Lab result explainedBlood count (CBC)Last updated November 1, 2026

Neutrophils on a blood test: what high and low absolute neutrophils mean

Neutrophils (absolute neutrophil count) (NEUT / ANC) · CBC with differential · reported in ×10³/µL (same as ×10⁹/L or thousands per mm³); also reported as %

Neutrophils are the most numerous white blood cells and the body's first responders to bacterial infection and tissue injury: they leave the blood within hours to engulf and destroy bacteria at the site of trouble. On an adult CBC with differential, most US labs call an absolute neutrophil count (ANC) of 1.5–8.0 ×10³/µL (1,500–8,000 cells per microlitre), or roughly 40–70% of white cells, normal. The two most common reasons it is high are an acute bacterial infection and physical stress (surgery, injury, smoking, steroids); the two most common reasons it is low are a recent viral infection and medication, with a benign inherited variant being a frequent explanation in people of African or Middle Eastern ancestry.

Because neutrophils respond fast and in large numbers, the count moves a lot from day to day. A high count during an obvious infection is expected and reassuring; a persistently high count with no infection needs a closer look. A low count matters mostly because of what it does to infection risk, which rises sharply only below 0.5 ×10³/µL, and far less at the mild levels most people worry about.

This page explains how the absolute count is derived from the percentage, the reference ranges and how they differ by ancestry and pregnancy, the causes of high and low neutrophils in order of how often they turn up, what a clinician reads the number beside, and when a low count is an emergency.

NEUT / ANC at a glance

  • Neutrophils are white blood cells that fight bacteria and fungi; the absolute neutrophil count (ANC) is the number that matters, not the percentage.
  • Normal adult ANC: about 1.5–8.0 ×10³/µL (40–70% of white cells); people with the Duffy-null variant normally run 1.0–1.5 ×10³/µL.
  • High neutrophils (neutrophilia) most often mean bacterial infection, inflammation, physical stress, smoking or steroid use.
  • Low neutrophils (neutropenia): mild 1.0–1.5, moderate 0.5–1.0, severe below 0.5 ×10³/µL; infection risk rises mainly below 0.5.
  • Fever with an ANC under 0.5 ×10³/µL (or under 1.0 and falling) is a medical emergency; go to the emergency department.
  • Next step: repeat the count when well; persistent results outside the range get a blood film and a review of medications and infection history.

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What NEUT / ANC measures

The neutrophil result is part of the white cell differential on a complete blood count. An automated analyser classifies white cells by size, internal complexity and light scatter, reporting neutrophils as a percentage of all white cells and as an absolute count (ANC), which is the percentage multiplied by the total white cell count. Some reports also list bands, which are slightly immature neutrophils; a rising band count, sometimes called a left shift, is a sign the marrow is pushing cells out early to meet demand.

Clinicians use the absolute count because the percentage can mislead. If lymphocytes are high after a viral illness, neutrophils can read as 35% while the absolute count is normal. Only about half of your neutrophils are counted at any moment; the rest sit along blood vessel walls (the marginated pool) and can be released into circulation within minutes by adrenaline, exercise or steroids, which is why counts can jump without any new cells being made.

Normal range for NEUT / ANC

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

GroupTypical range (×10³/µL (same as ×10⁹/L or thousands per mm³); also reported as %)Notes
Adults, absolute neutrophil count1.5–8.0 ×10³/µLMany labs use 1.8–7.7 or 2.0–7.5. Neutrophilia is usually defined as above 7.7–8.0.
Adults, percentage40–70% of white blood cellsSome reports give 40–60%. Check the absolute count.
Duffy-null phenotype (common in African and some Middle Eastern ancestry)1.0–1.5 ×10³/µL is normalFormerly called benign ethnic neutropenia; infection risk is not raised.
PregnancyUp to 10–13 ×10³/µL in the third trimester and labourA physiological rise; bands may appear.
NewbornsUp to 26 ×10³/µL in the first daysFalls to childhood levels within weeks.
Neutropenia gradesMild 1.0–1.5; moderate 0.5–1.0; severe below 0.5 ×10³/µLInfection risk climbs steeply below 0.5.

High neutrophils (neutrophilia)

A high absolute neutrophil count usually means the body is responding to a bacterial infection, inflammation or physical stress. The count can double within hours as cells are released from the marrow and from vessel walls, and it falls back within days once the trigger is gone. A count of 8–15 ×10³/µL with a clear reason is expected and not itself dangerous.

What matters is context and persistence. Neutrophilia with fever and a focus of infection is doing its job. Neutrophilia with no infection that persists over weeks, or that climbs above 25–30 ×10³/µL, or that comes with immature cells, basophilia, anaemia or an enlarged spleen, needs a blood film and sometimes tests for chronic myeloid leukaemia (BCR-ABL) or other marrow disorders.

Common causes

  1. Acute bacterial infection

    Pneumonia, urinary infection, appendicitis, cellulitis and abscesses are the classic causes. Cytokines such as G-CSF and IL-6 release stored neutrophils and speed up marrow production, often with a left shift (more bands).

  2. Inflammation and tissue injury

    Heart attack, burns, surgery, trauma, gout flares and active autoimmune disease all raise neutrophils through the same signals as infection, without any germs involved.

  3. Smoking

    Smokers run neutrophil counts around 1–2 ×10³/µL higher than non-smokers because of chronic airway inflammation. Heavy smokers can sit persistently just above the reference range; counts normalise over months to years after quitting.

  4. Corticosteroids

    Prednisone, dexamethasone and even high-dose inhaled or injected steroids push neutrophils off vessel walls and delay their exit from blood, raising the count within hours. A count of 12–20 ×10³/µL on steroids is common and expected.

  5. Physical and emotional stress, exercise

    Adrenaline releases the marginated pool, so vigorous exercise, a panic attack, a seizure or labour can raise neutrophils by 50–100% for a few hours. Testing after a hard workout is a classic cause of a spuriously high result.

  6. Obesity

    Low-grade metabolic inflammation raises neutrophil counts modestly; counts fall with weight loss.

  7. Other medications

    Lithium, G-CSF (filgrastim), beta-agonists such as albuterol, and adrenaline raise neutrophils. Clozapine can cause either a rise or a dangerous fall.

  8. Asplenia

    People without a spleen have persistently higher neutrophil and platelet counts.

  9. Chronic myeloid leukaemia and myeloproliferative neoplasms

    CML causes a sustained, often very high neutrophil count (frequently above 25 ×10³/µL) with immature cells and basophils on the film and an enlarged spleen. Polycythaemia vera and essential thrombocythaemia can cause milder neutrophilia with raised red cells or platelets.

  10. Solid cancers

    Some lung, kidney and gastrointestinal cancers secrete G-CSF and cause paraneoplastic neutrophilia. It is uncommon, but a persistently unexplained high count in a smoker with weight loss should prompt a search.

Symptoms that can go with it

  • Fever, chills, pain or redness at a site of infection
  • None, when caused by smoking, steroids, stress or exercise
  • Joint pain and swelling in gout or inflammatory arthritis
  • Fatigue, night sweats, weight loss, fullness under the left ribs or bone pain when a marrow disorder is the cause
  • Easy bruising or breathlessness if other cell lines are also abnormal

Low neutrophils (neutropenia)

A low absolute neutrophil count means fewer cells are available to fight bacteria and fungi. Mild neutropenia (1.0–1.5 ×10³/µL) is very common, often transient after a viral infection or a normal inherited trait, and does not meaningfully raise infection risk. Moderate neutropenia (0.5–1.0) deserves explanation but is usually tolerated. Severe neutropenia (below 0.5), particularly below 0.2, carries a real and rising risk of serious bacterial infection and needs urgent attention if fever develops.

The pattern over time matters as much as the number. A single low reading in a well person is most often a viral after-effect or a lab snapshot, and the first move is to repeat it. Neutropenia that persists, worsens, or comes with anaemia or low platelets points toward a marrow, nutritional, autoimmune or drug cause and needs a work-up.

Common causes

  1. Recent viral infection

    Influenza, COVID-19, EBV, hepatitis, HIV, measles and many common viruses suppress neutrophil production or increase their use for one to several weeks. This is the most common cause of a new, mild neutropenia in an otherwise healthy adult.

  2. Duffy-null associated neutrophil count (DANC)

    A common, harmless inherited variant in the ACKR1 (Duffy) gene, present in most people of sub-Saharan African ancestry and some of Middle Eastern ancestry, keeps more neutrophils in tissues rather than blood. Counts of 1.0–1.5 ×10³/µL are normal for this group and infection risk is not increased.

  3. Medications

    Chemotherapy is the most predictable cause. Others include clozapine, methotrexate, azathioprine, sulfasalazine, antithyroid drugs (methimazole, propylthiouracil), trimethoprim-sulfamethoxazole, some antibiotics and anticonvulsants, and valganciclovir. Drug-induced neutropenia usually starts within weeks to months of a new drug.

  4. Autoimmune neutropenia

    Antibodies against neutrophils occur on their own or with lupus, rheumatoid arthritis (Felty syndrome, with an enlarged spleen) and Sjögren syndrome. The marrow is usually normal and counts fluctuate.

  5. Vitamin B12, folate or copper deficiency

    All three are needed for marrow cell production. B12 and folate deficiency typically cause neutropenia with large red cells (high MCV); copper deficiency, seen after bariatric surgery or with excess zinc intake, causes neutropenia with anaemia.

  6. Chronic idiopathic neutropenia

    A stable, mild-to-moderate neutropenia with no identifiable cause, more common in women, that is followed over time rather than treated. Diagnosed after other causes are excluded.

  7. Severe infection or sepsis

    Overwhelming bacterial infection can consume neutrophils faster than the marrow can replace them. A low count in a very unwell person with fever is an ominous sign, not a reassuring one.

  8. Hypersplenism

    An enlarged spleen from cirrhosis, portal hypertension or blood disorders traps and removes neutrophils, usually along with platelets.

  9. Bone marrow disorders

    Myelodysplastic syndromes, aplastic anaemia, leukaemia, large granular lymphocyte leukaemia and marrow infiltration cause neutropenia that persists and usually comes with other count abnormalities. Diagnosis needs a blood film and often a marrow biopsy.

  10. Cyclic and congenital neutropenia

    Rare inherited disorders (ELANE and other gene variants) cause counts that fall to near zero every three weeks or so, or are persistently very low from childhood, with recurrent mouth ulcers and infections.

Symptoms that can go with it

  • Usually none when mild (1.0–1.5 ×10³/µL)
  • Recurrent mouth ulcers, gum infections or sore throats
  • Frequent or slow-to-clear skin infections, boils, sinus or ear infections
  • Fever, chills or feeling suddenly unwell when severe; the usual signs of infection (pus, redness) may be muted because there are too few neutrophils to make them
  • Fatigue, pallor or bruising if red cells and platelets are also low

Read it alongside

  • Total white blood cell count and lymphocytes — ANC is percentage × WBC; a low neutrophil percentage with high lymphocytes after a virus is not true neutropenia.
  • Bands (immature neutrophils) — a left shift with high neutrophils supports acute bacterial infection; bands with a low count suggest the marrow is struggling.
  • Hemoglobin and platelets — neutropenia with anaemia or thrombocytopenia points to a marrow, nutritional or hypersplenism cause rather than a simple viral dip.
  • MCV — a high MCV with low neutrophils raises B12 or folate deficiency or myelodysplasia; it directs the next test.
  • CRP — a high CRP alongside neutrophilia confirms infection or inflammation as the driver; a normal CRP with persistent neutrophilia is more suspicious.
  • Basophils and eosinophils — basophilia with marked neutrophilia is a clue to chronic myeloid leukaemia.
  • Blood film — confirms the analyser count, grades maturity and shows abnormal or immature cells.

What usually happens next

  1. Repeat the CBC with differential in 2–4 weeks if you were recently unwell, on steroids or tested right after exercise; most mild results normalise.
  2. Review every medication and supplement started in the past three months with your clinician; drug-induced neutropenia reverses on stopping the drug.
  3. If a low count persists, expected tests are a blood film, B12, folate, copper (if at risk), HIV, hepatitis screen, ANA and rheumatoid factor, and sometimes Duffy antigen typing.
  4. For persistent neutrophilia with no infection, expect CRP, a blood film, a smoking and steroid history, and if the count is high or immature cells appear, a BCR-ABL test and haematology referral.
  5. Ask what ANC threshold should prompt you to seek care for fever; for most people it is below 1.0 ×10³/µL, and below 0.5 is an emergency.

Diet, lifestyle and natural levers with evidence

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

Stop smoking

Strong evidence

Large population studies, including EPIC-Norfolk and NHANES analyses, show current smokers run neutrophil counts about 1–2 ×10³/µL higher than never-smokers, with counts falling toward normal over years after quitting. For an unexplained mildly high count in a smoker, quitting is the first and most effective step.

Correct a measured B12, folate or copper deficiency

Strong evidence

Replacing a documented deficiency restores neutrophil counts within two to six weeks; copper repletion reversed neutropenia in most patients in a Mayo Clinic series of copper-deficient adults. Supplement only for a confirmed low level, because taking high-dose zinc without need can itself cause copper deficiency and neutropenia.

Test first. High-dose zinc (above 40 mg/day for months) lowers copper and can cause neutropenia.

Weight loss and regular moderate exercise

Moderate evidence

Neutrophil counts rise with BMI and fall with weight loss; bariatric and diet trials show reductions of around 0.5–1.0 ×10³/µL in total white cells. Regular moderate exercise lowers resting counts and inflammatory tone, while a single intense session raises neutrophils for several hours, so avoid blood draws straight after training.

Sleep and stress management

Preliminary evidence

Sleep restriction and acute psychological stress raise circulating neutrophils through cortisol and adrenaline in experimental studies, and shift work is associated with higher counts. Consistent sleep and stress reduction are reasonable for a mildly high count but have not been tested as a treatment for neutrophilia.

Food safety and hygiene when neutropenic

Moderate evidence

For a low count, nothing in diet or supplements reliably raises neutrophils; the levers that matter are reducing infection exposure: hand hygiene, dental care, avoiding undercooked meat, eggs and unpasteurised products, and prompt attention to fever. Strict neutropenic diets have not been shown to reduce infections in trials, but basic food safety is still advised.

When to see a clinician promptly

  • Fever of 100.4°F (38°C) or higher with an ANC below 1.0 ×10³/µL, and any fever with an ANC below 0.5: go to the emergency department the same hour; this is neutropenic fever.
  • An ANC below 0.5 ×10³/µL on any test, even without symptoms, needs a same-day call to your clinician.
  • A new low count while taking clozapine, methotrexate, antithyroid drugs or chemotherapy: contact the prescribing team the same day.
  • Neutrophils persistently above 15 ×10³/µL with no infection, or any count with immature cells, anaemia, low platelets or an enlarged spleen.
  • Recurrent mouth ulcers, skin infections or sinus infections alongside a low count.
  • Night sweats, unexplained weight loss, bone pain or bruising with any abnormal count.

Frequently asked questions

What is a dangerously high neutrophil count?

There is no single dangerous number, because a count of 15–20 ×10³/µL during pneumonia is appropriate. Counts above 25–30 ×10³/µL without an obvious infection, or any high count with immature cells, basophils, anaemia or an enlarged spleen, need prompt evaluation for a marrow disorder such as chronic myeloid leukaemia. Counts above 50 ×10³/µL (a leukaemoid reaction) are investigated urgently.

Is an absolute neutrophil count of 1.3 bad?

An ANC of 1.3 ×10³/µL is mild neutropenia and does not meaningfully increase infection risk. It is commonly seen after a viral illness and is normal for most people with the Duffy-null variant. The usual approach is to repeat the test in a few weeks; if it stays low, a short list of tests looks for a cause.

Can stress or anxiety raise neutrophils?

Yes, briefly. Adrenaline from acute stress, a panic attack or hard exercise releases neutrophils stuck to vessel walls, raising the count by up to double for a few hours. It falls back on its own. Chronic stress and poor sleep raise counts modestly through cortisol, but rarely outside the normal range.

What ANC is too low for chemotherapy?

Most chemotherapy protocols require an ANC of at least 1.0–1.5 ×10³/µL before a cycle is given. Oncology teams check the count on the day of treatment and may delay a dose, reduce it, or give G-CSF (filgrastim) support if it is below their threshold. Fever with an ANC under 0.5 during chemotherapy is an emergency.

Does a high neutrophil count mean cancer?

Rarely. The great majority of high counts are from infection, inflammation, smoking, steroids or stress. Leukaemia becomes a consideration when the count is very high and persistent, when immature cells or basophils appear on the film, or when red cells and platelets are also abnormal. A blood film and a BCR-ABL test settle the question quickly.

Why are my neutrophils low but lymphocytes high?

This pattern is typical in the week or two after a viral infection: the virus briefly suppresses neutrophil production while lymphocytes multiply to fight it. It usually normalises within a month. If it persists, chronic viral infection (EBV, HIV, hepatitis), autoimmune disease or, rarely, a lymphocyte disorder is considered.

Can a neutrophil count be wrong?

Analyser counts are accurate, but timing matters: counts rise after exercise, meals, smoking and steroid doses, and fall after a viral illness. A blood sample left overnight before processing can also lose neutrophils. If a result does not fit how you feel, a repeat test at a calm time of day with a manual film review is reasonable.

What foods increase neutrophils?

No food raises neutrophils in a person who is not deficient. If a low count is caused by a lack of vitamin B12, folate or copper, replacing it (through diet or supplements) restores the count. Otherwise, the useful dietary step for neutropenia is food safety to reduce infection risk, not trying to push the number up.

References

  1. Blood differential test. MedlinePlus, US National Library of MedicineView source
  2. Neutropenia (low neutrophil count). Mayo ClinicView source
  3. Neutropenia. Merck Manual Professional VersionView source
  4. Riley LK, Rupert J. Evaluation of patients with leukocytosis. American Family Physician (2015)View source
  5. Newburger PE, Dale DC. Evaluation and management of patients with isolated neutropenia. Seminars in Hematology (2013)
  6. 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)
  7. 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)
  8. Halfdanarson TR, Kumar N, Li CY, Phyliky RL, Hogan WJ. Hematological manifestations of copper deficiency: a retrospective review. European Journal of Haematology (2008)
  9. Smith MR, Kinmonth AL, Luben RN, et al.. Smoking status and differential white cell count in men and women in the EPIC-Norfolk population. Atherosclerosis (2003)
  10. Vitamin B12: fact sheet for health professionals. NIH Office of Dietary SupplementsView source
  11. Copper: fact sheet for health professionals. NIH Office of Dietary SupplementsView source
  12. Arber DA, Orazi A, Hasserjian R, et al.. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood (2016)

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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.