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Neutrophilia: Causes, Symptoms and Treatment

Neutrophilia is an elevated count of neutrophils in the blood, often indicating infection, inflammation, or other medical conditions.

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Things worth knowing about "Neutrophilia"

Neutrophilia is an elevated count of neutrophils in the blood, often indicating infection, inflammation, or other medical conditions.

What is Neutrophilia?

Neutrophilia (also called neutrocytosis) refers to an abnormally high number of neutrophilic granulocytes in the bloodstream. Neutrophils are the most abundant type of white blood cell and serve as the body's first line of defense against bacteria, fungi, and other pathogens. In healthy adults, neutrophil counts typically range from about 1,800 to 7,500 cells per microliter of blood. Counts above this range are classified as neutrophilia. The condition itself is not a disease but rather a marker of an underlying process in the body.

Causes

Neutrophilia is broadly categorized as either reactive (secondary) neutrophilia, which occurs in response to an external trigger, or clonal (primary) neutrophilia, which results from a disorder of the bone marrow.

Common Causes of Reactive Neutrophilia

Bacterial infections: e.g., pneumonia, urinary tract infections, appendicitis
Inflammatory conditions: e.g., rheumatoid arthritis, inflammatory bowel disease
Tissue damage: e.g., after surgery, trauma, myocardial infarction, or burns
Physical or emotional stress
Medications: e.g., corticosteroids, G-CSF (granulocyte colony-stimulating factor), lithium
Smoking
Pregnancy
Vigorous physical exercise

Causes of Clonal Neutrophilia

Chronic myeloid leukemia (CML)
Polycythemia vera
Primary myelofibrosis
Other myeloproliferative neoplasms

Symptoms

Neutrophilia itself typically does not cause specific symptoms. Any symptoms experienced by the patient are usually related to the underlying condition. Associated symptoms may include:

Fever and chills (in cases of infection)
Fatigue and general weakness
Pain, depending on the underlying cause
Enlarged lymph nodes or spleen (in hematological disorders)
Unintentional weight loss and night sweats (in malignant conditions)

Diagnosis

Neutrophilia is identified through a complete blood count (CBC) with differential, which measures the specific proportions of each white blood cell type. To determine the underlying cause, additional tests may be ordered:

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) for inflammation markers
Blood, urine, or swab cultures to detect infection
Bone marrow biopsy if a hematological malignancy is suspected
Molecular genetic tests (e.g., BCR-ABL testing to rule out CML)
Imaging studies such as ultrasound or CT scan

Treatment

Treatment of neutrophilia is always directed at the underlying cause. An elevated neutrophil count alone does not require independent treatment.

Infections: Antibiotics or antifungal medications as appropriate
Inflammatory conditions: Anti-inflammatory drugs, including corticosteroids or immunosuppressants
Myeloproliferative disorders: Specialized oncological therapy, e.g., tyrosine kinase inhibitors for CML
Drug-induced neutrophilia: Adjustment or discontinuation of the causative medication under medical supervision

References

Berliner, N. - Neutrophilia. In: Hoffman R. et al. (eds.): Hematology: Basic Principles and Practice, 7th edition, Elsevier, 2018.
Dale, D. C. - Neutrophilia. MSD Manual, Professional Edition. Merck Sharp & Dohme, 2023. Available at: https://www.msdmanuals.com
Palmblad, J., Nilsson, C. C., Hoglund, P., Papadaki, H. A. - How we diagnose and treat neutrophilia and neutropenia. Current Opinion in Hematology, 2012.

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