Neutrophil granulocytes are cellular components of the blood. They are a subset of leukocytes (white blood cells) and are considered part of the nonspecific innate immune system. The rod-nucleated granulocyte is the penultimate maturation stage of granulopoiesis (cellular development of granulocytes), it is characterized by a rod-shaped, unsegmented nucleus.The segment-nucleated granulocyte is the last maturation stage of granulopoiesis, it is characterized by a segmented nucleus. The segmented-nucleated graulocyte is the most abundant form of granulocyte in peripheral blood. Neutrophil granulocytes are determined as part of the differentiation of leukocytes (see “Differential Blood Count” below).
The procedure
Material needed
- 4 ml EDTA blood (mix well! ); for children, at least 0.25 ml.
Preparation of the patient
- Not necessary
Disruptive factors
- None known
Indications
- Acute and chronic diseases
- Malignant (malignant) neoplasms
Normal values
Age | Absolute values | Percentage(of total leukocyte count) | ||
Neutrophil rod-nucleated granulocytes | Neutrophil segment-nucleated granulocytes | Neutrophil rod-nucleated granulocytes | Neutrophil segment-nucleated granulocytes | |
Infants | 0-1,500/μl | 2,250-9,750/μl | 0-10 % | 22-65 % |
Children | 0-1,200/μl | 2,000-7,800/μl | 0-10 % | 25-65 % |
Adults* | 150-400/μl | 3,000-5,800/μl | 3-5 % | 50-70 % |
Interpretation
Interpretation of elevated values (neutrophilia).
- Stress
- Acute diseases
- Hemorrhage (bleeding)
- Hemolysis (dissolution of red blood cells).
- Cardiovascular (e.g., myocardial infarction, see myocardial infarction diagnostics).
- Burns
- Intoxications (poisonings)
- Acute and chronic inflammatory reactions
- Chronic obstructive pulmonary disease (COPD) (30-50% or more; correlates with poor lung function).
- Autoimmune diseases
- Cushing’s syndrome – group of diseases leading to hypercortisolism (hypercortisolism).
- Malignant neoplasms
- Chronic myeloid leukemia (CML).
- Metastatic malignancies
- Myeloproliferative diseases
- Osteomyelosclerosis
- Polycythaemia vera (PV), benign familial polycythemia; erythropoietic stem cell disorder; autonomous proliferation of the three cell series.
- Drugs
- Epinephrine
- Glucocorticoids
- Hormonal contraceptives
- Lithium
Interpretation of decreased values (neutropenia).
- Infections
- Bacteria
- Brucellosis
- Tuberculosis
- Parasites
- Malaria
- Visceral leishmaniasis (synonyms: kala-azar; oriental bump; also known as dum-dum fever or black fever).
- Viruses; in one study, 0.8% of participants with normal neutrophil levels were found to have severe viral disease in the four years after blood analysis; if neutropenia was previously shown to be present, the proportion was three to six times higher
- Hepatitis viruses
- HIV
- Other viral-related neutropenias: Influenza, measles, rubella, ringworm (parvovirus B19), varicella, Epstein-Barr virus.
- Bacteria
- Malnutrition: e.g. vitamin B12, folic acid, iron, copper deficiency.
- Leukemias; in one study, 0.4% of participants with neutrophils in the reference range developed hematologic disease in the four years after blood analysis, and the proportion ranged from 2 to 38% in those with neutropenia
- Acute myeloid leukemia (AML).
- Myelodysplastic syndrome (MDS)
- Solid tumors; a tumor was diagnosed primarily when neutropenia was accompanied by elevated CRP levels; in such cases, the tumor rate was approximately four times higher than in neutropenia and normal CRP levels
- Drug-induced autoimmune neutropenia: eg.B. β-lactam antibiotics, analgesics (painkillers), antimalarials, proton pump inhibitors (proton pump inhibitors, PPI; frequency: rare), thyrostatic drugs (drugs that suppress thyroid hormone production); cytostatic-induced neutropenia (in the context of cancer therapy).
- Congenital neutropenia
Further notes
- Toxic neutrophils: bacterial infections (80% sensitivity).
- Neutropenia:
- <1,000/µl = increased risk of infection.
- < 500/µl, severe (bacterial) infections (gingivitis (inflammation of the gums) and ulceration/ulceration of the oral mucosa, recurrent otitis media (recurrent inflammation of the middle ear), tonsillitis (inflammation of the tonsils) and skin abscesses) up to sepsis (= severe chronic neutropenia (SCN)) occur regularly.
- Other possible symptoms include:
- Decrease of other blood cell series, but also organ malformations, failure to thrive, metabolic disorders, immune phenomena and viral infections.
- Diagnostics: search for antigranulocytic antibody.
- 4 years after severe neutropenia was detected, more than 52% of patients had died
- Other possible symptoms include:
- Agranulocytosis (most severe form of granulocytopenia; reduction of granulocytes to below 500 cells/µl of blood or almost complete absence of neutrophilic granulocytes); common triggers are:
- Analgesics
- Non-acidic analgesics (metamizole)
- Nonsteroidal anti-inflammatory drugs (NSAIDs; diclofenac, ibuprofen).
- Antiarrhythmic drugs (quinidine; ajmaline, amiodarone).
- Antibiotics
- Ampicillin
- Cefotaxime
- Cefuroxime
- Clindamycin (if used for longer than 3 weeks, check blood count regularly).
- Cotrimoxazole
- Flucytosine
- Fusidic acid
- Imipenem/cilastatin
- Lincomycin (check blood count regularly if used for longer than 3 weeks).
- Nafcillin
- Oxacillin
- Penicillin G
- Sulfasalcin
- Sulfones (dapsone)
- Antidiabetics (sulfonylurea antidiabetics).
- Antiepileptic drugs (phenytoin)
- Antimalarials (quinine)
- Antiprotozoal agents
- Nitroimidazoles (benznidazole)
- Intestinal therapeutics (cimetidine, mesalazine, metoclopramide).
- Deferiprone (1%), re-treatment with deferiprone contraindicated.
- Gold compounds (sodium aurothiomalate).
- Intestinal anti-inflammatory (sulfasalcin).
- Mitoxantrone
- Monoclonal antibodies (adalimumab, alemtuzumab)
- Neuroleptics (clozapine: 0.8-2%, of which 70-80% in first 18 weeks of treatment with peak in 6th-10th week of treatment, 90% in first year; granulocytopenia 3%)
- Psychotropic drugs (clozapine, fluoxetine).
- Thyrostatic drugs (carbimazole, propylthiouracil, thiamazole).
- Ticlopidine-HCI
- Antivirals (boceprevir, didanosine).
- Cytostatic drugs (cyclophosphamide, fluorouracil, methylthiouracil (1-3%))
- Analgesics
- Symptoms
- Fever
- Odynophagia – pain in the mouth, throat, or esophagus when swallowing liquids or solid foods
- Mucosal/tonsillar ulceration (angina agranulocytotica: inflammation of the pharyngeal lymphatic ring associated with ulceration (ulceration), indicating agranulocytosis)
- Severe feeling of illness
- Bacterial infections with fever, chills and tachycardia (heartbeat too fast: > 100 beats per minute).
- Sepsis (blood poisoning)