What is grade I/II/III/IV neutropenia?

Note about medical information:
This information is presented for informational purposes only and is intended for professionals. While we strive to provide accurate information, this information might be outdated, unintentionally misleading or incorrect. Consult a medical professional and/or read the primary sources cited in our article before basing any decision on this information.

Neutropenia is a reduced number of neutrophil granulocytes in the blood. Normally, one would expect a number \geq 1500\ \frac{\text{neutrophils}}{\mu l} in the peripheral blood, with a typical value of 2500-4500 \frac{\text{neutrophils}}{\mu l}.
The decreased number of neutrophils is associated with reduced immune response and hence causes an increased chance of infection. Patients with neutropenia have a risk of developing febrile neutropenia (also known as neutropenic sepsis). Febrile neutropenia is a medical emergency and hence requires immediate treatment!

Neutropenia can be easily diagnosed using a complete blood count to count the number of neutrophils in the peripheral blood. In case a lab report does not contain the absolute neutrophil count (ANC), you can also multiply the percentage of neutrophils with the leukocyte count.

The different grades of neutropenia are defined in the Common Terminology Criteria for Adverse Events (CTCAE). On this page, we use Version 5.0 published in 2017.

Grade 1 neutropenia

is defined as an absolute neutrophil count (ANC) of

\leq 1500\ \frac{\text{neutrophils}}{\mu l} or equivalently
\leq 1500\ \frac{\text{neutrophils}}{mm³} or equivalently
\leq 1.5\ billion\ \frac{\text{neutrophils}}{l} or equivalently
\leq 1.5e9\ \frac{\text{neutrophils}}{l}

Grade 2 neutropenia

is defined as an absolute neutrophil count (ANC) of

1000\dotsb 1500\ \frac{\text{neutrophils}}{\mu l} or equivalently
1000\dotsb 1500\ \frac{\text{neutrophils}}{mm³} or equivalently
1000\ billion\ \dotsb 1500\ billion\ \frac{\text{neutrophils}}{l} or equivalently
1e9\dotsb 1.5e9\ \frac{\text{neutrophils}}{l}

Grade 3 neutropenia

is defined as an absolute neutrophil count (ANC) of

500\dotsb 1000\ \frac{\text{neutrophils}}{\mu l} or equivalently
500\dotsb 1000\ \frac{\text{neutrophils}}{mm³} or equivalently
500\ billion\ \dotsb 1000\ billion\ \frac{\text{neutrophils}}{l} or equivalently
0.5e9\dotsb 1e9\ \frac{\text{neutrophils}}{l}

Grade 4 neutropenia

is defined as an absolute neutrophil count (ANC) of

\leq 500\ \frac{\text{neutrophils}}{\mu l} or equivalently
\leq 500\ \frac{\text{neutrophils}}{mm³} or equivalently
\leq 500\ million\ \frac{\text{neutrophils}}{l} or equivalently
\leq 0.5e9\ \frac{\text{neutrophils}}{l}

Grade 5 neutropenia

is defined as death (like all Grade 5 adverse events).