Neutrophilia

Last updated Nov. 1, 2025, 10:24 p.m. by ivo

The neutrophil reference range will vary depending on the age, gender and pregnancy status of the patient, as well as the laboratory performing the test. In general, the neutrophil count is considered elevated when it is above 8 x 10⁹/L.

Causes

The most common causes of neutrophilia include infection/inflammation, drugs (e.g. steroids, lithium), smoking, heavy exercise or any intercurrent illness (e.g., trauma, seizure).
Neutrophilia may also be a manifestation of a myeloproliferative neoplasm such as Chronic Myeloid Leukaemia. Concern about a myeloproliferative neoplasm is increased when there is a progressive rise in neutrophils and other blood cells (often basophils), with an abnormal blood film and possibly splenomegaly on examination. The presence of associated cytopenias also warrants further haematological investigation.
Severity, the presence of ‘left shift’ and a rapid increase, particularly in an unwell patient, will increase the level of concern about neutrophilia. In these cases, management is directed at treatment of the underlying cause, which is usually non-haematological.

Non-haematological causes

Infection
Reactive: exercise, physical stress/trauma, emotional stress (e.g. panic attacks), heat stroke, surgery
Smoking
Chronic inflammation
Medications: corticosteroids, beta agonists, lithium
Splenectomy
Pregnancy
Congenital

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When To Refer

Symptoms

Unxplained fevers > 38° C
Unintentional weight loss
Night sweats

Physical examination

Hepatosplenomegaly
Lymphadenopathy

Laboratory

BCR-ABL/JAK2 PCR positive
Anaemia (Hb < 100 g/L)
Thrombocytopenia (PLT < 100x10⁹/L)
Immature cells on peripheral blood film
Dysplastic features on peripheral blood film
Monocytosis

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