From the Guidelines
Elevated absolute neutrophils typically require investigation to identify and treat the underlying cause, rather than immediate treatment for the neutrophilia itself. The condition, also known as neutrophilia, is characterized by an absolute neutrophil count above the normal range of approximately 1,500-8,000 cells per microliter. Common causes include bacterial infections, inflammation, stress, certain medications (like corticosteroids), and some medical conditions such as leukemia. To address elevated neutrophils, the underlying cause must be identified and treated. For bacterial infections, appropriate antibiotics would be prescribed based on the specific infection, as guided by recommendations such as those from the Infectious Diseases Society of America 1. For medication-induced neutrophilia, adjusting or discontinuing the causative medication may be necessary. For inflammatory conditions, anti-inflammatory medications might be recommended.
Key Considerations
- Neutrophilia itself is not a disease but a sign of an underlying process, as neutrophils are produced in the bone marrow and released into the bloodstream in response to various stimuli.
- Regular monitoring of neutrophil counts is important, especially if the elevation is significant or persistent, as this may indicate a more serious condition requiring specialized treatment.
- In the context of febrile neutropenia, management guidelines such as those from ESMO 1 provide recommendations on the duration of antibiotic therapy, emphasizing the importance of risk assessment and the role of neutrophil count recovery in decision-making.
Management Approach
- Identify the underlying cause of neutrophilia and direct treatment accordingly, whether it be antibiotics for bacterial infections, adjustment of medications, or management of inflammatory conditions.
- Consider the patient's risk factors, such as the anticipated duration of neutropenia, presence of medical co-morbidities, and specific clinical conditions like hypotension or pneumonia, to guide the intensity and venue of care, as recommended by guidelines like those from the Infectious Diseases Society of America 1.
- For patients with febrile neutropenia, follow established clinical guidelines for the management of fever and neutropenia, including the consideration of antifungal therapy in cases of persistent fever despite neutrophil recovery 1.
From the Research
Elevated Absolute Neutrophils
- Elevated absolute neutrophils can be an indicator of various conditions, including infections, inflammatory diseases, and malignancies 2.
- A study published in the Journal of Thrombosis and Thrombolysis found that persistent neutrophilia is associated with an increased risk of venous thrombosis, even in the absence of underlying conditions such as cancer, infection, or steroid use 2.
- The study defined persistent neutrophilia as an absolute neutrophil count greater than 7.8 x 10^9/L on at least three complete blood counts, at least 2 months apart 2.
- Patients with neutrophil counts greater than or equal to 9.0 x 10^9/L were found to be twice as likely to be diagnosed with venous thromboembolism (VTE) compared to those with normal neutrophil counts, while those with neutrophil counts greater than or equal to 10.0 x 10^9/L were at an even higher risk 2.
Treatment of Infections
- Meropenem, a broad-spectrum antibacterial agent, has been shown to be effective in the treatment of various serious bacterial infections, including complicated intra-abdominal infections, complicated skin and skin structure infections, and bacterial meningitis 3.
- Ceftriaxone, another antibacterial agent, has been compared to standard of care therapy for the treatment of methicillin-susceptible Staphylococcus aureus bloodstream infections, with similar clinical and microbiological cure rates 4.
- Cefepime, a first-line agent for empiric sepsis therapy, has been associated with increased mortality for extended-spectrum beta-lactamase-producing Enterobacterales, but may be effective for bloodstream infections caused by ceftriaxone-resistant, cefepime-susceptible Escherichia coli and Klebsiella pneumoniae 5.
Blood Culture Positivity
- Obtaining blood cultures before antibiotic therapy is crucial for accurate pathogen identification, as antibiotic administration can significantly reduce blood culture positivity 6.
- A prospective clinical cohort study found that blood culture positivity was significantly higher among patients who did not receive antibiotics before sampling, with Gram-positive and Gram-negative pathogens more frequently detected in blood culture sets drawn before antibiotic therapy 6.