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Causes of neutrophil increase and decrease
Last reviewed: 06.07.2025
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Neutrophilia (neutrophilia) - an increase in the neutrophil content above 8×10 9 /l. Sometimes the leukocyte reaction is expressed very sharply and is accompanied by the appearance in the blood of young elements of hematopoiesis up to myeloblasts. In such cases, it is customary to speak of a leukemoid reaction.
Leukemoid reactions are reactive blood changes resembling leukemia by the degree of increase in the leukocyte content (above 50×10 9 /l) or by cell morphology. High neutrophilic leukocytosis (up to 50×10 9 /l) with rejuvenation of the leukocyte composition (shift to the left of varying degrees up to promyelocytes and myeloblasts) can occur in acute bacterial pneumonia (especially lobar) and other severe infections, acute hemolysis. Leukemoid reactions of the neutrophilic type (with or without leukocytosis) are possible in malignant tumors (cancer of the renal parenchyma, mammary and prostate glands), especially with multiple metastases to the bone marrow. Differential diagnostics with blood diseases is carried out on the basis of data from a biopsy of the red bone marrow, a study of alkaline phosphatase in leukocytes (in leukemoid reactions it is high, in chronic myelogenous leukemia it is low), and hemogram dynamics.
Neutrophilia is one of the main objective diagnostic criteria of any suppurative process, especially sepsis. It has been established that the higher the leukocytosis, the more pronounced the positive reaction of the body to the infection. The number of leukocytes in the peripheral blood, especially in staphylococcal sepsis, can reach 60-70×10 9 /l. Sometimes the dynamics of the leukocyte reaction has a wave-like character. Sepsis caused by gram-negative flora usually occurs with a less pronounced leukocyte reaction. In gram-negative sepsis, an increase in leukocytes to 18×10 9 /l significantly worsens the prognosis of the disease. Along with an increase in the number of leukocytes in sepsis, their decrease to 3-4×10 9 /l is also possible, which is more often observed in gram-negative sepsis. The most significant suppression of the leukocyte reaction is observed in septic shock (2×10 9 /l). Severe forms of pseudomonas sepsis with the development of septic shock are characterized by the development of pronounced leukopenia, reaching 1.6×10 9 /l. In patients with renal failure, neutropenia up to agranulocytosis is also quite often observed.
Neutropenia is the content of neutrophils in the blood below 1.5×10 9 /l. The main etiologic factors causing neutropenia are listed in Tables 2-20. However, when analyzing the causes of neutropenia, it is necessary to remember the rare diseases accompanied by a decrease in the number of neutrophils in the blood, some of which are listed 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 are either absent or their content does not exceed 1-2%) and is accompanied by various infections, initially by pustules on the body - furuncles and carbuncles, later by repeated pneumonia, lung abscesses. Symptoms of the disease appear in the 1-3rd week after birth, if children do not die in the 1st year of life, then the severity of infectious processes decreases somewhat, relative compensation of the disease occurs. The total number of leukocytes in the blood is usually within the normal range (due to an increase in the number of monocytes and eosinophils), neutropenia is very deep, the neutrophil content is less than 0.5×10 9 /l.
Benign hereditary neutropenia is a familial disease that often has no clinical manifestations. In most patients, the total number of leukocytes is normal, neutropenia is moderate (up to 20-30%), and other blood parameters are normal.
Cyclic neutropenia is a disease characterized by periodic (usually at a fairly precise interval - from 2-3 weeks to 2-3 months, each patient is individual) disappearance of neutrophils from the blood. Before the onset of the "attack", the patient's blood has a normal composition, and when neutrophils disappear, the content of monocytes and eosinophils increases.
Diseases and conditions accompanied by changes in the number of neutrophils in the blood
Neutrophilia |
Neutropenia |
Acute bacterial infections:
Inflammation or tissue necrosis: myocardial infarction, extensive burns, gangrene, rapidly developing malignant tumor with decay, polyarteritis nodosa, acute rheumatic fever Exogenous intoxications: lead, snake venom, vaccines, bacterial toxins Endogenous intoxications: uremia, diabetic acidosis, gout, eclampsia, Cushing's syndrome Medicines Myeloproliferative diseases (chronic myelogenous leukemia, erythremia) Acute hemorrhages |
Bacterial infections (typhoid, 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 is a sharp decrease in the number of granulocytes in the peripheral blood up to 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 occurrence, a distinction is made between myelotoxic and immune agranulocytosis. Myelotoxic agranulocytosis occurs as a result of the action of cytostatic factors. It is characterized by a combination of leukopenia with thrombocytopenia and often with anemia (i.e. pancytopenia). Immune agranulocytosis is mainly of two types: haptenic and autoimmune, as well as isoimmune.