Neutrophils

and Eva Rudolf-Müller, doctor

Eva Rudolf-Müller is a freelance writer in the medical team. She studied human medicine and newspaper sciences and has repeatedly worked in both areas - as a doctor in the clinic, as a reviewer, and as a medical journalist for various specialist journals. She is currently working in online journalism, where a wide range of medicine is offered to everyone.

More about the experts All content is checked by medical journalists.

Neutrophils are a type of white blood cell (leukocyte). They make up about two thirds of all leukocytes. They are determined with a blood count. Neutrophils are part of the cellular immune system and fight pathogens. Here you can read more about neutrophils, what their role is and when they are increased or decreased.

What is the role of neutrophils?

Neutrophils are an important part of the innate immune system. Most of them rest in the bloodstream. When foreign bodies or pathogens enter the body, substances are released that attract the neutrophils. These then leave the bloodstream and enter the tissue. There they take on their role as scavenger cells, so-called phagocytes: they absorb pathogens and destroy them.

In addition, neutrophils clean up destroyed tissue cells. This creates pus from them and the destroyed tissue cells.

Neutrophils: classification

Depending on the shape of their nuclei, a distinction is made between rod-like and segmented neutrophils: mature granulocytes have a nucleus consisting of three to four parts and are therefore referred to as segmented nucleus. In contrast, rod-like granulocytes have an elongated nucleus. It is the immature form of neutrophilic granulocytes. They usually make up only up to five percent of all cells in the differential blood count.

Neutrophils: normal values

The normal values ​​for neutrophils depend on age and gender. The values ​​are given in percent (proportion of the total leukocyte count):

NEUTROPHILIC GRANULOCYTES
age	Female	masculine
up to 14 days	15,2 - 66,1 %	20,2 - 46,2 %
15 to 30 days	10,6 - 57,3 %	14,0 - 54,6 %
31 to 60 days	8,9 - 68,2 %	10,2 - 48,7 %
61 to 180 days	14,1 - 76,0 %	10,9 - 47,8 %
0.5 to 1 year	16,9 - 74,0 %	17,5 - 69,5 %
2 to 5 years	22,4 - 69,0 %	22,4 - 69,0 %
6 to 11 years	29,8 - 71,4 %	28,6 - 74,5 %
12 to 17 years	39,0 - 73,6 %	32,5 - 74,7 %
from 18 years	34,0 - 71,0 %	34,0 - 67,9 %

The standard values ​​for rod-like granulocytes are also given in percent (proportion of the total leukocyte count):

age	Standard values ​​for core rods
1 to 2 days	0,0 - 18,0 %
3 to 9 days	0,0 - 15,0 %
10 to 13 days	0,0 - 14,0 %
14 days to 5 months	0,0 - 12,0 %
6 to 12 months	0,0 - 8,0 %
1 to 13 years	3,0 - 6,0 %
from 14 years	3,0 - 5,0 %

The standard values ​​for segmented granulocytes are also given in percent (proportion of total leukocyte count):

age	Standard values ​​for segment core
up to 12 months	17,0 - 60,0 %
1 to 13 years	25,0 - 60,0 %
from 14 years	50,0 - 70,0 %

When are neutrophils increased?

If there are more rod-like granules than normal, doctors call it a "left shift". A regular shift to the left occurs, for example, with bacterial infections, but also with abacterial inflammations such as venous or colon inflammation (colitis). Also in the case of cell disintegration, for example in the case of burns, rod-nucleus neutrophils are increased. Other reasons for an increase in rod-like granules are:

• Virus infection, fungal or parasite infestation
• Heart or lung attack
• pregnancy
• Acidosis in the body
• Overactive thyroid gland (hyperthyroidism)
• Malignant haematological diseases ("blood cancer") such as acute myeloid leukemia
• Physical recovery phase after bone marrow damage (for example after radiation or chemotherapy)

If, on the other hand, segmented neutrophils are too high, this is referred to as a "right shift". It occurs above all when cell production in the bone marrow is impaired: the bone marrow is unable to produce new granulocytes, so the proportion of older, segmented granulocytes increases. The cause can be ongoing chemotherapy or radiation therapy or a certain form of anemia - megaloblastic anemia (caused for example by folic acid deficiency). A reduced breakdown of segmented granulocytes, for example after a spleen has been removed, also increases their proportion in the blood.

When are neutrophils decreased?

The shortage of neutrophils is called neutropenia and it is very dangerous. Without the granulocytes, the body is defenseless against invading pathogens and infections cannot be fought as well.

If neutrophils are low, it can have both congenital and acquired causes. Examples of rare congenital diseases with neutropenia include:

• congenital disorders of granulocyte formation
• Fanconi anemia
• Metabolic diseases such as glycogenosis
• congenital immunodeficiency diseases

The causes of neutropenia acquired later in life include:

• Autoimmune diseases such as systemic lupus erythematosus
• Infections such as the flu (influenza) or varicella (chickenpox, shingles)
• Bone marrow diseases such as plasmacytoma
• Use of certain medications (for example, proton pump inhibitors, antibiotics, or anti-inflammatory drugs like ibuprofen)

If there are too few neutrophils in a patient, the underlying disease is treated if possible. The administration of drugs that promote neutrophil production or a transfusion are rarely necessary.

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