Gene Therapy
What To Know About Low White Blood Cell Count (Neutropenia)
Medically reviewed by Steffini Stalos, DOMedically reviewed by Steffini Stalos, DO
White blood cells are blood cells that are part of the immune system. They are responsible for ingesting, killing, and digesting harmful pathogens like viruses or bacteria. The body's level of white blood cells is usually measured with a blood test to measure the number of neutrophils, a type of white blood cell. When the neutrophil count is too low, it is known as neutropenia.
Typically, a low neutrophil count (neutropenia) results in a low white blood cell count, meaning your body does not have enough white blood cells to fight infection. People with a low white blood cell count have lowered immunity levels (immunocompromised).
Cancer and cancer treatments are common causes of neutropenia. Other possible causes include chronic (long-term) health conditions and infections. Sometimes, the cause is unknown. A low white blood cell count raises the risk of serious infection. Possible symptoms include recurrent infections, fever, chills, and a chronic cough. There are a few ways to treat neutropenia and lower the risk of infection.
Symptoms of Low White Blood Cell CountA low white blood cell count raises the risk of serious infection. Possible symptoms of chronic infections include:
Neutropenia may cause no symptoms at all. Neutrophils cause the immune system reaction of redness and swelling when an area of the body is infected. If your neutrophil count is low, as it would be with neutropenia, then your body might experience infections without you having a strong immune system reaction. Due to the lack of symptoms, you could be unaware you are experiencing an infection.
CausesA low white blood cell count occurs when the body does not have enough white blood cells to fight infection. Neutrophils are responsible for ingesting, killing, and digesting harmful viruses, bacteria, and fungi. Cancer is a common cause of neutropenia.
Cancer treatments like chemotherapy, radiation, bone marrow (stem cell) transplant, and corticosteroids may also cause a low white blood cell count. Most people experience neutropenia about seven to 12 days after chemotherapy.
Infections that can lead to neutropenia include Helicobacter pylori (H. Pylori), human immunodeficiency virus (HIV), and parvovirus B19. Multiple sclerosis is a neurological disorder that may also cause neutropenia.
Other types of neutropenia are caused by immune disorders, including:
When the Cause Is UnknownIdiopathic neutropenia refers to a low white blood cell count with no known cause. People with idiopathic chronic neutropenia have low levels of white blood cells for at least three months with no known cause.
Diagnosing NeutropeniaYour healthcare provider can diagnose neutropenia with a blood test. If you have noticed that you are repeatedly getting sick or experiencing chronic skin infections, your provider may recommend checking your white blood cell count.
A complete blood count (CBC) measures the amount of red blood cells, white blood cells, and platelets in the blood. To determine if you have neutropenia, your provider will review the test results to determine your absolute neutrophil count (ANC).
A normal range for white blood cells is 4,000-11,000 per microliter (uL) of blood. To find your absolute neutrophil count, your provider would multiply the number of white blood cells by the percentage of neutrophils in your blood.
For example, if your white blood cell count is 8,000/uL and the percentage of neutrophils in the blood is 75%, then your ANC is found by multiplying 8,000 by 0.75, resulting in an ANC of 6,000. A healthy range for the ANC is 2,500-6,000.
People with neutropenia have an ANC lower than 1,000. The risk of serious infection increases significantly when the ANC falls below 500.
TreatmentsThe treatment for neutropenia is to first address the cause. For example, if neutropenia is caused by chemotherapy, it will resolve once the treatment stops.
Treatment options for low white blood cell count include:
Myeloid growth factors: Sometimes referred to as growth factors or colony-stimulating factors (CSFs), these proteins stimulate the bone marrow to produce more white blood cells. Examples include Neupogen (filgrastim), Granix (tbo-filgrastim), Neulasta (pegfilgrastim), Rolvedon (eflapegrastim), and Ryzneuta (efbemalenograstim alfa).
Antibiotics: These medications help prevent infection.
Pausing treatment: If cancer treatments or other medications are causing your neutropenia, your care team may recommend pausing treatment until your ANC increases to a safer level.
In many cases, neutropenia cannot be prevented. If you are experiencing neutropenia, your healthcare team will work with you to lower the risk of infection while your immune system is suppressed.
To prevent infections while you have a low white blood cell count, take the following precautions:
Wash your hands frequently
Brush your teeth twice daily
Avoid people who are sick
Consider avoiding crowds
Wear a mask in public
Focus on food safety with proper washing and cooking
People with neutropenia are at a high risk of infection. Once your level of white blood cells is very low (ANC less than 500), you may experience an infection without the usual symptoms like a fever or swelling. When this occurs, the infection can spread and worsen with no signs.
Possible complications of neutropenia include:
Living With Low White Blood Cell CountThe prognosis for neutropenia depends on the underlying cause. If your neutropenia is caused by cancer treatment, it will likely resolve once treatment stops.
While you live with a low white blood cell count, it is important to take precautions to protect yourself from infection. To lower your risk of coming in contact with pathogens, wash your hands frequently, especially after using the bathroom and before eating. Plan to shower every day and brush your teeth twice daily.
When preparing food, wash your hands well and make sure your cooking surface is clean. Do not eat partially cooked food, and immediately store leftovers in the refrigerator.
Talk with your healthcare provider about which vaccines you need, and ask your family members to stay up to date with their vaccines. Try to avoid spending time with people who are sick, and avoid crowds when your ANC is low.
A Quick ReviewA low white blood cell count occurs when the body does not have enough white blood cells to fight infection. White blood cells are part of the immune system and are responsible for attacking invading pathogens. When you have a low white blood cell count (neutropenia), your risk of infection is high.
Common causes of neutropenia include cancer and cancer treatments like chemotherapy and radiation therapy. Neutropenia raises the risk of recurrent infections, and symptoms may include fever, chills, diarrhea, and a chronic cough.
Your healthcare provider can diagnose neutropenia with a blood test called a complete blood count. Treatment for neutropenia includes medications and lifestyle changes to reduce the risk of infection.
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I Was Given Six Months To Live. But I Wasn't Told
One day in August 2013, I was with friends as my children, Hudson, Lola, and Bella, then ages 3, 5, and 7, were having a play date. I started to not feel well and, when I went to the restroom, I noticed I had blood in my stool. I knew this wasn't normal, so I called my doctor and then headed to urgent care. I figured they would run some tests and maybe prescribe some medication and I told my husband, Scott, that I would be home shortly.
Then the lab test came back and the results showed a platelet count of 1,000. The typical number of platelets in the blood is usually 150,000 to 450,000, so my count was incredibly low. The doctor even repeated the test, assuming the equipment must have malfunctioned the first time. It had not.
Instead of going home with a prescription in hand, an ambulance took me to the hospital. I was admitted and ended up staying for about 43 days. After nearly a month and a half and countless tests, I was diagnosed with Stage II diffuse large B-cell non-Hodgkin lymphoma. I came to learn that this is a type of cancer that affects your white blood cells, or lymphocytes, and that it's particularly fast-moving and aggressive.
As you can imagine, I was scared. At 32 years old, I was a young mom with a wonderful husband and three beautiful children, with so much life left to live. A cancer diagnosis was the furthest thing from my mind. But, I came to find out that this cancer typically responds well to treatment, and my disease was caught in a relatively early stage, which would increase my chances for survival.
I began a standard protocol of chemotherapy. Halfway through treatment, a scan showed no tumors. I was ecstatic, but about seven months later, tests revealed that the cancer had returned. Next was a stem cell transplant, which was just the hardest treatment that you could ever imagine. But my body wasn't responding the way it should and the cancer was still there.
The transplant was unsuccessful. I was driving my kids in the car when I got the news from my doctor that my transplant had failed. It took everything in me to hold it together for them. When I got home, I lost it. I was completely heartbroken. I knew I was quickly running out of options.
At this point, my chances of survival were incredibly low. In fact, I was given only six months to live, but I didn't even know it. A doctor had shared that with my husband, but he didn't tell me because he wanted to protect me as best he could from the scary stuff while I focused on my treatment. He knew how important it was for me to continue to have hope. Sometimes, when you realize how dire things are, you do become hopeless, and it's so much harder to fight when you're hopeless.
Emily Dumler (L) pictured with her family before her diagnosis. Emily pictured (R) during her treatment process. Emily Dumler (L) pictured with her family before her diagnosis. Emily pictured (R) during her treatment process. Emily DumlerWhen we finally met with my doctor, he told me that my only option left was a clinical trial. The challenge was that this clinical trial wasn't available in my home state of Kansas yet, and my doctor didn't know if I had enough time to even make it. You'd think that I would have been distressed by that news, but in that moment when faced with this life-or-death situation, all I felt was hope and faith instead of fear. I knew we would find a way.
This clinical trial, ZUMA-1 as it was called, was exploring an entirely new way of treating cancer in 2015 that the doctors told me was my best—and maybe only—chance for survival at that point. It was an immunotherapy called Chimeric Antigen Receptor T-cell therapy, or CAR T-cell therapy. This one-time therapy is designed to use my immune system to fight the cancer.
CAR T-cell therapy involves using your own T cells, a type of white blood cell, which were collected through a process called leukapheresis—blood withdrawal—and sent to a manufacturing facility where they add receptors to those T cells that match the protein on the cancer. These "supercharged" T cells are then infused into the body to fight the cancer.
My local hospital wasn't participating in this trial, so I had to travel to a hospital in Houston. I hopped on a plane to see if I qualified for this trial. I was a perfect fit and was quickly enrolled.
Nearly two years after my cancer journey had begun, I became just the third person in the world to take part in the clinical trial. Ultimately this treatment developed by Kite Pharma became the first CAR T-cell therapy approved by the U.S. Food and Drug Administration in 2017 to treat the type of cancer that I had. By participating in the clinical trial, I helped pave the way for thousands of blood cancer patients like me who have been successfully treated since.
Within a month, scans showed that the cancer was gone. The same thing at 18 months. And now, nine years later, I'm still cancer-free. I never gave up hope or my faith, both in God and in the incredible doctors who were treating me. I'm grateful to be a survivor and for the opportunity to be a part of something as revolutionary as CAR T-cell therapy.
I truly feel that I'm here for a reason, that it wasn't my time to go. I believe that there were things that I was meant to accomplish, and I feel a responsibility to use my experience to help others.
I've been actively involved with the Leukemia and Lymphoma Society, as have my children who grew up with their mom fighting this battle. Over the years, we've helped to raise more than $200,000 for research. I never imagined that I could be passionate about something like this, but I just feel like that was part of what I was called to do in order to give back.
Today, I'm healthy and Scott and I are happier than we've ever been. Our children are now 18, 16, and 14. Bella just started college, Lola is playing on her high school golf team, and Hudson wants to be an oncologist. I think back on the years dealing with my cancer and just trying to survive, and I feel like I missed a really special time in my family's life. That makes me appreciate the time we have now even more.
I remember thinking that I could never imagine being normal and healthy again, and that I'd never be able to get back to a normal routine. I now know that my life isn't completely the same and I've changed as a person because of this experience. People often ask me about it, and I tell them I wouldn't take it back or go back in time and not have cancer, which may seem shocking. But it helped me look at life differently and I've grown—we've all grown—so much because of that and I would never want to take that away.
Emily Dumler was diagnosed with stage II diffused large B-cell non-Hodgkin lymphoma at the age of 32 in 2013 and given six months to live. With no other approved treatment options available, Emily was brave enough to try CAR T-cell therapy that was in clinical trial stages at the time. Within a month of the trial, Emily was declared cancer-free and remains so to this day. CAR T-cell therapy is now an approved treatment.
All views expressed are the authors' own.
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Mayo Clinic Study Links White Blood Cell Issues To Melanoma Risk
Around 8 to 10 million Americans over age 40 have excess cloned white blood cells (lymphocytes), a condition called monoclonal B-cell lymphocytosis (MBL). Although many with MBL have no symptoms, a Mayo Clinic study shows they may have a higher risk of health issues, including melanoma. MBL is also linked to chronic lymphocytic leukemia (CLL), which raises melanoma risk.
Our study is the first to show that people with MBL have a 92% higher risk of developing melanoma, similar to those with chronic lymphocytic leukemia," said Dr. Susan Slager from Mayo Clinic. This suggests that MBL, even at low levels, could be an early warning sign for melanoma. Dr. Slager's team studied over 7,000 people and followed them for four years, finding related diagnoses in those with MBL.
The researchers found that people with MBL also have a higher risk of cancers in the lymphatic system and severe infections, including COVID-19. Dr. Slager explains that MBL isn't just part of aging; it has health risks like infections and melanoma.
Advances in flow cytometry, a technology that helps examine blood cells, have made it easier to identify MBL, which can lead to CLL.
People with CLL have over 5,000 cloned lymphocytes per microliter of blood, while those with MBL have 1-5. Thanks to better technology, scientists can now detect MBL early.
The study shows that having MBL, no matter the number of cloned lymphocytes, raises the risk of melanoma. Dr. Slager suggests that people with MBL should follow skin cancer prevention guidelines, like using sunscreen and protective clothing.
Dr. Slager's team will next explore if there is a genetic link between MBL, CLL, and melanoma. They believe a genetic variant that raises the risk of MBL and CLL may also increase melanoma risk. They will also study whether MBL affects melanoma outcomes, such as survival rates or response to treatment.
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