Key takeaways:
An absolute neutrophil count (ANC) is a measure of the number of neutrophils in your bloodstream.
Neutrophils are a type of white blood cell (WBC). They’re an important part of your blood’s ability to fight infections.
An extremely high or low absolute neutrophil count can be a life-threatening condition if not treated.
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Have you ever looked at the lab report from blood work 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, which play a key role in your overall well-being. An absolute neutrophil count tells a healthcare professional 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) measures the exact number of neutrophils in your white blood cells (WBCs). Neutrophils are the most common type of white blood cell in a 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.
Normal ANC
A normal ANC count usually ranges from 2,500 to 7,000 cells per microliter of blood. When your ANC is in this normal range, your body is most able to fight infections.
What does it mean if you have an abnormal ANC?
An abnormal ANC means you have more or less neutrophils than the average for someone your age.
Abnormalities in ANC levels can happen because of issues with the production or destruction of your neutrophils. Let’s take a closer look at what it means to have a high or low ANC and what could be causing these abnormal lab results.
High ANC
When your overall white blood cell numbers are too high, it’s called leukocytosis. A high ANC means your neutrophil levels are above normal. This usually means you have more than 7,700 cells per microliter of blood. This is a condition known as neutrophilia, and is usually the result of an overproduction of neutrophils.
Causes of a high ANC include:
Low ANC
An ANC that’s lower than the normal range is referred to as neutropenia. This usually means fewer than 1,500 cells per microliter of blood.
A low ANC can happen if your bone marrow doesn’t make enough neutrophils. It can also happen if your body destroys neutrophils too quickly after they’re produced.
Causes of a low ANC include:
Some medications, like chemotherapy or hydralazine
Aplastic anemia
Autoimmune conditions, like lupus
Hyperthyroidism (overactive thyroid)
Deficiencies in vitamins or minerals, including vitamin B12 or iron
Certain cancers, like lymphoma and leukemia
Genetic disorders
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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. In some cases, it can also be a sign of a serious underlying condition, such as cancer. If you have a high ANC, your healthcare professional will then do further testing to look for the cause. The results 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, low ANC can be chronic, meaning it lasts for months or years. Sometimes the cause can be unknown (idiopathic neutropenia). In other cases, ANC can rise and fall over time (cyclic neutropenia).
The severity of neutropenia can be described as follows:
Mild neutropenia: ANC below 1,500 neutrophils per microliter
Moderate neutropenia: ANC below 1,000 neutrophils per microliter
Severe neutropenia: ANC 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.
Testing for ANC
Your ANC level is determined by collecting a complete blood count (CBC). This is a blood test that measures the different types and numbers of blood cells in your body, including your WBCs.
There are several types of white blood cells that make up your total number of WBCs, including lymphocytes, neutrophils, and band cells, just to name a few.
The ANC is calculated using the percentage of neutrophils and band cells (young neutrophils) in your blood, along with the total number of WBCs. To find your ANC, add the percentage of neutrophils and band cells, divide by 100, and then multiply by the total WBC count.
Here is the formula: ANC = WBC ✕ [(%Neutrophil ＋%Band cells)➗100].
What happens when your ANC drops too low?
Neutrophils play an important role in fighting infections. When their numbers are low (neutropenia), your immune system is severely weakened.
Symptoms of severe neutropenia include:
Recurrent fevers
Mouth ulcers
Swollen gums
Recurrent infections, like strep throat or ear infections
Abdominal pain (neutropenic colitis)
Joint pain
Poor wound healing
If severe neutropenia isn’t treated, it can lead to serious and life-threatening complications, including:
Frequent, severe infections
Bacteremia (bacteria in your bloodstream)
Sepsis
People with severe neutropenia should take special precautions to avoid infections. Neutropenia precautions may include:
Wearing high-filtration face masks in public
Avoiding crowds
Washing your hands often
Not sharing eating utensils
Wearing gloves when caring for your pets
Eating fully cooked meat and eggs
What happens when your ANC gets too high?
A high ANC will sometimes cause symptoms related to the underlying cause. Common symptoms associated with a high ANC include:
Fevers
Fast heart rate (tachycardia)
Unexplained weight loss
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. In these cases, ANC levels can reach 50,000 cells per microliter or higher.
Very high ANC levels can increase your risk of blood clots and stroke.
How can you fix an abnormal ANC?
Treatment for 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 raise 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, such as during a leukemoid reaction, you may need emergency treatments. A hematologist (blood specialist) or oncologist (cancer specialist) may recommend treatments to quickly reduce the ANC, including:
Chemotherapy
Leukapheresis (a process to remove white blood cells from your blood)
Medications, like hydroxyurea
Low ANC
If your low ANC is caused by malnutrition or a vitamin deficiency, a nutritional supplement may be enough to increase your ANC. If the cause is 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 medications help trigger your bone marrow to produce more white blood cells.
Frequently asked questions
High ANC levels can be seen in some types of solid tumors and blood cancers. Some of the common cancers that have high neutrophils include:
Leukemia
Lymphoma
Lung cancer
Breast cancer
Colon cancer
Kidney cancer
Melanoma
In some cases, a high ANC level may be related to a higher risk of complications. This is more commonly seen with melanoma, lung cancer, or kidney cancer.
Yes, stress can affect neutrophil levels. When you’re under stress, hormones like cortisol and adrenaline are released. These hormones can trigger your bone marrow to release neutrophils into your bloodstream.
A healthcare professional may recommend a “neutropenic diet” if your neutrophils are very low. This diet usually includes cooked meats and vegetables and avoids raw foods. Raw foods are thought to increase infection risk, but research hasn’t really shown that this diet prevents infections. In some cases, a neutropenic diet may increase your risk of malnutrition because food choices are limited. If you have neutropenia, talk to your healthcare team to develop a healthy eating plan.
High ANC levels can be seen in some types of solid tumors and blood cancers. Some of the common cancers that have high neutrophils include:
Leukemia
Lymphoma
Lung cancer
Breast cancer
Colon cancer
Kidney cancer
Melanoma
In some cases, a high ANC level may be related to a higher risk of complications. This is more commonly seen with melanoma, lung cancer, or kidney cancer.
Yes, stress can affect neutrophil levels. When you’re under stress, hormones like cortisol and adrenaline are released. These hormones can trigger your bone marrow to release neutrophils into your bloodstream.
A healthcare professional may recommend a “neutropenic diet” if your neutrophils are very low. This diet usually includes cooked meats and vegetables and avoids raw foods. Raw foods are thought to increase infection risk, but research hasn’t really shown that this diet prevents infections. In some cases, a neutropenic diet may increase your risk of malnutrition because food choices are limited. If you have neutropenia, talk to your healthcare team to develop a healthy eating plan.
The bottom line
The absolute neutrophil count (ANC) is an important lab result that helps healthcare professionals understand how many infection-fighting blood cells you have. When the ANC is abnormal, it can give clues to underlying medical conditions like infection, inflammation, or chronic disease. Treating an abnormal ANC is usually focused on finding and treating the underlying cause.
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References
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Centers for Disease Control and Prevention. (n.d.). What you need to know: Neutropenia and risk for infection.
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Gulliver, T., et al. (2024). The neutropenic diet and its impacts on clinical, nutritional, and lifestyle outcomes for people with cancer: a scoping review. Journal of Nutritional Science.
Lustberg, M. B. (2012). Management of neutropenia in cancer patients. Clinical Advances in Hematology and Oncology.
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