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

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Neutropenia is a reduced number of neutrophil granulocytes in the blood. Normally, one would expect a number [latex]\geq 1500\ \frac{\text{neutrophils}}{\mu l}[/latex] in the peripheral blood, with a typical value of [latex]2500-4500 \frac{\text{neutrophils}}{\mu l}[/latex]. 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

[latex display=“true”]\leq 1500\ \frac{\text{neutrophils}}{\mu l}[/latex] or equivalently [latex display=“true”]\leq 1500\ \frac{\text{neutrophils}}{mm³}[/latex] or equivalently [latex display=“true”]\leq 1.5\ billion\ \frac{\text{neutrophils}}{l}[/latex] or equivalently [latex display=“true”]\leq 1.5e9\ \frac{\text{neutrophils}}{l}[/latex]

Grade 2 neutropenia

is defined as an absolute neutrophil count (ANC) of

[latex display=“true”]1000\dotsb 1500\ \frac{\text{neutrophils}}{\mu l}[/latex] or equivalently [latex display=“true”]1000\dotsb 1500\ \frac{\text{neutrophils}}{mm³}[/latex] or equivalently [latex display=“true”]1000\ billion\ \dotsb 1500\ billion\ \frac{\text{neutrophils}}{l}[/latex] or equivalently [latex display=“true”]1e9\dotsb 1.5e9\ \frac{\text{neutrophils}}{l}[/latex]

Grade 3 neutropenia

is defined as an absolute neutrophil count (ANC) of

[latex display=“true”]500\dotsb 1000\ \frac{\text{neutrophils}}{\mu l}[/latex] or equivalently [latex display=“true”]500\dotsb 1000\ \frac{\text{neutrophils}}{mm³}[/latex] or equivalently [latex display=“true”]500\ billion\ \dotsb 1000\ billion\ \frac{\text{neutrophils}}{l}[/latex] or equivalently [latex display=“true”]0.5e9\dotsb 1e9\ \frac{\text{neutrophils}}{l}[/latex]

Grade 4 neutropenia

is defined as an absolute neutrophil count (ANC) of

[latex display=“true”]\leq 500\ \frac{\text{neutrophils}}{\mu l}[/latex] or equivalently [latex display=“true”]\leq 500\ \frac{\text{neutrophils}}{mm³}[/latex] or equivalently [latex display=“true”]\leq 500\ million\ \frac{\text{neutrophils}}{l}[/latex] or equivalently [latex display=“true”]\leq 0.5e9\ \frac{\text{neutrophils}}{l}[/latex]

Grade 5 neutropenia

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