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    Absolute Neutrophil Count (ANC)

    Frequently used to assess neutropenic fever in chemotherapy patients.
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    ×10³/µL

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    Advice

    • Neutropenic fever (without a source of infection found) is typically the result of direct toxic effects of chemotherapy on mucosal surfaces and the immune system in addition to the impact of the underlying malignancy. It is defined as a single oral temperature of 38.3º C (101 º F) or a temperature of greater than 38.0º C (100.4 º F) sustained for more than 1 hour in a patient with neutropenia. It is typically seen in those who have received anti-cancer therapies in the last 6 weeks. Filgrastim (Neupogen), AKA G-CSF, can stimulate production of neutrophils, but is rarely indicated in the evaluation and treatment of neutropenic fever.
    • Additional tools to risk stratify a neutropenic fever patient and predict complications include the Clinical Index of Stable Febrile Neutropenia (CISNE) score and Multinational Association for Supportive Care in Cancer (MASCC) score.

    Management

    • Obtain a complete blood count with differential
    • ANC is calculated as 10 * WBC count in 1000s * (% PMNs + % Bands)
    • Classify neutropenia as mild, moderate, or severe as in More Info
    • ANC values also can be interpreted by NCI risk categories as in the table below:
    NCI Risk Category ANC
    0 Within normal limits
    1 ≥ 1500 - < 2000/mm3
    2 ≥ 1000 - < 1500/mm3
    3 ≥ 500 - < 1000/mm3
    4 < 500/mm3

    Critical Actions

    If the clinical scenario is suggestive of neutropenic fever, appropriate cultures and infectious disease workup should be instituted along with prompt initiation of empiric broad-spectrum antibiotics to cover mostly endogenous flora.

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