cells/μL
%
ANC Interpretation
Normal ANC: 1,500-8,000 cells/μL
Mild neutropenia: 1,000-1,499 cells/μL
Moderate neutropenia: 500-999 cells/μL
Severe neutropenia: <500 cells/μL
Neutrophilia: >8,000 cells/μL
Clinical Notes
- ANC = WBC count × (Neutrophil % ÷ 100)
- Critical ANC <500: High risk of severe infection
- Monitor for fever, signs of infection in neutropenic patients
- Consider prophylactic antibiotics for ANC <500
Absolute Neutrophil Count (ANC) Calculator
The Absolute Neutrophil Count (ANC) is a critical laboratory value used to assess a patient's risk of infection, particularly in oncology and hematology patients. ANC is calculated by multiplying the total white blood cell count by the percentage of neutrophils in the differential count.
Calculation Formula
ANC = WBC count × (Neutrophil % ÷ 100)
ANC Interpretation
Normal ANC: 1,500-8,000 cells/μL
- Clinical significance: Normal neutrophil count
- Infection risk: Normal
- Management: No special precautions needed
Mild Neutropenia: 1,000-1,499 cells/μL
- Clinical significance: Slightly decreased neutrophil count
- Infection risk: Slightly increased
- Management: Monitor for signs of infection
Moderate Neutropenia: 500-999 cells/μL
- Clinical significance: Moderately decreased neutrophil count
- Infection risk: Moderate
- Management: Monitor closely, consider prophylactic antibiotics
Severe Neutropenia: <500 cells/μL
- Clinical significance: Critically low neutrophil count
- Infection risk: High risk of severe infection
- Management: Protective isolation, immediate medical attention
Neutrophilia: >8,000 cells/μL
- Clinical significance: Elevated neutrophil count
- Possible causes: Infection, inflammation, stress, medications
- Management: Evaluate underlying cause
Clinical Applications
Oncology Patients
- Chemotherapy monitoring: ANC nadir typically occurs 7-14 days post-treatment
- Dose adjustments: May require chemotherapy dose reduction or delay
- Growth factor support: Consider G-CSF for ANC <1,000
- Infection prophylaxis: Antibiotics for ANC <500
Hematology Patients
- Bone marrow disorders: Monitor for progression
- Transplant patients: Critical for engraftment assessment
- Autoimmune conditions: Monitor treatment response
Important Considerations
Monitoring
- Monitor ANC trends, not just single values
- Consider duration of neutropenia
- Assess for fever and signs of infection
- Monitor other cell lines (platelets, hemoglobin)
Limitations
- Does not assess neutrophil function
- May not reflect bone marrow reserve
- Consider timing relative to chemotherapy
- Evaluate in clinical context
Clinical Pearls
- ANC <500: High risk of severe infection, consider protective isolation
- Fever with ANC <500: Medical emergency requiring immediate evaluation
- Monitor for signs of infection regardless of ANC level
- Consider growth factor support for prolonged neutropenia
- Evaluate underlying cause of persistent neutropenia
This calculator provides a standardized method for calculating ANC, which is essential for assessing infection risk and guiding clinical management in patients with hematologic disorders or receiving myelosuppressive therapy.
References
- National Comprehensive Cancer Network. Prevention and Treatment of Cancer-Related Infections. Version 2.2023.
- Freifeld AG, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93.
- Dale DC, et al. How I diagnose and treat neutropenia. Curr Opin Hematol. 2016;23(1):1-10.
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