They are a type of white blood cells that protect us against bacterial infections, among other functions.
About 40 to 60 percent of white blood cells are neutrophils. These cells are the first cells to arrive on the scene when we experience bacterial infections .
Damage to cells results in the release of ” chemokines ” that attract neutrophils to the site in a process called chemotaxis. Neutrophils may be best known to the casual observer as the main component of pus.
Neutrophils make up the largest fraction of blood cells produced by the bone marrow. They are our “first responders” who play the role of the first line of defense against infectious organisms that enter our bodies.
They target foreign invaders by “eating” them, a process known as phagocytosis, or by bringing them into the cell in a process called endocytosis.
Once the foreign organism is inside the neutrophil, it is “treated” with enzymes that result in the destruction of the organism. Neutrophils also help regulate the immune response in general.
These cells have a very short lifespan, averaging only 8 hours, but our bodies produce approximately 100 billion of these cells each day.
After being released from the bone marrow, about half of these cells are present along the lining of the blood vessels and the other half are found in the tissues of the body.
Anatomy and structure
Neutrophils can be clearly seen under the microscope as cells, with a characteristic 2 to 5 lobes in the nucleus, and staining pink or purple with neutral tints. The term “PMN” or polymorphonuclear leukocyte refers to this finding.
Neutrophils, White Blood Cells, and the Immune System
It can be confusing if you hear about white blood cells and neutrophils. If neutrophils are just one type of white blood cell, why do oncologists talk about a low white blood cell count and a low neutrophil count interchangeably with chemotherapy?
A simple answer is that low neutrophils, in particular, can be more dangerous in predisposing people to infections.
All blood cells (white blood cells, red blood cells, and platelets) form in the bone marrow, the spongy tissue in the central area of the bones, such as the hips.
In the bone marrow, all of these cells originate as a type of cell known as a hematopoietic stem cell.
These stem cells then differentiate from the different types of cells in a process known as hematopoiesis.
Since all of these cells start with a common stem cell, processes that damage the bone marrow, such as chemotherapy, often affect all the different types of blood cells. This is known as chemotherapy bone marrow suppression.
In addition to red blood cells and platelets, there are several types of white blood cells. White blood cells develop along 2 different lines.
A stem cell can develop along the lymphoid line, resulting in the eventual formation of T and B lymphocytes or the myeloid line.
A cell in the myeloid line can become a neutrophil, an eosinophil, a monocyte, or a basophil.
Neutrophils start out as myeloblasts, which mature into promyelocytes, myelocytes, metamyelocytes, bands, and then mature neutrophils.
A normal or absolute ANC neutrophil count is usually between 2,500 and 7,500 neutrophils per microliter.
Neutrophil levels below 2500 are known as neutropenia, although the degree of decline is significant. A count less than 1000 is the most serious and can seriously predispose someone to infections.
Your blood count report can break down neutrophils into two categories which can be segmented (also known as mature) neutrophils and immature neutrophils known as banding.
In severe infections, the bone marrow is stimulated to release more banded neutrophils (immature neutrophils) resulting in a high number of bands in your report.
Conditions with an abnormal number of neutrophils
When doctors monitor a complete blood count (CBC) or a white blood cell count (WBC), the most common abnormality is an increase or decrease in the expected number of neutrophils.
Neutrophil testing is therefore a very important part of evaluating the disease in the laboratory.
Causes of neutrophilia
Thinking about the function of neutrophils makes an increase in the number easier to understand. Mechanisms that can increase the number of these white blood cells include:
- Reactive: With reactive neutrophilia, there is an increase in the number of these blood cells in response to infection or stress. The stress hormones in our body cause more than expected amounts of these cells to be released from the bone marrow.
- Proliferative (increased production in the bone marrow): This type refers to an increase in the number of neutrophils caused by an increase in their production in the bone marrow. This is most commonly seen with cancers, such as acute myeloid leukemia.
- Demargination: Neutrophils often “live” attached to the lining of blood vessels. These neutrophils can become “demarcated” and circulate in the bloodstream due to stress, infection, and sometimes exercise.
Conditions that can cause neutrophilia
Some specific causes of an increased neutrophil count (neutrophilia) include:
- Stress .
- Blood cell-related cancers such as leukemia.
- Autoimmune disorders such as rheumatoid arthritis.
- Trauma and burns.
- Of smoking.
- The pregnancy.
Immature neutrophils in the blood
Most of the neutrophils in our blood are mature. Immature neutrophils can be found in a blood smear if the body is stressed and there is a great need for more neutrophils.
When this occurs, a greater number of immature neutrophils can reach the blood of the bone marrow before reaching maturity. Your doctor may mention that you have a greater number of bands, or even less mature neutrophils, in your blood count.
Alternatively, increased production of immature neutrophils may occur with leukemias, such as acute promyelocytic disease.
Causes of neutropenia
Your neutrophil count may be lowered on its own, or lowered instead along with other types of blood cells.
The term pancytopenia refers to a reduction in the three main types of blood cells; red blood cells (called anemia) platelets (called thrombocytopenia) and white blood cells.
Mechanisms that can result in a low neutrophil count can include:
- Decreased or absent bone marrow production: for example, when the bone marrow is damaged as with chemotherapy, or there is a vitamin deficiency causing inadequate production.
- Bone marrow infiltration: when the bone marrow is “taken up” by cells such as cancer cells.
- Demand for more neutrophils: for example, to fight infection or in response to trauma. Initially, with most bacterial infections, the neutrophil count increases. However, with severe infections, a low neutrophil count can occur because the infection can overwhelm the immune system.
- Decreased Neutrophil Survival: While infections generally lead to increased neutrophil count, overwhelming infection, as well as infections with some viruses and rickettsial infections can lead to decreased neutrophil survival and a low count.
- Neutrophils can also face immune destruction due to antibodies directed against self in conditions like lupus.
- Destruction of neutrophils already produced.
- Neutropenia cíclica.
Conditions that can cause neutropenia
Through the above mechanisms, a reduced neutrophil count could be due to:
- Aplastic anemia.
- Exposure to radiation.
- Blood-related cancers that infiltrate the bone marrow, such as leukemia.
- Viral infections
- Overwhelming infections (sepsis).
- Rickettsial Infections.
- Typhoid fever.
- Drug reactions, for example, to penicillin, ibuprofen, and phenytoin.
- Vitamin B12 deficiency (megaloblastic anemia) and folic acid deficiency.
- Kostmann’s neutropenia (a genetic condition that affects young children).
- Idiosyncratic (meaning that no one knows for sure why the neutrophil count is low).
Importance of a low neutrophil count
The severity of a low neutrophil count depends on several factors, especially the degree of neutropenia. You are probably familiar with stories of “bubble babies” – children born with severely compromised immune systems, but there are many grades in between.
A low neutrophil count is one of the serious side effects of chemotherapy. When these cells are limited in number or function or both, our bodies are less able to fight infections, even with bacteria that generally do not cause serious infections.
Examples: Olivia’s neutrophil count was low after her chemotherapy treatment, so her oncologist recommended that she start antibiotics to prevent infection.