From the Guidelines
Yes, prednisone can cause an elevation in neutrophil counts, as it decreases neutrophil migration out of the bloodstream, increases release of neutrophils from bone marrow, and prolongs neutrophil survival in circulation 1. When a patient starts prednisone, neutrophil counts typically increase within hours to days after initiation. This effect is temporary and neutrophil counts generally return to baseline after discontinuation of the medication. Some key points to consider:
- The elevation in neutrophil counts is usually dose-dependent, with higher doses causing more significant increases.
- Clinicians should be aware of this phenomenon when interpreting complete blood counts in patients on corticosteroid therapy to avoid misinterpreting the neutrophilia as a sign of infection or other pathological processes.
- This steroid-induced neutrophilia is part of the broader effect that corticosteroids have on white blood cell distribution, which also includes decreases in lymphocytes, monocytes, and eosinophils. However, it's worth noting that the provided evidence does not directly address the effect of prednisone on neutrophil counts, but rather discusses the pathology of refractory asthma and the use of corticosteroids in other contexts 1. Despite this, the general principles of corticosteroid therapy and its effects on white blood cell distribution can be applied to this question. In clinical practice, it's essential to consider the potential effects of prednisone on neutrophil counts and to monitor patients accordingly to minimize the risk of adverse outcomes and improve quality of life.
From the Research
Elevation of Neutrophils after Starting Prednisone
- The use of prednisone, a type of corticosteroid, can lead to an increase in neutrophil count, as observed in several studies 2, 3, 4.
- A study published in 2010 found that systemic glucocorticoids, such as prednisone, were associated with a slight increase in neutrophil count, although this increase was likely due to underlying disease rather than the glucocorticoid use itself 2.
- Another study from 2016 found that inhaled corticosteroids, such as budesonide and fluticasone, increased blood neutrophil count by decreasing the expression of neutrophil adhesion molecules Mac-1 and L-selectin 3.
- A 2025 study found that corticosteroid administration in hospitalized patients without infection or immune dysfunction led to a significant increase in white blood cell count, including neutrophils, with the peak increase occurring 48 hours after steroid administration 4.
- The mechanisms underlying neutrophil-endothelial cell interactions, including the role of adhesion molecules such as Mac-1 and L-selectin, have been studied in detail 5.
- Neutrophils play a crucial role in the immune system, with potent antimicrobial properties and the ability to phagocytose and kill microorganisms 6.