What is neutropenia?

Neutropenia happens when a child has low levels of a type of white blood cell, called a neutrophil.

The main role of white blood cells is to fight infections caused by viruses or bacteria. There are many types of white blood cells. Neutrophils surround and destroy harmful bacteria.

Neutropenia can happen if: 

  • Your child’s body does not make enough neutrophils.
  • Neutrophils are destroyed after they are made.
  • Neutrophils collect in a certain spot in the body instead of moving through the bloodstream.
  • The most common causes in children are: 

    • A temporary decrease in the number of white blood cells the bone marrow makes
    • An increase in the number of white blood cells being destroyed after a viral infection 

    It can take a lot of white blood cells to fight a viral infection. The count can fall quite low and may stay low for many months. Most of the time, this type of neutropenia does not raise the risk of serious infections much. It usually gets better on its own over time.

    Other possible causes for neutropenia include: 

    • A child’s immune system attacking their own blood cells.
    • Getting chemotherapy medicines for cancer. The drop in blood cell levels tends to be worse with more intense treatment.
    • Taking certain other medicines that reduce the number of neutrophils being made.
    • Not getting enough of some vitamins, such as B12 . This may reduce the number of blood cells your child’s body makes.
    • Blood diseases or problems with the bone marrow, like aplastic anemia, that can cause low blood cell levels.
    • Some infections that can reduce blood cell levels, such as tuberculosis (TB). 

    In addition, having slightly lower neutrophil levels may be normal in children of some ethnic or racial backgrounds (especially African-Americans). Children with “benign ethnic neutropenia” are not at higher risk of infection and usually do not need treatment.

Neutropenia at Seattle Children’s

At Seattle Children’s Cancer and Blood Disorders Center, we offer a full range of services to diagnose and treat this disease.

Our experience helps us know what to watch for and how to prevent and treat problems early. This increases the chances of successful treatment and helps your child feel better.

Please contact the center at 206-987-2106 for more information, a second opinion or to make an appointment.

  • Our doctors are nationally known for treating children who have blood disorders. The doctors who guide your child’s care are board certified in pediatric hematology. This means they are approved to give the specialized care your child needs, and they constantly expand their knowledge about blood disorders.

    Our team has the skills and experience to find the cause of your child’s neutropenia. 

    • If your child has a bone marrow disorder, our Bone Marrow Failure team will care for them.
    • For an immune system disorder, your child will get expert care from specialists at our Immunology Clinic, which has over 40 years of experience diagnosing and treating children.
    • Genetic counseling can be helpful if your child may have an inherited condition (passed from parents to children).
    • Our infectious disease team can help manage infections that may arise due to neutropenia. 

    We help your child stay healthy and fight infections that happen. Your family has a full team behind you. Your child’s team will include doctors, nurses, social workers and other specialists as needed, such as nutritionists. Read more about the supportive care we offer.

    Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. Our experts base their treatment plans on years of experience and the newest research on what works best – and most safely – for children.

  • Having a child with neutropenia can be stressful. We offer same-day appointments for children with urgent needs, such as fever. New patients whose needs are not urgent usually can be seen within 1 or 2 weeks.

    During visits, we take time to explain your child’s condition. We help you fully understand your treatment options and make the choices that are right for your family.

    Our child life specialists and social workers help your child and your family through the challenges of this condition. We connect you to community resources and support groups.

    At Seattle Children’s, we work with many children and families from around the Northwest and beyond. Whether you live nearby or far away, we can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

  • For the 25th year in a row, Seattle Children’s ranks among the nation's best children's hospitals, according to U.S. News & World Report.

    Our physician-scientists help set national standards for care of young people with blood disorders.

    Seattle Children’s provides the most advanced treatments in our region. Our experience helps us recommend the right treatment at the right time to have the best results for your child and your family.

Symptoms of Neutropenia

Children with neutropenia are more likely to get infections. These often affect the throat, ears, sinuses, lungs, skin or urinary tract. They may have sores in their mouth or red, swollen (inflamed) gums. Children may show no symptoms until they start having infections.

Fever is a common sign of infection. Other symptoms depend on where the infection is: 

  • Ear infections cause pain in the affected ear.
  • Sinus infections may cause headache, congestion or cough.
  • Pneumonia is a lung infection and may cause chills, coughing, shortness of breath and muscle aches.
  • A bladder infection may cause fever, nausea or pain when peeing.

Diagnosing Neutropenia

If your child gets frequent or uncommon infections (such as infection in the blood), the doctor may suspect a problem with white blood cells, like neutrophils.

To diagnose neutropenia, your child’s doctor will take a blood sample to check the levels of each type of blood cell. This is called a complete blood count.

Depending on your child’s symptoms, doctors may do further tests to: 

  • Get a sample of bone marrow by doing a bone marrow aspiration or biopsy. This helps us understand why your child has low neutrophils.
  • Test the blood for antibodies against neutrophils.
  • Check how their immune system is working.
  • Check levels of vitamin B12 and folate.
  • Look for changes in genes that indicate an inherited marrow failure disorder. 

The doctor may check your child’s blood cell levels from time to time if your child gets treatment for an illness and doctors know the treatment may cause neutropenia. For example, chemotherapy to treat cancer can cause neutropenia. Regularly checking blood cell levels helps discover neutropenia early. Doctors may be able to treat it before infections increase.

Treating Neutropenia

Neutropenia does not always require treatment. It depends on how severe the condition is and what caused it. Even if doctors cannot pin down the cause, we can help manage the neutropenia to avoid problems.

Most often children get neutropenia after fighting off an infection caused by a virus. With time, their bodies will build up their neutrophil level again. Until then, your child will need care for any infection they get.

If your child’s neutropenia is caused by a disease of the blood, bone marrow or immune system, we will treat the underlying cause. Read more about our programs to treat bone marrow failure and immune system disorders.

For children of some ethnic or racial backgrounds (especially African-Americans), it may be normal to have slightly lower levels of neutrophils than what is normal for children from European backgrounds (Caucasians). This is called “benign ethnic neutropenia” and does not usually need treatment.

Your child’s care plan depends on their illness. We watch your child closely and recommend the right treatment options.

  • Your child’s doctor will suggest ways to help avoid infection, such as: 

    • Frequent hand washing
    • Avoiding crowds and limiting contact with sick people
    • Getting all recommended vaccines
    • Good care of teeth and regular dental check-ups to avoid problems with gums 

    Fever (over 38.50 C or 101.30 F) is a sign of infection and needs attention right away. We will give you guidelines about what to do if your child gets a fever.

    They may need antibiotics to help fight infections caused by bacteria. Usually, antibiotics are given into your child’s vein using a tube, called an IV (intravenous) line.

    A child who gets an infection may need to stay in the hospital until we are sure their infection is controlled.

  • For more severe neutropenia that has led to infections, we may suggest giving your child injections of a neutrophil growth factor. This boosts the number of white blood cells your child’s body makes. It is given as a shot under the skin.

Contact Us 

If you would like an appointment, ask your child’s primary care provider for a referral.

If you have a referral or would like a second opinion, call the Cancer and Blood Disorders Center at 206-987-2106.

Providers, see how to refer a patient.