Hey everyone. This is Abby with nursing.com. Today, we’re going to discuss a lab value called absolute neutrophil count, abbreviated as ANC. Let’s get started.

Absolute neutrophil count, or ANC, measures the real number of white blood cells that are neutrophils. It’s a percentage actually: the number of neutrophils in a blood sample taken through a CBC with differential measures the number of white blood cells times the percent of them that are neutrophils. Sometimes that’s divided by a hundred depending on the reporting agency. And that equals our absolute neutrophil count. Now, we’re talking about neutrophils. This is a very important cell component of our immune system, and it’s produced in the bone marrow, just like white blood cells, red blood cells, and platelets. Can you think of a clinical picture of when we might need this lab value? Are you thinking about someone that maybe has an increased immune response or maybe a dampened immune system? Because you’d be right. A clinical indication for evaluating ANC is in times of infection or inflammation.

That’s when the bone marrow is producing a ton of these neutrophils. It wants these cells to get out and help in an immune response. Also, it’s monitored in certain leukemias. Sometimes the bone marrow is suppressed. Therefore the ANC will be low, or in some leukemias, it might even be high. Certain medications can either increase or decrease the ANC as well. When I worked in the cancer Institute, I used to draw labs from a port just like this picture. Oftentimes the lab value that the oncologist cared about the most was the ANC. The absolute neutrophil count we needed to know because it evaluates the patient’s ability to mount an immune response. If they’re suppressed, it’s going to be low. If they have an infection or inflammation and they actually have those neutrophils, it’s going to be high. A normal value is between 2.5 and 6,000 cells per microliter. Remember how I talked about it being divided by a hundred, sometimes that’s how this value would be reported. Whereas if the reporting agency doesn’t divide it by a hundred, you would just see it here in the thousands. Collection is done with a CBC with differential, and that’s going to be taken in a lavender top.

Neutrophilia is the term used when the lab value for ANC is increased. Like we mentioned, if someone actually has an immune system, then the count will be lots higher in terms of injury, infection, and inflammation. Certain types of leukemia will actually increase the number of neutrophils and also a drug reaction to certain drugs, just depending. And then you look over at neutropenia. That’s the term used for decreased ANC it can either be acquired or congenital. Now, most often we see neutropenia as a side effect of cancer treatment. The cytotoxic drugs are certainly hard on the bone marrow. Again, you’ll see some consistencies over here. So it just kind of depends on the leukemia, but some types of leukemia will actually suppress the bone marrow. Nutritional deficiencies also play a role. If someone has low vitamin B12 or folate deficiencies, we know that to be termed pernicious anemia, those nutrients are essential for blood cell component production.

The same is true for autoimmune disorders. Some autoimmune disorders also suppress the bone marrow and decrease the amount of neutrophil production. Linchpins for this lesson are absolute neutrophil count is the percent of white blood cells that are actually neutrophils. It’s reported typically in this format of 2.5 to 6,000 cells per microliter. Neutrophilia means that the immune system is mounting a response and we have a high number of ANC and neutropenia is in a patient that’s immunocompromised. It means that their ANC or absolute neutrophil count is so low that they’ll have trouble mounting an immune response. You did great on this lesson, everyone. Now go out and be your best self today and as always happy nursing.

References:

• https://www.uptodate.com/contents/low-neutrophils-in-adults?search=Absolute%20neutrophil%20count&source=panel_search_result&selectedTitle=3~150&usage_type=panel&display_rank=1
• https://www.uptodate.com/contents/approach-to-the-adult-with-unexplained-neutropenia?search=ANC&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H1875273819
• https://www.cancer.org/treatment/understanding-your-diagnosis/tests/understanding-your-lab-test-results.html#:~:text=A%20healthy%20person%20has%20an,1%2C000%20it%20is%20called%20neutropenia%20
• https://my.clevelandclinic.org/health/body/22313-neutrophils