Neutrophils: Symptoms/Causes For Variation & What You Can Do About It

Given that they are the first line of defence against any infection, a variation in the number of neutrophils can cause or indicate serious health problems. Let us look at what could go wrong and how we can best assist these white blood cells in doing their job. Think of them as powerful soldiers in your body’s perpetual battle against microbial invaders. As part of the innate immune system, neutrophils are the first cells to migrate to a site of infection in your body and kill the attacking organisms, such as bacteria and parasites. They constitute about 50-70 percent of the white blood cells (WBC) in the human body. Etymologically, neutrophil comes from two words - ‘neuter’ in Latin meaning ‘neither’ and ‘philein’ in Greek meaning ‘to love’. In the laboratory, these cells are stained neither by acidic nor alkaline (basic) dyes, but by neutral ones (made up of salts that do not have an electric charge). In other words, they are filled with neutrally-staining granules, which are small pouches of enzymes that allow the cell to destroy an invading micro-organism.   Like all WBC, neutrophils are produced in the bone marrow and then transferred into the bloodstream and lymphatic system. As most neutrophils have a lifespan of only a few hours – at best a couple of days – there is a constant demand for new cells to be produced in huge numbers. In fact, in healthy individuals, the bone marrow is known to be armed with a significant reserve of neutrophils in order to deal with any prospective infection. Neutrophils are counted as part of the complete blood count (CBC) test and the WBC differential examination. Typically, the normal range for the neutrophil count is 1500 to 8000. The absolute neutrophil count (ANC) is obtained by multiplying the percentage of neutrophils by the total number of white blood cells. When the ANC is high, the condition is called neutrophilia, while a low ANC constitutes neutropenia. Both conditions call for timely diagnosis and appropriate medical measures.   Too much of a good thing A neutrophil level of more than 8000 per microlitre of blood is considered to be neutrophilia. The condition is common during acute bacterial infections and factors that can cause the condition include:

• Rapidly growing, cancerous tumours, or acute haemorrhage (internal bleeding). Conditions such as polycythemia vera (long-term increase in red blood cells and other types of cells), or myeloid metaplasia (where the bone marrow grows in abnormal places in the body) can also be the root cause.
• Severe damage or inflammation of tissues – say burn injuries or heart attack – is known to lead to a high ANC.
• Sudden kidney failure can also up the neutrophil numbers drastically.
• Sometimes, even seemingly harmless activities like an overenthusiastic session at the gym can spike stress levels, thereby bringing up the ANC figures. However, the effect is usually temporary, lasting for not more than half an hour.
• In certain cases where the body finds it difficult to break down fats, ketones (acids and poisonous chemical substances) are produced, leading to a condition known as ketoacidosis that can cause a high neutrophil count.
• Eclampsia (a pregnancy-related complication characterised by high blood pressure and huge amounts of protein in the urine) is also known to trigger neutrophilia.
• Other medical conditions that can cause an abnormally high neutrophil count include mononucleosis (virus infection), hepatitis (liver infection), toxoplasmosis (infection seen in birds, reptiles, and other animals that can also occur in humans) and cytomegalovirus ( a virus that usually causes infections in the eye and abdominal area).
• Certain medications such as corticosteroids and lithium carbonate can lead to a spike in the number of neutrophils in the body. Similarly, a blood transfusion can also trigger neutrophilia.

The symptoms of neutrophilia vary depending on the underlying cause. Patients with bacterial infections, for instance, may experience symptoms such as inflammation, enlarged lymph nodes, fever and chills, while for cancer patients the symptoms may include localised swelling, enlarged lymph nodes and sudden weight gain or weight loss. So, the most important step in treating the condition is determining the real cause of the problem. If it is a bacterial infection, it can be treated with antibiotics; if it is drug-induced, the medication in question should be stopped immediately. Time is of the essence here, and it is imperative that the patient seeks medical advice at the earliest. No matter what the cause, a CBC count with differential is vital; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) could also be suggested. In certain cases, a bone marrow study or peripheral blood smear may also be necessary to determine the cause of the problem. Less is not more In adults, ANC of less than 1,500 neutrophils per microlitre of blood is considered neutropenia. Neutrophil counts of less than 1,000 neutrophils per microlitre are termed moderate cases, while counts of less than 500 neutrophils per microlitre are called acute. For children, the number varies with age. Patients with neutropenia are known to be more susceptible to disease and infection. In certain cases, the condition may even become life threatening. There are quite a few causes for the decrease in the production of neutrophils in the body. Here are some of them:

• Leukaemia (blood cancer) and myelofibrosis (bone marrow is replaced by fibrous tissue) are common causes. Neutropenia is also a side-effect of chemotherapy in many cancer patients.
• In some cases, there may be damage caused to the bone marrow by infections, medications or radiation (cancer therapy).
• One could be born with a congenital condition such as Kostmann’s syndrome (low production of neutrophils), Myelokathexis (failure of neutrophils to enter the bloodstream), or Chediak-Higashi syndrome (massive decrease in white blood cells).
• Sometimes, the culprit could be an autoimmune disorder such as systemic lupus erythematosus (SLE) or rheumatoid arthritis.
• Bacterial infections are also known to destroy these vital WBC in the body.
• Medical procedures like cardiopulmonary bypass or dialysis affect the production of neutrophils, too.  
• Medications, such as phenothiazines drugs (used to treat psychosis, allergies and vomiting) and phenylbutazone (used to reduce inflammation of bone joints), are known to bring down the ANC numbers.
• An oft-ignored cause of neutropenia is vitamin B12 deficiency.

The biggest challenge lies in timely diagnosis as most patients with neutropenia may not show any symptoms. It often takes a routine blood test or an infection to get the problem to the fore. Unattended, even a minor infection – mostly in the mouth, throat, lungs, sinuses and skin - can become serious in no time. So, it is important not to ignore any signs of infection, such as high fever, sore throat, mouth ulcers, toothache, stomach pain, burning sensation during urination, unusual vaginal discharge, diarrhea, cough, shortness of breath, pus, redness, swelling, or pain, particularly around a cut or wound.   What can be done? While mild cases of neutropenia may not need any treatment, it is essential to keep tabs on the ANC levels. If the ANC drops below 500 neutrophils per microlitre of blood over a couple of days, the patient is considered to be at a very high risk of acquiring an infection. If the ANC is 100 or fewer neutrophils per microlitre of blood for over a week, the risk of getting a serious infection is particularly high. In case a patient has neutropenia for more than three months, it is considered to be a chronic case, calling for dedicated medical management. Depending on the severity of the condition, there are several ways of dealing with neutropenia. If the underlying cause is an infection, antibiotics could be effective. In the case of drug-induced neutropenia, changing medications is a good strategy.  To stimulate the bone marrow to produce more WBC, the doctor may suggest a treatment called granulocyte colony-stimulating factor (G-CSF). In certain cases, stem cell transplants, or granulocyte transfusion could offer promising results. As the saying goes, prevention is always better than cure. More so in the case of patients with neutropenia; they need to take special care to prevent infections. Simple, commonsense measures such as maintaining good hygiene - frequent hand washing and good dental care – can go a long way in averting medical misadventures. Electric shavers are a better option than razors. However, if and when there are cuts and scrapes on the body, it is important to clean the site immediately with an antiseptic and then, cover the area with a bandage. The idea is to avoid contact with anything that could trigger a probable infection - sick people, animal waste, ponds, etc. In terms of diet, it is essential to steer clear of unpasteurised dairy foods, undercooked meat, raw fruits and uncooked vegetables. Further, studies have shown that vegetarians are at an increased risk of developing neutropenia. So, if you are a vegetarian, do consult with your doctor to check if you need to start on vitamin B-12 supplements. And, of course, regular health checks and blood tests are recommended to keep tabs on the hemoglobin levels.

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