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The causes of increase and decrease of neutrophils
Last reviewed: 19.10.2021
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Neutrophilia (neutrophilia) - an increase in the neutrophil count above 8 × 10 9 / l. Sometimes the leukocyte reaction can be expressed very sharply and is accompanied by the appearance in the blood of young elements of hemopoiesis up to the myeloblasts. In such cases, it is customary to speak of a leukemoid reaction.
Leukemoid reactions are changes in the blood of a reactive nature, reminiscent of leukemia, according to the degree of increase in the content of leukocytes (above 50 × 10 9 / l) or by cell morphology. High neutrophilic leukocytosis (up to 50 × 10 9 / L) with rejuvenation of the composition of leukocytes (a shift to the left of different degrees up to promyelocytes and myeloblasts) can occur with acute bacterial pneumonia (especially croupous) and other severe infections, acute hemolysis. Leukemoid reactions of neutrophil type (with or without leukocytosis) are possible in malignant tumors (cancer of the kidney parenchyma, milk and prostate gland), especially with multiple metastases to the bone marrow. Differential diagnostics with blood diseases are performed on the basis of bone marrow biopsy data, studies of alkaline phosphatase in leukocytes (with leukemia reactions it is high, with chronic myeloid leukemia - low), hemogram dynamics.
Neutrophilia is one of the main objective diagnostic criteria for any suppuration, especially sepsis. It was found that the higher the leukocytosis, the more pronounced the positive reaction of the organism to infection. The number of leukocytes in the peripheral blood, especially with staphylococcal sepsis, can reach 60-70 × 10 9 / l. Sometimes the dynamics of the leukocyte reaction has a wavy character. Sepsis, caused by gram-negative flora, usually occurs with less pronounced leukocyte reaction. With gram-negative sepsis, the increase in leukocytes to 18 × 10 9 / L significantly worsens the prognosis of the disease. Along with the increase in the number of leukocytes in sepsis, it is possible to reduce them to 3-4 × 10 9 / l, which is more often observed with gram-negative sepsis. The most significant suppression of the leukocyte reaction is noted with septic shock (2 × 10 9 / L). For severe forms of Pseudomonas septicemia with development of septic shock, development of severe leukopenia, reaching 1.6 × 10 9 / L, is characteristic . In patients with renal insufficiency, neutropenia is also often observed right up to agranulocytosis.
Neutropenia - the content of neutrophils in the blood below 1.5 × 10 9 / l. The main etiological factors causing neutropenia are given in Table. 2-20. However, when analyzing the causes of neutropenia, one should also remember about rare diseases accompanied by a decrease in the number of neutrophils in the blood, some of which are presented below.
Kostmann's neutropenia is an autosomal recessive hereditary disease caused by a defect in the colony-stimulating factor receptor. It is characterized by severe neutropenia (neutrophils or none at all, or their content does not exceed 1-2%) and is accompanied by various infections, first by abscesses on the body - furuncles and carbuncles, then - by repeated pneumonia, lung abscesses. Symptoms of the disease appear on the 1-3th week after birth, if children do not die at the age of 1, then the severity of the infectious processes decreases somewhat, the relative compensation of the disease begins. The total number of leukocytes in the blood is usually within the norm (due to an increase in the number of monocytes and eosinophils), neutropenia is very deep, the neutrophil count is less than 0.5 × 10 9 / l.
Benign hereditary neutropenia is a familial disease that is not often clinically manifested. In most patients, the total number of white blood cells is normal, neutropenia is moderate (up to 20-30%), other blood counts are normal.
Cyclic neutropenia is a disease characterized by a periodic (usually after a fairly accurate interval - from 2-3 weeks to 2-3 months, for each individual patient) by the disappearance of neutrophils from the blood. Before the occurrence of an "attack" the patient's blood has a normal composition, and with the disappearance of neutrophils, the content of monocytes and eosinophils increases.
Diseases and conditions accompanied by a change in the number of neutrophils in the blood
Neurotrophilia | Neutropenia |
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Acute bacterial infections:
Inflammation or necrosis of tissues: myocardial infarction, extensive burns, gangrene, rapidly developing malignant tumor with decay, nodular polyarteritis, acute rheumatic fever Exogenous intoxications: lead, snake venom, vaccines, bacterial toxins Intoxication endogenous: uremia, diabetic acidosis, gout, eclampsia, Cushing's syndrome Medications Myeloproliferative diseases (chronic myelogenous leukemia, erythremia) Acute hemorrhage |
Bacterial infections (typhus, paratyphoid, tularemia, brucellosis, subacute bacterial endocarditis, miliary tuberculosis) Viral infections (infectious hepatitis, influenza, measles, rubella) Myelotoxic effects and suppression of granulocytopoiesis:
Immune agranulocytosis:
Redistribution and sequestration in organs:
Hereditary forms (cyclic neutropenia, familial benign neutropenia, etc.) |
Agranulocytosis - a sharp decrease in the number of granulocytes in the peripheral blood until their complete disappearance, leading to a decrease in the body's resistance to infections and the development of bacterial complications. Depending on the mechanism of origin, myelotoxic and immune agranulocytosis are distinguished. Myelotoxic agranulocytosis occurs as a result of the action of cytostatic factors. He is characterized by a combination of leukopenia with thrombocytopenia and often with anemia (that is, pancytopenia). Immune agranulocytosis is mainly of two types: haptenic and autoimmune, and also isoimmune.