Assessment of neutropenia

Last reviewed: 11 Aug 2025
Last updated: 31 Jul 2025

Summary

Differentials

Common

  • Sepsis
  • Typhoid infection
  • Brucellosis
  • HIV infection
  • Viral hepatitis
  • Influenza infection
  • Infectious mononucleosis
  • Respiratory syncytial virus infection
  • Erythema infectiosum
  • Rickettsial diseases
  • Drug-induced
  • Cytotoxic chemotherapy
  • Radiotherapy
  • Immune neutropenia
  • Acute myelogenous leukaemia
  • Acute lymphocytic leukaemia
  • Myelodysplastic syndrome
  • Chronic lymphocytic leukaemia (CLL)
  • Hodgkin's lymphoma
  • Non-Hodgkin's lymphoma
  • Infiltration by secondary malignancy
  • Aplastic anaemia
  • Vitamin B12/folate deficiency
  • Alcohol-use disorder
Full details

Uncommon

  • Cytomegalovirus infection
  • Rubella
  • Measles infection
  • Acute varicella-zoster (Chicken pox)
  • Human granulocytic ehrlichiosis
  • Malaria infection
  • Leishmaniasis
  • Transfusion reaction
  • Copper deficiency
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Sjogren's syndrome
  • Felty's syndrome
  • Increased neutrophil margination
  • Laboratory artifact
  • Bone marrow failure syndromes
  • Isolated neutropenia syndromes
  • Immunodeficiency syndromes
  • Inborn errors of metabolism
Full details

Contributors

Authors

Edward Copelan, MD, FACP

Professor and Chairman

Department of Hematologic Oncology and Blood Disorders

Levine Cancer Institute

Carolinas HealthCare System

Charlotte

NC

Disclosures

EC declares that he has no competing interests.

Belinda Avalos, MD

Professor and Vice-Chair

Department of Hematologic Oncology and Blood Disorders

Levine Cancer Institute

Carolinas HealthCare System

Charlotte

NC

Disclosures

BA declares that she is on the Executive Committee of the American Society of Hematology.

Reed Friend, MD

Assistant Professor

Hematologic Oncology and Blood Disorders

Levine Cancer Institute

Carolinas HealthCare System

Charlotte

NC

Disclosures

RF declares that she has no competing interests.

Acknowledgements

Dr Edward Copelan, Dr Belinda Avalos, and Dr Reed Friend would like to gratefully acknowledge Dr Lisa Sproat, the previous contributor to this topic.

Disclosures

LS declares that she has no competing interests.

Peer reviewers

Sally E. Kinsey, MD, FRCP, FRCPath, FRCPCH

Professor of Paediatric Haematology

University of Leeds and Leeds Teaching Hospitals NHS Trust

St. James's University Hospital

Leeds

UK

Disclosures

SEK is a medical advisory board member of the Severe Chronic Neutropenia International Registry (not remunerated) and is an author of references cited in the topic including data from the registry. SEK has been in receipt of educational grants from Chugai Pharma.

Laurence A. Boxer, MD

Professor

Pediatric Hematology/Oncology

Associate Chair

Department of Pediatrics and Communicable Diseases

Henry and Mala Dorfman Family Professorship

Pediatric Hematology/Oncology

Ann Arbor

MI

Disclosures

LAB is an author of references cited in this topic. LAB declares that he has no competing interests.

Cornelia Zeidler, MD

SCNIR

DCC Europe

Medizinische Hochschule Hannover

Kinderklinik

Hannover

Germany

Disclosures

Not disclosed.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Boxer LA, Newberger PE. A molecular classification of congenital neutropenia syndromes. Pediatr Blood Cancer. 2007 Oct 15;49(5):609-14.Full text  Abstract

Cham B, Bonilla MA, Winkelstein J. Neutropenia associated with primary immunodeficiency syndromes. Semin Hematol. 2002 Apr;39(2):107-12. Abstract

Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. J Clin Oncol. 2018 May 10;36(14):1443-53.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Guidelines

    • 2024 update of the AGIHO guideline on diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients with solid tumours and hematological malignancies
    • Management of fever and neutropenia in pediatric patients with cancer and hematopoietic cell transplantation recipients
    More Guidelines
  • Patient information

    Cellulitis and erysipelas

    Chickenpox

    More Patient information
  • Calculators

    Absolute neutrophil count

    More Calculators
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