Absolute Neutrophil Count (ANC): Normal Range and What Low or High Results Mean

Your absolute neutrophil count, usually shortened to ANC, tells you how many neutrophils are circulating in a given amount of blood. Neutrophils are the white blood cells that respond first to bacteria and fungi, so this single number is one of the most useful ways to judge how well your body can fight infection. It appears on most complete blood counts that include a differential, and doctors watch it closely during chemotherapy and with certain medicines. A result slightly outside the range is common and often harmless, while a very low or very high count needs attention.

In this article you’ll learn what the ANC measures, how it is calculated, the normal range and the levels used to grade a low count, the common causes of low and high results, why some healthy people naturally run lower, and when a result calls for a doctor’s visit.

What the absolute neutrophil count measures

Neutrophils are the most common type of white blood cell and your body’s main defense when bacteria, viruses or other germs get in, according to MedlinePlus. Cleveland Clinic notes that they make up 55% to 70% of white blood cells and that a healthy adult produces more than 100 billion of them every day. Because they live only a short time, the count responds quickly to infection, inflammation, medicines and problems in the bone marrow, where they are made.

The ANC is reported in the white blood cell differential, the section of a complete blood count that splits white cells into their five main types; to see how the whole report is organized, read our guide de la numération formule sanguine. Next to it sits the total white cell count, which you can explore by opening our leukocytes blood test guide.

Absolute count vs neutrophil percentage

Many reports show neutrophils twice: as a percentage of all white cells and as an absolute number. The percentage alone can mislead. A neutrophil percentage of 40% looks low, but if your total white cell count is high, the absolute number may be perfectly normal; a reassuring 70% can hide a low absolute count when the total is low. Doctors base decisions on the absolute value. For a broader view of how neutrophil levels rise and fall, see our neutrophils blood test guide.

How the absolute neutrophil count is calculated

Most modern analyzers report the ANC directly. When a lab reports only percentages, the absolute neutrophil count can be worked out by hand: multiply the total white blood cell count by the percentage of mature neutrophils (sometimes labeled segs or segmented neutrophils) plus young neutrophils called bands, then divide by 100.

For example, with a white blood cell count of 6,000 cells per microliter, 55% segmented neutrophils and 5% bands, the ANC is 6,000 × 60 ÷ 100 = 3,600 cells per microliter. Units vary between labs: 3,600 cells per microliter is the same as 3.6 × 10⁹ per liter or 3.6 × 10³ per microliter. Checking the unit before comparing results avoids a common source of alarm when a report seems to show a count of 3.6.

Normal range for the absolute neutrophil count

Reference ranges differ between laboratories, so the range printed on your report is the one to use. Cleveland Clinic gives a typical adult range of 2,500 to 7,000 neutrophils per microliter, and many labs set the lower limit at 1,500 to 1,800. Neutropenia is graded by how far the count falls, as shown below.

The mild, moderate and severe cutoffs follow Cleveland Clinic. Children, especially infants, have different ranges, and some healthy adults run lower all their lives, as explained below.

What a low absolute neutrophil count means

A low count, called neutropenia, often causes no symptoms and is discovered on a routine blood test, as Mayo Clinic points out. The concern is what it can lead to: with fewer neutrophils, infections can start more easily and spread faster. Cleveland Clinic lists the signs that an infection may be developing: fever, tiredness, sore throat, swollen lymph nodes, mouth sores, diarrhea and burning when you pee. Because neutrophils create much of the redness and pus of an infection, these signs can be milder than expected, so fever is often the earliest clue.

Causes fréquentes

Mayo Clinic and Cleveland Clinic list several groups of causes:

• Cancer treatment, especially chemotherapy, and cancers that affect the bone marrow such as leukemia, lymphoma and multiple myeloma.
• Medicines, including some antibiotics, antivirals, antithyroid drugs, antipsychotics and anti-inflammatory drugs.
• Viral infections such as Epstein-Barr virus, hepatitis, HIV or COVID-19, and overwhelming infection (sepsis).
• Autoimmune diseases such as lupus and rheumatoid arthritis.
• Low levels of vitamin B12, folate or copper.
• Bone marrow disorders such as aplastic anemia and myelodysplastic syndromes, and inherited conditions.

Because some of these causes are easy to correct, a doctor may check vitamin levels alongside a repeat count; learn how those results are read by reviewing our vitamin B12 blood test guide and checking our copper blood test guide. When a low ANC appears with low red cells or platelets, a marrow problem becomes more likely; to understand that concern, consult our leukemia symptoms guide.

Naturally lower counts: the Duffy-null pattern

Many healthy people of African or Middle Eastern ancestry have an ANC below the standard range without any extra risk of infection. This pattern, long called benign ethnic neutropenia, is now named Duffy-null associated neutrophil count (DANC), after a common blood group variant. Cleveland Clinic lists it among the causes of low counts, and a 2025 review notes that it is found in 80% to 100% of people of Sub-Saharan African and Arab descent and is not considered a disease. A simple blood group test can identify it, which can spare people repeated testing, bone marrow biopsies or unnecessary changes to their treatment.

Neutropenia during chemotherapy

Chemotherapy lowers neutrophils along with cancer cells. The CDC explains that counts usually reach their lowest point 7 to 12 days after a treatment, and advises calling your doctor right away for a temperature of 100.4°F (38°C) or higher for more than an hour, or a single reading of 101°F or higher. Fever during neutropenia can signal a fast-moving infection; read about the warning signs by opening our sepsis symptoms guide. The CDC’s precautions include washing your hands often, avoiding crowds and people who are sick, cooking meat and eggs thoroughly, washing raw fruit and vegetables, bathing daily, wearing gloves when gardening or cleaning up after pets, and getting a seasonal flu vaccine.

Medicines that need ANC monitoring

Some medicines require regular ANC checks because they can rarely cause severe neutropenia. Clozapine, used for treatment-resistant schizophrenia, is the best-known example. In 2025 the FDA removed the program that required pharmacies to see an ANC result before dispensing it, but the agency states that prescribers should keep monitoring ANC as described in the prescribing information.

What a high absolute neutrophil count means

A high count, called neutrophilia, is most often a sign that the body is responding to something. MedlinePlus lists infections, autoimmune and inflammatory disorders, allergic reactions, steroid use, and blood cancers such as leukemia or Hodgkin disease. Mayo Clinic adds smoking, pregnancy, burns, rheumatoid arthritis, medicines such as corticosteroids and epinephrine, and bone marrow disorders such as polycythemia vera and myelofibrosis among the causes of a high white cell count.

Short-lived rises

Many high readings are temporary. A bacterial infection, a course of steroid tablets or a recent injury can push the ANC up for days to weeks, and the count settles once the cause passes. Inflammation markers often rise at the same time; to see how they are interpreted, check our guide sur la CRP dans le sang.

When a high count needs more tests

Doctors look further when the count is very high, stays high on repeat tests without a clear cause, or comes with other abnormal lines such as immature white cells, anemia or unusual platelet counts. Symptoms such as weight loss, night sweats or a large spleen also prompt further testing, which may include a blood smear examined under the microscope.

Reading your ANC alongside the rest of your blood count

The ANC is most informative next to the other lines of your report. A few common patterns:

• Low ANC alone, stable over months or years, with no history of unusual infections: often a benign pattern such as DANC or a mild drug effect; repeat testing guides the next step.
• Low ANC together with low hemoglobin or platelets: suggests the bone marrow may be involved and usually needs prompt evaluation.
• High ANC with high CRP and fever: points toward infection or inflammation.
• High ANC with low lymphocytes: a common stress response during acute illness; to read the other half of that picture, open our lymphocytes blood test guide.

Quand consulter un médecin

Seek urgent care if you have a low ANC or are receiving chemotherapy and develop a fever of 100.4°F (38°C) or higher, chills, a sore throat, a new cough, burning when you pee or any sign of infection. Book a prompt appointment if any of the following applies:

• Your ANC is below 1,000 for the first time, or below 500 at any time.
• You have frequent infections, mouth sores or gum problems.
• Your ANC is high on more than one test without an obvious reason such as an infection or steroid use.
• Other parts of your blood count are also abnormal, or you have unexplained weight loss, night sweats or fatigue.
• You take a medicine known to lower neutrophils and your count has dropped.

A single mildly low or high value with no symptoms is usually rechecked in a few weeks rather than acted on straight away.

Dernières avancées scientifiques

Recent research is changing how doctors interpret a low ANC, especially in people with the Duffy-null blood group.

Low counts are often benign when nothing else is wrong

A 2025 review of isolated chronic neutropenia in adults, meaning a low count that lasts more than three months with no other blood problem, describes the main causes, including medicines, autoimmune conditions and inherited forms. It stresses that decisions should depend on a person’s history of infections more than on the number alone. What this means for you: a stable, mildly low ANC without infections is often watched rather than treated.

Duffy-null people may need their own reference range

A 2026 study of 122 healthy adults with the Duffy-null blood group calculated a normal ANC range of about 1,000 to 4,300 cells per microliter, well below the usual range and partly below the standard neutropenia cutoff. What this means for you: if you have this blood group, a result your report flags as low may be normal for you; ask whether a Duffy blood group test is worth doing.

Adjusted ranges reduce false alarms during treatment

A 2026 analysis of people taking azathioprine or methotrexate, two medicines that require blood count monitoring, used data from the All of Us research program. With standard cutoffs, people with the Duffy-null variant were several times more likely to be labeled abnormal; with Duffy-adjusted cutoffs, the difference disappeared. What this means for you: genotype-aware ranges could prevent medicines from being stopped for no reason. The approach is not yet standard everywhere.

Apparent neutropenia can delay cancer care

A 2026 study of 493 women with breast cancer in Bahrain found that about 1 in 7 had DANC. Their low counts often delayed chemotherapy, yet only one developed a fever with neutropenia, and survival was no different from other patients. What this means for you: if you are starting cancer treatment and your baseline ANC is low, ask your oncologist whether DANC has been considered.

Clozapine-related neutropenia is uncommon

A 2025 study of 402 people who started clozapine in a large US health system found that 10, about 1 in 40, developed neutropenia within two years. Most cases were mild and passed, but one was fatal. What this means for you: the risk is small but real, so keep up the blood tests your prescriber recommends even though the national monitoring program has ended.

Glossaire

Questions fréquentes

What is a dangerously low absolute neutrophil count?

An ANC below 500 cells per microliter is classed as severe neutropenia and carries a high risk of serious infection. Between 500 and 1,000 is moderate. At these levels, a fever of 100.4°F (38°C) or higher needs urgent medical attention, especially during chemotherapy. Your care team will tell you which precautions to take until the count recovers.

Should I worry about a slightly low ANC?

Usually not, if you feel well and do not get frequent infections. Counts between 1,000 and 1,500, or just under your lab’s lower limit, are common and often caused by a recent viral illness, a medicine or a naturally lower baseline such as DANC. Your doctor will typically repeat the test and look at the trend before deciding whether further tests are needed.

What does a high absolute neutrophil count mean?

It most often means your body is fighting an infection or responding to inflammation, stress on the body, smoking or steroid medicines. These rises are usually temporary. A count that stays high without a clear reason, or comes with other abnormal blood results, is investigated further to rule out a bone marrow disorder.

Is the ANC the same as the neutrophil percentage on my CBC?

No. The percentage tells you what share of your white cells are neutrophils, while the ANC is the actual number. The ANC is calculated from the total white cell count and the neutrophil percentage, and it is the value doctors use to judge infection risk and to decide whether treatment needs to change.

Can a low neutrophil count go back to normal?

Often, yes. Counts lowered by a viral infection usually recover within weeks, counts lowered by chemotherapy rebound between treatment cycles, and correcting a vitamin B12, folate or copper deficiency can restore them. If a medicine is the cause, your doctor may adjust or change it. A naturally low baseline such as DANC stays low but does not need treatment.

How can I raise my neutrophil count?

The fix depends on the cause, so there is no single food or supplement that raises neutrophils in everyone. Doctors treat the underlying problem, correct any deficiency, review medicines and, during some cancer treatments, prescribe growth factor injections that stimulate the bone marrow. While your count is low, the CDC’s infection precautions, such as handwashing and food safety, help protect you.

Sources

• MedlinePlus, National Library of Medicine — Blood Differential — MedlinePlus Lab Tests, updated 2024 — medlineplus.gov
• Cleveland Clinic — What Are Neutrophils? — Health Library, reviewed 2025 — my.clevelandclinic.org
• Cleveland Clinic — Neutropenia: What It Is, Types, Symptoms and Causes — Health Library, reviewed 2022 — my.clevelandclinic.org
• Mayo Clinic Staff — Neutropenia: Causes and definition — Mayo Clinic, 2025 — mayoclinic.org
• Mayo Clinic Staff — High white blood cell count: Causes and definition — Mayo Clinic, 2026 — mayoclinic.org
• Centers for Disease Control and Prevention (CDC) — Neutropenia and Risk for Infection — Preventing Infections in Cancer Patients — cdc.gov
• U.S. Food and Drug Administration (FDA) — FDA removes Risk Evaluation and Mitigation Strategy (REMS) program for the antipsychotic drug clozapine — Drug Safety and Availability, 2025 — fda.gov
• Njue L, Porret N, Andres M, Rovó A — Isolated Chronic Neutropenia in Adults: Causes, Diagnostic Work-Up, and Management. A Narrative Review — Journal of Clinical Medicine, 2025 — doi.org/10.3390/jcm14217495
• Barouqa M, Ashfaq MA, Jiang KJ, et al. — Establishing Reference Intervals for White Blood Cell and Absolute Neutrophil Counts in Duffy Null Individuals — Hematology Reports, 2026 — doi.org/10.3390/hematolrep18030038
• Asiimwe E, Hu D, Cheng J, et al. — Clinical Implications of the Duffy-Null Genotype in Patients on Azathioprine or Methotrexate in the All of Us Cohort — The Journal of Applied Laboratory Medicine, 2026 — doi.org/10.1093/jalm/jfag056
• Prem Sudha S, Abdelfattah NM, et al. — Clinical Implications and Prevalence of Duffy-Null Associated Neutrophil Count in Patients With Breast Cancer of Middle Eastern Ethnicity — JCO Global Oncology, 2026 — doi.org/10.1200/GO-26-00032
• Nofziger JL, Kline-Simon AH, et al. — Clozapine-Associated Neutropenia Prevalence in a Large, Integrated Healthcare System — Pharmacoepidemiology and Drug Safety, 2025 — doi.org/10.1002/pds.70249

Pour aller plus loin

• Compare the white cells that clean up after infection by reading our monocytes blood test guide.
• Check the cells linked to allergies and parasites by reviewing our guide sur la numération des éosinophiles.
• Decode the rarest white cell on your report by opening our guide sur la numération des basophiles.
• Follow the other bone marrow line doctors watch during treatment by exploring our platelet count guide.
• Understand a cancer that can change white cell counts by visiting our lymphoma symptoms guide.

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