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Absolute Neutrophil Count (ANC)

Calculators  Hematology
Absolute Neutrophil Count (ANC) measures the percentage of neutrophils in total white blood count. Neutrophils help fight against infection. The lower absolute neutrophil count, the more susceptible the patient is to infection.
% neutrophils
%
% bands
%
White Blood Cell Count
Per 1000. Enter as 8.4, not 8400
×
Result:

Background

Measured Factor
ANC
Measured Factor Disease
  • Bacterial infection
  • Opportunistic infection
  • Neutropenic fever
  • Neutropenia
Measured Factor Detail
The ANC is  used to assess the risk of infection in patients with a low neutrophil count, such as those taking chemotherapy or Clozapine that decrease neutrophil count . A neutropenic patient should be monitored for signs of infection.
Speciality
Multi-Speciality
Body System
Hematology
Formula
ANC = 10 * White blood cell count * (% neutrophils + % bands) White blood cell (WBC) count is per1000s; % neutrophils is same as % segmented neutrophils; % bands is same as % segmented bands.
Measured Factor Low Impact
  • Neutropenia is indicated when ANC is < 1500 cells / mm³. Mild neutropenia is indicated when ANC is 1000-1500 cells / mm³. Moderate neutropenia is indicated when ANC is 500-999 cells / mm³. Severe neutropenia is indicated when ANC is < 500 cells / mm³.
Process
WBC count is per1000s; % neutrophils is same as % segmented neutrophils; % bands is same as % segmented bands.
Preparation
  • A blood test is used to determine WBC count, % neutrophils, and % bands

Result Interpretation

Ranges Ranges
  • Critical Low: < 500 cells / mm³
  • Normal: 2200-8000 cells/ mm³
  • Normal Adult Male: 2200-8000 cells/ mm³
  • Normal Adult Female: 2200-8000 cells/ mm³
  • Normal Geriatric Male: 2200-8000 cells/ mm³
  • Normal Geriatric Female: 2200-8000 cells/ mm³
Result Low Conditions
  • Bacterial infection
  • Opportunistic infection
  • Neutropenic fever
  • Neutropenia
Test Limitations
Absolute neutrophil count might need to be adjusted for ethnic groups with benign ethnic neutropenia, such as  African descent and some ethnic groups in the Middle East, because they normally have low neutrophil counts .
References: 2

Studies

Study Validation 1
A retrospective cross-sectional study evaluated how well WBC and ANC predicted the risk for sepsis in newborns. Among 67,623 newborns, 245 newborns were tested positive for blood infection. As compared to newborns without infection, those with infection had lower mean WBC counts and mean ANCs; however, their mean proportions of immature neutrophils were higher. The likelihood ratio for ANC < 1000 was 115 at ≥4 hours. Both WBC counts and ANCs were most predictive for sepsis when they were very low.
References: 3
Study Validation 2
This study validated an earlier published study that claimed the nadir ANC in the first cycle of chemotherapy can predict future neutropenic events. Patients had six cycles of fluorouracil, doxorubicin, and cyclophosphamide without hematopoietic support from colony-stimulating factor. Data showed first-cycle nadir ANC was the sole significant (P < 0.0001) predictor of neutropenic events. Patients with a  first-cycle ANC of equal to or less than 0.25 × 109/liter were more likely to experience febrile neutropenia (30% versus 10%, P = 0.04). Prophylactic treatment with colony-stimulating factor was recommended for patient with a low first-cycle ANC
References: 4
Study Additional 1
A prospective study evaluated assess the diagnostic value of WBC, ANC, Interleukin -6 (IL-6) and C-reactive protein (CRP) level to differentiate serious bacterial infection from self-limiting viral illness. A total of 195 febrile infants younger than three months old with a full sepsis were evaluated. Serious bacterial infection was diagnosed in 29 (14.9%) patients. Serum IL-6 had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 79/1%, 91.6%,75.4%, 60.3%, respectively. Serum CRP had sensitivity, specificity, PPV and NPV of 81.6%, 89.8%, 78.2%, and 52%, respectively. ANC had sensitivity, specificity, PPV and NPV of 34.5%, 76.2%, 52.6%, and 44.5%, respectively. WBC had sensitivity, specificity, PPV and NPV of 41.4%, 80.2%, 60%, and 41.1%, respectively. The predictive values of CRP and IL-6 were higher than WBC and ANC. The study concluded that IL-6 and CRP were better diagnostic markers than WBC count and ANC in predicting serious bacterial infection.
References: 5
Study Additional 2
This study compared two markers of immunosuppression, ANC to CD4 lymphocyte counts, in adult cancer patients following cytotoxic chemotherapy. A total of 80 cancer patients had their ANC and CD4 lymphocyte counts measured at days 0 and 12 of the first cycle of chemotherapy. Post-chemotherapy CD4 count was significantly reduced in patients with Non-Hodgkin's lymphoma (p=0.043), colorectal carcinoma (p=0.037) and other malignancies (p=0.030); however, post-chemotherapy ANC was not significantly reduced. The study concluded that CD4 lymphocyte count may be a better maker of immunosuppression than ANC in cancer patients undergoing cytotoxic chemotherapy.
References: 6

Authors

Layla A. Al-Gwaiz is a physician in the Department of Pathology at the King Khalid University Hospital in Riyadh, Kingdom of Saudi Arabia
https://www.scopus.com/authid/detail.uri?authorId=56251282300

References

  1. Al-Gwaiz LA, Babay HH. The diagnostic value of absolute neutrophil count, band count and morphologic changes of neutrophils in predicting bacterial infections. Med Princ Pract. 2007;16(5):344-7.
  2. Haddy TB, Rana SR, Castro O. Benign ethnic neutropenia: what is a normal absolute neutrophil count? J Lab Clin Med. 1999 Jan;133(1):15-22.
  3. Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics. 2010 Nov;126(5):903-9.
  4. Rivera E, Haim Erder M, Fridman M, Frye D, Hortobagyi GN. First-cycle absolute neutrophil count can be used to improve chemotherapy-dose delivery and reduce the risk of febrile neutropenia in patients receiving adjuvant therapy: a validation study. Breast Cancer Res. 2003;5(5):R114-20. Epub 2003 Jun 20.
  5. Zarkesh M, Sedaghat F, Heidarzadeh A, Tabrizi M, Bolooki-Moghadam K, Ghesmati S. Diagnostic value of IL-6, CRP, WBC, and absolute neutrophil count to predict serious bacterial infection in febrile infants. Acta Med Iran. 2015 Jul;53(7):408-11.
  6. Anazoeze M, Sunday O, Obike I, Awele C, Kenechi M. Comparison of absolute neutrophil to CD4 lymphocyte values as a marker of immunosuppression in cancer patients on cytotoxic chemotherapy. Afr Health Sci. 2015 Jun;15(2):581-9.