumatoid arthritis, inflammatory bowel disease

• Some medications, like filgrastim (Neupogen) and steroids

Low ANC

An ANC that’s lower than the normal range is referred to as neutropenia. This is typically a level less than 1,500 cells per microliter. A low ANC can be the result of the bone marrow not producing enough neutrophils. Or it can also be due to the body destroying neutrophils at a rapid rate after they’re produced.

Causes of a low ANC include:

• Some medications like chemotherapy and hydralazine

• Aplastic anemia

• Autoimmune conditions like lupus

• Hyperthyroidism (overactive thyroid)

• Deficiency in vitamins and minerals, such as vitamin B12 and iron

• Certain cancers like lymphoma and leukemia

• Genetic disorders

When is an abnormal ANC a cause for concern?

When your ANC reaches critical levels, it may indicate a serious underlying condition. This level will vary based on whether your ANC levels are too high or too low.

A high ANC is most commonly caused by an infection or inflammation. But sometimes it can be a sign of a serious underlying condition, such as cancer. If you have a high ANC, your healthcare provider will then do further testing to look for the cause. This will determine the best course of action for your care. 

A low ANC can range from mild (with little to no symptoms) to severe. In some cases it can be chronic (lasting months or years). Some people have unknown reasons for their low ANC (idiopathic neutropenia), or have a low ANC that comes and goes (cyclic neutropenia).

The severity of neutropenia can be described as follows:

• Mild neutropenia: ANC is below 1,500 neutrophils per microliter.

• Moderate neutropenia: ANC is below 1,000 neutrophils per microliter.

• Severe neutropenia: ANC is below 500 neutrophils per microliter.

When your ANC drops to a moderate or severe level of neutropenia, there may be cause for concern. That’s because there’s a high risk of serious infection. People with a moderate to  severely low ANC have a high risk of death if left untreated. 

What happens when your ANC drops too low?

Neutrophils play an important role in fighting infections. So when their numbers are low, your immune system is severely weakened. 

Symptoms of severe neutropenia include:

• Recurrent fevers

• Mouth ulcers

• Swollen gums 

• Recurrent infections like strep throat and ear infections

• Abdominal pain (neutropenic colitis)

• Joint pains

• Poor wound healing

Complications from untreated severe low ANC can be serious and even life-threatening. These can include:

• Frequent severe infections 

• Bacteremia (bacteria in the bloodstream)

• Sepsis 

People with a severe case of neutropenia should take special precautions to avoid infections. Neutropenia precautions may include:

• Wearing high filtration face masks out in public

• Avoiding crowds

• Handwashing frequently

• Not sharing eating utensils

• Wearing gloves when caring for your pets

• Eating meat and eggs that are fully cooked

What happens when your ANC gets too high?

A high ANC will sometimes have symptoms related to the underlying cause. Common symptoms associated with a high ANC include: 

• Fevers 

• Fast heart rate (tachycardia)

• Swollen lymph nodes 

• Unexplained weight loss

• Night sweats

• Fatigue 

• Body aches

Sometimes, the ANC level can become so high that it makes your blood very thick and sluggish. This can sometimes be seen in a condition known as leukemoid reaction. And ANC levels can reach as high as 50,000 cells per microliter or more. This can increase your risk of blood clots and stroke. 

How can you fix an abnormal ANC?

Fixing an abnormal ANC depends on the cause. In mild cases, correcting the underlying cause can return the ANC to normal. 

High ANC

Treating any underlying infection or inflammation can help to lower the ANC and white blood cell count. Discontinuing any medications that may be raising the ANC count can also help resolve the issue. 

If cancer or bone marrow disorders are causing your body to produce too many blood cells, you may need targeted treatments. 

If you have a dangerously high ANC as in leukemoid reaction, you may need emergency treatments. A hematologist (blood specialist) or oncologist (cancer specialist) may recommend treatments to quickly reduce the ANC like:

• Chemotherapy

• Leukapheresis (a process to remove white blood cells from the blood)

• Medications (like hydroxyurea)

Low ANC

If you have a low ANC due to malnutrition and vitamin deficiency, a nutritional supplement may be enough to increase your ANC. Or if it’s due to an underlying medical condition like hyperthyroidism, correcting the overactive thyroid would resolve the low ANC.

Severe neutropenia needs treatment to avoid death from a preventable infection. In these cases, you may need to take medications like filgrastim (Neupogen) or tbo-filgrastim (Granix). These help to trigger your bone marrow to produce more white blood cells.

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Written by:

Stephanie Reese, DO, MS

Dr. Reese is board-certified in family medicine and resides in Savannah, Georgia. She received her undergraduate degree from the Florida Institute of Technology and master’s in hematology/immunology from Long Island University.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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