From the Guidelines
The management of a patient with neutrophilia and lymphopenia should prioritize identifying and treating the underlying cause, with a focus on supportive care and addressing the primary stressor or infection. The approach to managing a patient with high neutrophil and low lymphocyte counts involves a comprehensive evaluation including a complete blood count with differential, peripheral blood smear, and relevant clinical history to determine the underlying cause. Common causes include infections (particularly bacterial), inflammation, stress responses, medications (such as corticosteroids), and hematologic disorders. For bacterial infections, appropriate antibiotics should be prescribed based on suspected pathogens and local resistance patterns, as guided by recommendations such as those from the Infectious Diseases Society of America 1. If medication-induced, consider dose reduction or alternative therapies when possible. For inflammatory conditions, treating the underlying disorder with anti-inflammatory medications or disease-modifying agents is essential. In cases of stress-induced changes (such as from surgery, trauma, or acute illness), supportive care and addressing the primary stressor are key. For hematologic malignancies, referral to hematology-oncology for specialized management is necessary. Regular monitoring of blood counts is important to assess response to treatment. The management approach is guided by understanding the physiologic basis of these findings: neutrophilia often represents acute inflammation or infection with increased bone marrow production and release of neutrophils, while lymphopenia may result from lymphocyte redistribution, decreased production, or increased destruction in various disease states. The use of myeloid growth factors, such as colony-stimulating factors (CSFs), can be considered to reduce the risk, severity, and duration of febrile neutropenia, especially in patients receiving myelosuppressive chemotherapy 1.
Key considerations in the management include:
- Identifying the underlying cause through comprehensive evaluation
- Appropriate use of antibiotics for bacterial infections
- Supportive care for stress-induced changes
- Referral to specialized care for hematologic malignancies
- Regular monitoring of blood counts
- Consideration of myeloid growth factors for prevention of febrile neutropenia in high-risk patients.
From the Research
Management Approach for Neutrophilia and Lymphopenia
The management approach for a patient with neutrophilia and lymphopenia depends on the underlying cause of these conditions.
- Neutrophilia can be caused by various factors such as infection, inflammation, or stress, while lymphopenia can be caused by immune system disorders, bone marrow disorders, or certain medications 2.
- A study published in the Bratislavske lekarske listy journal found that the ratio of neutrophil to lymphocyte counts can be used as a parameter to reflect the intensity of stress and/or systemic inflammation in critically ill patients 2.
- Another study published in the Lupus science & medicine journal found that neutrophil and lymphocyte counts are associated with different immunopathological mechanisms in systemic lupus erythematosus, and that the neutrophil to lymphocyte ratio (NLR) can be used as a marker of disease activity 3.
Neutrophil to Lymphocyte Ratio (NLR)
The NLR has been found to be a useful marker in various medical conditions, including:
Cancer 4
Cardiovascular disease 6
A normal range of NLR is between 1-2, and values higher than 3.0 or below 0.7 in adults are considered pathological 4.
The NLR can be used to stratify patients with cancer, and has been found to be associated with tumor size, stage, and metastatic potential 4.
The NLR has also been found to be a useful marker in the diagnosis and prognosis of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention 6.
Clinical Utility of NLR
The NLR has been found to be a cheap, simple, and fast responding parameter of stress and inflammation, with high sensitivity and low specificity 4.
- It can be used routinely in emergency departments, ICUs, and in acute medicine, including surgery, orthopedics, traumatology, cardiology, neurology, psychiatry, and oncology 4.
- Dynamic changes in NLR can precede the clinical state for several hours, and may warn clinicians about the ongoing pathological process early 4.