Kathryn Foucar, MD

Blood smear from a patient with rectal prolapse and acute bacterial infection is shown. Note toxic changes in the neutrophils. Anemia is also present, likely from chronic disease.

Blood smear from a patient receiving recombinant G-CSF shows toxic changes and left shift to blasts. Note that mature neutrophils predominate after early recovery occurs.



  • Granulocytosis


  • Absolute neutrophil count (ANC) that exceeds age-related normal ranges

    • Newborn > 28.0 × 109/L

    • Infant > 10.0 × 109/L

    • Child > 8.0 × 109/L

    • Adult > 7.0 × 109/L


Diverse Etiologies for 2° Neutrophilias

  • Infections (usually bacteria)

  • Occasional viral infections (SARS, Hantavirus)

  • Medications/hormones/endogenous overproduction

    • Colony-stimulating factors

    • Chemokines

    • CSF/chemokine-producing neoplasms

    • Epinephrine

    • Corticosteroids

    • Lithium

  • Inflammatory and metabolic disorders

    • Burns, trauma

    • Infarction, gout

    • Collagen vascular disease

    • Ketoacidosis

    • Eclampsia

  • Other

    • Stress

    • Asphyxia

    • Pregnancy

    • Smoking

    • Toxins

    • Venoms

Constitutional Neutrophilic Disorders

  • Leukocyte adhesion deficiency (LAD)

    • Neutrophil production increased

    • Marked neutrophilia in blood

    • Neutrophils unable to migrate to sites of infection

    • Multiple genetic types

  • Hereditary neutrophilia

  • Familial cold urticaria


  • Astronomical daily production rates of neutrophils in bone marrow

  • Large reserve of neutrophils, bands, and neutrophilic myelocytes is present in central medullary regions of bone marrow

  • Reserve pool can be released into blood

  • Neutrophils circulate for only a few hours before migrating to tissue

  • Neutrophils migrate by attaching to endothelium and passing through vessel wall

  • ANC highest normal range at birth

    • Should decline rapidly after birth

    • Lymphocytes outnumber neutrophils by 1 week of age

  • Neutrophil homeostasis maintained largely via steady bone marrow production

Mechanisms of Neutrophilia

Jun 13, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Neutrophilia
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