Lab result explainedBlood count (CBC)Last updated November 10, 2026

Absolute neutrophil count (ANC): normal range, how to calculate it, and the 1,500 / 1,000 / 500 neutropenia levels

Absolute neutrophil count (ANC) · Complete blood count (CBC) with differential · reported in ×10³/µL (K/µL, thousand per microlitre) or cells/µL (multiply ×10³/µL by 1,000)

The absolute neutrophil count (ANC) is the actual number of neutrophils, the white blood cells that fight bacterial and fungal infection, in a microlitre of your blood. It is calculated from two other CBC results: the total white blood cell count multiplied by the percentage of neutrophils (segmented neutrophils plus bands). On a US report it appears as "neutrophils absolute", "neut abs" or ANC, in thousands per microlitre (×10³/µL or K/µL) or as cells per µL. The adult normal range is about 1.5 to 8.0 ×10³/µL, that is 1,500 to 8,000 cells per µL, with small differences between laboratories.

The ANC is the number that matters for infection risk, which is why oncology, rheumatology and psychiatry teams track it so closely. Three thresholds are used worldwide: an ANC below 1,500 is neutropenia; below 1,000 is moderate neutropenia, at which infection risk starts to climb; and below 500 is severe neutropenia, at which the body cannot mount a normal response to bacteria and a fever becomes a medical emergency. Chemotherapy doses, clozapine prescriptions and decisions about protective antibiotics or growth-factor injections are all tied to these numbers.

A high ANC (neutrophilia, above about 7.7 to 8.0 ×10³/µL) is far more common and far less dangerous: it almost always means infection, inflammation, stress, steroids, smoking or pregnancy. This page covers the absolute count, how to calculate it, and what each level means. The neutrophils page covers the cells themselves in more detail, and the segmented neutrophils page covers the percentage.

ANC at a glance

What it is: the number of neutrophils per microlitre of blood, calculated as WBC × (segs % + bands %) ÷ 100.
Normal (adults): about 1.5–8.0 ×10³/µL (1,500–8,000 cells/µL); some labs use 1.8–7.7 or 2.0–7.0. Labs differ. Infants and children have their own ranges.
Neutropenia levels: mild 1,000–1,500; moderate 500–1,000; severe below 500; profound below 200 cells/µL. Infection risk rises below 1,000 and sharply below 500.
Fever (38.0 °C / 100.4 °F or higher) with an ANC below 500, or below 1,000 and expected to fall, is febrile neutropenia: go to the emergency department.
High ANC (above 7.7–8.0): bacterial infection, inflammation, stress, exercise, corticosteroids, smoking, obesity, pregnancy, splenectomy; rarely a marrow disorder.
A stable ANC of 1,000–1,500 in someone of African or Middle Eastern ancestry is usually the inherited Duffy-null trait, which carries no infection risk.

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What ANC measures

Neutrophils are produced in the bone marrow at a rate of around 100 billion a day, held in reserve for a few days, and released into the blood, where each cell circulates for only 6 to 10 hours before migrating into tissues. The ANC is a snapshot of the balance between release and departure, which is why it can double within an hour of stress or exercise (cells detach from vessel walls), rise within hours of a steroid dose, fall within days of chemotherapy, and swing for weeks around a viral infection.

The laboratory does not count neutrophils directly in isolation. The analyzer counts all white cells, then classifies them by size, granularity and light scatter into neutrophils, lymphocytes, monocytes, eosinophils and basophils, and multiplies the neutrophil fraction by the total to give the absolute count. If a manual differential is done, segmented neutrophils and bands are added together before multiplying. The arithmetic is simple enough to do yourself: a WBC of 6.2 ×10³/µL with 58 percent segs and 3 percent bands gives an ANC of 6.2 × 0.61 = 3.78 ×10³/µL, or 3,780 cells/µL.

Two technical points cause confusion. First, some analyzers count immature granulocytes separately and exclude them from the ANC, so a report during recovery from chemotherapy may show an ANC that looks lower than the segs percentage suggests. Second, a few laboratories still report neutropenia on the percentage alone, which is unreliable; always use the absolute number. The ANC does not require fasting and does not vary meaningfully with the time of day, though it is slightly higher in the afternoon and after meals.

Normal range for ANC

Reference ranges vary between labs and by age, sex and pregnancy. Use the range printed on your own report.

Group	Typical range (×10³/µL (K/µL, thousand per microlitre) or cells/µL (multiply ×10³/µL by 1,000))	Notes
Adults	1.5–8.0 ×10³/µL (1,500–8,000 cells/µL)	Some labs 1.8–7.7 or 2.0–7.0. Labs differ; use the printed range.
Duffy-null phenotype (common in people of African or Middle Eastern ancestry)	1.0–1.5 ×10³/µL can be normal; occasionally 0.8–1.0	An inherited variant with normal tissue neutrophils and no added infection risk.
Infants 2 weeks to 1 year	Neutropenia defined below 1.0 ×10³/µL	Counts are naturally lower in infancy; the adult 1.5 threshold applies from about age 1.
Children 1–10 years	1.5–8.5 ×10³/µL	Lymphocytes outnumber neutrophils until about age 4 to 6, but the absolute range is similar to adults.
Newborns, first 24 hours	Up to about 26 ×10³/µL	Falls rapidly over the first week.
Pregnancy, third trimester	Up to about 10–15 ×10³/µL	A physiological rise; higher still during labor.
Mild neutropenia	1.0–1.5 ×10³/µL (1,000–1,499 cells/µL)	Little or no added infection risk; most common causes are viral infection, drugs and Duffy-null trait.
Moderate neutropenia	0.5–1.0 ×10³/µL (500–999 cells/µL)	Infection risk begins to rise; chemotherapy is often delayed below 1.0 to 1.5.
Severe neutropenia	Below 0.5 ×10³/µL (under 500 cells/µL); profound below 0.2	High infection risk; fever at this level is an emergency. Agranulocytosis is a count near zero.

High absolute neutrophil count (neutrophilia)

An ANC above the upper limit, roughly 7.7 to 8.0 ×10³/µL, is neutrophilia. In the great majority of cases it is reactive: the marrow and the marginated pool are responding to infection, inflammation, tissue damage, stress or a drug. Bacterial infections typically push the ANC to 10 to 25 ×10³/µL, often with a left shift (more bands and immature granulocytes), and the count falls within days of effective treatment. Corticosteroids produce a similar rise within hours, without a left shift and without a raised CRP, and keep it up for as long as they are taken.

Persistent mild neutrophilia of 8 to 12 ×10³/µL in someone who feels well is most often explained by smoking, obesity, pregnancy, lithium or a missing spleen. These do not need a work-up beyond confirming the cause and, where possible, addressing it; stopping smoking and losing weight each lower the count by around 0.5 to 1.0 ×10³/µL over a year.

Neutrophilia above about 30 ×10³/µL, or any neutrophilia accompanied by immature cells, basophilia, abnormal platelets, anemia or an enlarged spleen, raises the possibility of a myeloproliferative neoplasm such as chronic myeloid leukemia and is referred for a blood film and BCR-ABL test. A leukemoid reaction, in which a severe infection or cancer drives the count above 50 ×10³/µL without a marrow disorder, is the main alternative and is distinguished on the film and by the clinical setting.

Common causes

Bacterial infection
Pneumonia, urinary tract and kidney infection, cellulitis, abscess, appendicitis and sepsis raise the ANC to 10 to 25 ×10³/µL with a left shift; the count normalizes as the infection clears.
Inflammation and tissue injury
Surgery, trauma, burns, heart attack, pancreatitis, gout, inflammatory arthritis and inflammatory bowel disease all raise neutrophil release.
Corticosteroids
Prednisone, methylprednisolone and dexamethasone raise the ANC by 2 to 5 ×10³/µL within 4 to 6 hours of a dose by demargination and delayed tissue migration; the rise is sustained during a course.
Stress, pain, exercise and seizures
Adrenaline doubles the circulating count within minutes; the rise is transient and resolves within an hour or two of rest.
Smoking
Current smokers run counts 1 to 2 ×10³/µL higher than non-smokers, in proportion to daily cigarettes; the count falls over the years after quitting.
Obesity
Adipose-tissue cytokines sustain a mild chronic neutrophilia of 7 to 10 ×10³/µL; weight loss lowers it.
Pregnancy and labor
The ANC rises steadily to 10 to 15 ×10³/µL near term and higher during labor, returning to baseline a few weeks after delivery.
Medications: G-CSF, lithium, beta-agonists, epinephrine
Filgrastim and pegfilgrastim can push the ANC above 30 to 50 ×10³/µL for a few days; lithium causes a persistent mild rise; inhaled or injected beta-agonists a brief one.
Splenectomy or non-functioning spleen
Without the spleen's reservoir, the ANC and platelet count stay mildly raised permanently.
Myeloproliferative neoplasms and leukemoid reactions
Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia and primary myelofibrosis cause sustained neutrophilia; severe infection or cancer can mimic them with a leukemoid reaction above 50 ×10³/µL.

Symptoms that can go with it

Often none when the rise is from stress, exercise, smoking, obesity, pregnancy or steroids
Fever, chills, sweats and a localised source of infection (cough, painful urination, red hot skin, abdominal pain)
Pain, swelling and redness at a surgical or injured site
Fast heart rate, fast breathing, confusion or low blood pressure with sepsis, which is an emergency
Fatigue, night sweats, weight loss, fullness under the left ribs, easy bruising or bone pain, which point to a marrow disorder

Low absolute neutrophil count (neutropenia)

An ANC below 1.5 ×10³/µL (1,500 cells/µL) is neutropenia. The grade sets the risk: at 1,000 to 1,500 the risk of infection is barely increased and most people are well; at 500 to 1,000 the risk starts to rise, mainly for bacterial infections of the mouth, skin, lungs and urinary tract; below 500 the body cannot confine bacteria, infections spread quickly, and the usual warning signs (pus, a localised abscess, a high white count) may be absent. Below 200, or in agranulocytosis (near zero), life-threatening infection can develop within hours. These thresholds come from work in leukemia patients in the 1960s and have held up since.

How the count fell matters as much as the level. A chemotherapy nadir 7 to 14 days after a cycle, a viral dip that lasts two weeks, and a stable lifelong count of 1,200 are all "ANC 1,200" on paper but carry different risks. A sudden fall to below 500 in someone on clozapine, methimazole, propylthiouracil, carbamazepine or a sulfonamide antibiotic is idiosyncratic agranulocytosis, which usually occurs in the first 3 months of the drug and needs the drug stopped immediately and the person assessed the same day.

The commonest cause of a mildly low ANC in an otherwise healthy adult is the inherited Duffy-null phenotype, which lowers the circulating count to 1.0 to 1.5 ×10³/µL (occasionally a little lower) without reducing the neutrophils available in tissues; in the US national survey NHANES, 4.5 percent of Black participants had an ANC below 1.5 compared with 0.8 percent of white participants. People with this trait have normal infection defence, do not need investigation beyond confirming that the count is stable and the rest of the CBC is normal, and should not have chemotherapy or clozapine doses limited by the usual thresholds; many protocols now use an ANC of 500 rather than 1,000 as the action level in this group.

Common causes

Chemotherapy and radiotherapy
The most common cause of severe neutropenia; the count typically reaches its lowest point (nadir) 7 to 14 days after a cycle and recovers by day 21 to 28. Growth-factor injections (G-CSF) shorten the dip.
Viral infections
Influenza, COVID-19, Epstein-Barr virus, hepatitis, HIV, measles and many common viruses lower the ANC for one to four weeks, usually to 1.0 to 1.5 and occasionally below 1.0.
Idiosyncratic drug reactions
Clozapine, methimazole, propylthiouracil, carbamazepine, valproate, sulfonamides (including trimethoprim-sulfamethoxazole), dapsone, rituximab and some NSAIDs can cause sudden severe neutropenia, usually within the first 3 months; risk is about 1 percent with clozapine and 0.2 to 0.5 percent with antithyroid drugs.
Immunosuppressants
Methotrexate, azathioprine, mycophenolate, cyclophosphamide and biologics such as tocilizumab lower counts dose-dependently and are monitored with regular CBCs.
Duffy-null (benign ethnic) neutropenia
Carried by about two thirds of people of West African ancestry and many of Middle Eastern ancestry; produces a stable ANC of 1.0 to 1.5 with no infection risk and no need for treatment.
Vitamin B12, folate or copper deficiency
All three impair granulocyte production; copper deficiency follows bariatric surgery, prolonged zinc supplementation above 40 to 50 mg a day, or long-term tube feeding.
Autoimmune disease
Lupus, rheumatoid arthritis (Felty syndrome), Sjögren's syndrome and primary autoimmune neutropenia reduce the count through antibodies or marrow suppression.
Enlarged spleen
Cirrhosis, lymphoma and storage diseases trap neutrophils, platelets and red cells in an enlarged spleen.
Bone marrow failure or infiltration
Aplastic anemia, myelodysplastic syndromes, acute leukemia, large granular lymphocyte leukemia and marrow metastases reduce production, usually with anemia or low platelets as well.
Overwhelming sepsis, alcohol and chronic idiopathic neutropenia
Severe infection can consume neutrophils faster than they are made; heavy drinking suppresses the marrow; chronic idiopathic neutropenia is a stable, unexplained adult neutropenia diagnosed once other causes are excluded.

Symptoms that can go with it

Often none at 1,000 to 1,500, and none at all with the Duffy-null trait
Fever, which below 500 may be the only sign of a serious infection
Mouth ulcers, sore gums, sore throat, swollen glands
Skin infections, boils or abscesses that keep recurring, often without much pus
Cough, breathlessness, painful urination or abdominal pain from infections that take hold more easily
Fatigue, pallor and easy bruising when red cells and platelets are also low

Read it alongside

WBC and the differential percentages — the ANC is calculated from them; always check that the absolute number, not the percentage, is what was flagged.
Segmented neutrophils and bands — a left shift with a high ANC favors bacterial infection; a left shift with a low ANC suggests the marrow is overwhelmed.
Immature granulocytes — a raised IG during chemotherapy recovery predicts the ANC will rise within a day or two.
Hemoglobin and platelets — neutropenia with anemia or low platelets points toward marrow failure, B12/folate deficiency or hypersplenism rather than a drug or viral effect.
Lymphocytes and monocytes — monocytes often rise first during marrow recovery; lymphopenia with neutrophilia is typical of steroids and stress.
CRP and procalcitonin — in a neutropenic person with fever, these help gauge the severity of infection when the white count cannot.
Vitamin B12, folate and copper — for unexplained neutropenia, especially after bariatric surgery or with zinc supplements.
ANA, rheumatoid factor and HIV test — when neutropenia is persistent and unexplained.

What usually happens next

Confirm the number: calculate ANC = WBC × (segs % + bands %) ÷ 100 and check it against the laboratory's range. A flagged percentage with a normal ANC needs no action.
For a high ANC with an obvious trigger, repeat the CBC 4 to 6 weeks after it resolves. A count that stays above 10 to 12 ×10³/µL without a cause, or any count above 30, is reviewed on a blood film with BCR-ABL testing if indicated.
For a mild low ANC (1.0 to 1.5) in someone who feels well, the standard approach is a repeat CBC in 2 to 4 weeks with a blood film, B12, folate and a review of medications and recent illnesses; a stable count with a normal film is usually followed, not investigated further.
For an ANC below 1.0 that persists, is falling, or comes with anemia, low platelets, infections or an enlarged spleen, expect referral to haematology; a bone marrow examination is sometimes needed.
If you take clozapine, antithyroid drugs, methotrexate or chemotherapy, your prescriber has specific ANC action levels (commonly interrupting clozapine below 1,000, or below 500 in people with the Duffy-null trait, and delaying chemotherapy below 1,000 to 1,500); do not stop or change these medicines on your own.
During chemotherapy, ask for your ANC at each cycle and know the date of your expected nadir; a thermometer at home and a plan for what to do if you reach 38 °C (100.4 °F) are standard.

Diet, lifestyle and natural levers with evidence

What can move ANC once the cause is known. Nothing here replaces finding the cause.

No supplement or herb reliably raises a low ANC

Strong evidence

Neutropenia from chemotherapy, drugs, viral infection or marrow disease does not respond to vitamins, echinacea, elderberry, mushrooms or "immune" products in controlled trials; G-CSF is the only intervention shown to shorten chemotherapy-related neutropenia (reducing febrile neutropenia by roughly half in meta-analyses). The exception is a documented nutritional deficiency, below. Products marketed to raise white cells are not a substitute for monitoring.

Some supplements (high-dose zinc, excessive green tea extract, certain herbal products contaminated with drugs) have themselves been linked to neutropenia or marrow suppression; tell your team about everything you take.

Correct vitamin B12, folate and copper deficiency

Moderate evidence

When neutropenia is caused by a deficiency, replacement works: the ANC recovers within 2 to 6 weeks of B12 or folate repletion, and copper-deficiency neutropenia (often with anemia, after bariatric surgery or months of zinc above 40 to 50 mg a day) resolves over 4 to 12 weeks of oral or intravenous copper once excess zinc is stopped. Replacement does nothing when levels are already normal.

Folic acid can mask B12 deficiency while nerve damage continues; check B12 first.

Stop smoking (for a high ANC)

Strong evidence

Smoking is the commonest cause of a persistent mild neutrophilia in healthy adults. Cohort studies show white cell counts 15 to 25 percent higher in current smokers, dose-related, with a fall of about 0.5 to 1.0 ×10³/µL in the first year after quitting and a return toward never-smoker levels over about five years.

Weight loss (for a high ANC)

Moderate evidence

Neutrophil counts rise with waist size through adipose-tissue inflammation. After bariatric surgery, total white cell counts fell by about 1.0 ×10³/µL over a year, mostly from neutrophils, and diet-based losses of 5 to 10 percent of body weight produce smaller reductions alongside falls in CRP.

Reduce heavy alcohol intake (for a low ANC)

Moderate evidence

Alcohol suppresses marrow precursors and interferes with folate; heavy drinkers commonly show mild neutropenia, macrocytosis and low platelets that improve within 2 to 4 weeks of abstinence or substantial reduction, without other treatment.

Food safety and mouth care while neutropenic

Preliminary evidence

These do not change the count but reduce the chance of infection while it is low. Trials of strict "neutropenic diets" have not shown fewer infections than ordinary safe food handling (thorough cooking, washed produce, avoiding unpasteurised products and raw meat or fish), which is now what most cancer centers recommend. Regular gentle tooth brushing and saline mouth rinses reduce mouth infections during chemotherapy.

When to see a clinician promptly

A temperature of 38.0 °C (100.4 °F) or higher, or chills or feeling very unwell, when your ANC is below 500 or below 1,000 and falling (for example 7 to 14 days after chemotherapy): febrile neutropenia is an emergency; antibiotics should be started within an hour of arrival.
A new fever, sore throat or mouth ulcers while taking clozapine, methimazole, propylthiouracil, carbamazepine or a sulfonamide antibiotic: stop and call the prescriber the same day, or go to the emergency department if unwell.
Any ANC below 500 on a routine test, even without symptoms, needs same-day contact with a clinician.
An ANC above 20 to 30 ×10³/µL, or any high count with immature cells, basophilia, anemia, abnormal platelets or an enlarged spleen.
Neutropenia with anemia or low platelets, night sweats, unexplained weight loss, bone pain or easy bruising.
A high ANC with fever, shaking chills, a fast heart rate, fast breathing, confusion or severe pain, which suggests serious bacterial infection or sepsis.

Frequently asked questions

How do you calculate absolute neutrophil count?

Multiply the total white blood cell count by the neutrophil percentage (segmented neutrophils plus bands) and divide by 100. For example, a WBC of 4.0 ×10³/µL with 45 percent segs and 5 percent bands gives an ANC of 4.0 × 0.50 = 2.0 ×10³/µL, or 2,000 cells/µL. If your report lists "neutrophils absolute" or "neut abs", that calculation has already been done.

What is a normal ANC?

For adults about 1,500 to 8,000 cells per µL (1.5 to 8.0 ×10³/µL); some laboratories use 1,800 to 7,700 or 2,000 to 7,000. Children over one year have a similar range, infants under one year are naturally lower, and newborns are much higher for the first days. People with the Duffy-null trait, common in those of African or Middle Eastern ancestry, normally run 1,000 to 1,500.

What are the neutropenia levels?

Mild neutropenia is an ANC of 1,000 to 1,500 cells/µL, moderate 500 to 1,000, severe under 500 and profound under 200. Agranulocytosis means the count is near zero. Infection risk is barely changed in the mild range, starts to rise in the moderate range, and becomes serious below 500, where a fever is treated as an emergency.

What ANC is too low for chemo?

Most chemotherapy protocols require an ANC of at least 1,000 to 1,500 cells/µL on the day of treatment and delay or reduce the dose below that; some regimens, particularly in leukemia, proceed at lower counts under close supervision. Your oncology team decides based on the drugs, the cycle and your history, and may add G-CSF injections to keep the count up. Ask what threshold applies to you.

Is an ANC of 1,200 or 1,300 dangerous?

No. An ANC of 1,000 to 1,500 is mild neutropenia and does not meaningfully raise infection risk. It is commonly seen for a few weeks after a viral illness, with some medications, or permanently in people with the Duffy-null trait. It is usually rechecked in a few weeks with a blood film and B12 and folate levels; if stable and the rest of the CBC is normal, no further action is needed.

What does neutrophils absolute high mean?

An absolute count above about 7,700 to 8,000 cells/µL is neutrophilia. It usually means your body is responding to a bacterial infection, inflammation, injury, stress or a steroid medication, and milder persistent rises are typical of smoking, obesity and pregnancy. Counts above 20,000 to 30,000, or any high count with immature cells, basophils, anemia or an enlarged spleen, are reviewed on a blood film to exclude a bone marrow disorder.

What is febrile neutropenia?

A single temperature of 38.3 °C (101 °F) or a temperature of 38.0 °C (100.4 °F) sustained for an hour, in someone whose ANC is below 500 cells/µL or is below 1,000 and expected to fall below 500. Because a neutropenic person cannot wall off bacteria, it is treated as a medical emergency: blood cultures and intravenous antibiotics are started within an hour, before the source is known.

Can ANC go up on its own?

Yes, when the cause is temporary. After chemotherapy the count recovers over one to three weeks as the marrow regenerates; after a viral infection within one to four weeks; after stopping a causative drug usually within one to three weeks. A low count from the Duffy-null trait does not rise and does not need to. A count that stays low or keeps falling with no explanation needs haematology review.

References

White blood count (WBC). MedlinePlus, US National Library of Medicine (2022)View source
Blood differential test. MedlinePlus, US National Library of Medicine (2023)View source
Neutropenia (low neutrophil count). Mayo Clinic (2024)View source
Neutropenia. Merck Manual Professional Version (2024)
Freifeld AG, Bow EJ, Sepkowitz KA, et al.. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clinical Infectious Diseases (2011)
Taplitz RA, Kennedy EB, Bow EJ, et al.. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. Journal of Clinical Oncology (2018)
Bodey GP, Buckley M, Sathe YS, Freireich EJ. Quantitative relationships between circulating leukocytes and infection in patients with acute leukemia. Annals of Internal Medicine (1966)
Hsieh MM, Everhart JE, Byrd-Holt DD, Tisdale JF, Rodgers GP. Prevalence of neutropenia in the U.S. population: age, sex, smoking status, and ethnic differences. Annals of Internal Medicine (2007)
Reich D, Nalls MA, Kao WH, et al.. Reduced neutrophil count in people of African descent is due to a regulatory variant in the Duffy antigen receptor for chemokines gene. PLoS Genetics (2009)
Newburger PE, Dale DC. Evaluation and management of patients with isolated neutropenia. Seminars in Hematology (2013)
Andrès E, Maloisel F. Idiosyncratic drug-induced agranulocytosis or acute neutropenia. Current Opinion in Hematology (2008)
Riley LK, Rupert J. Evaluation of patients with leukocytosis. American Family Physician (2015)

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This page is educational and is not medical advice or a diagnosis. Lab results have to be interpreted together with your history, symptoms and other results by a clinician who knows you. Do not start or stop a supplement to change a lab value before the cause is known.