Neutrophils Blood test In Australia, Get Tested Today

What are neutrophils?

‍

Neutrophils are a type of white blood cell, and the most common one in your bloodstream. Consider them your body’s first responders when it comes to combating infections. They play a crucial role in your immune system, particularly in the innate immune response, which serves as your body’s first line of defence. Upon detecting harmful invaders, such as bacteria or viruses, neutrophils spring into action by surrounding and breaking them down from within. They also release specialised substances and create what are known as neutrophil extracellular traps that engulf these pathogens. In addition to fighting infections, they also help initiate and regulate inflammation, especially after injuries or during illness.

‍

What are the different tests related to Neutrophils?

The tests for checking neutrophils can be used for either assessing neutrophil levels or detecting antibodies against neutrophils.

Absolute neutrophil count

Neutrophil count testing is known as the Absolute neutrophil count test. This test is typically done as part of your complete blood count (CBC) with a differential test. The CBC with differential examines various components of your blood, like how many white blood cells (WBCs), red blood cells (RBCs), and platelets you have.

It also divides WBCs into different cell types, namely neutrophils, eosinophils, basophils, monocytes, and lymphocytes, and looks at their number and physical features. This provides doctors with a clearer understanding of how your immune system is functioning.

Antineutrophil cytoplasmic antibodies test

The antineutrophil cytoplasmic antibodies test is a blood test that detects specific antibodies called antineutrophil cytoplasmic antibodies (ANCA) in your bloodstream. Typically, your body produces antibodies to combat germs, such as bacteria and viruses. However, in autoimmune diseases, the body sometimes mistakenly creates antibodies that attack its own healthy cells. The ANCA specifically targets neutrophils and are often found in diseases that cause inflammation in small blood vessels.

The two main types of ANCA are p-ANCA, and c-ANCA. Each type targets a specific protein inside your white blood cell. This helps your doctor establish a diagnosis of a particular type of autoimmune vasculitis, in which the immune system attacks the blood vessels. This test enables doctors to assess the situation and select the most suitable treatment. Additionally, testing for p-ANCA can assist in diagnosing certain types of inflammatory bowel disease (IBD).

When is it essential to perform neutrophil blood tests?

Absolute neutrophil count

Your doctor will usually recommend doing a neutrophil blood test:

• If there is evidence of active or previous infection or inflammation in the body
• For assessing symptoms, such as recent weight loss, decreased appetite, swollen glands, a new palpable mass, generalised body aches, fatigue, night sweats, and fever
• If you have a family history of high neutrophils, recent changes in medication, intense exercise, cigarette smoking, or physical or emotional stress

Antineutrophil cytoplasmic antibodies (ANCA) test

Your doctor will recommend the ANCA test:

• To determine if you have autoimmune vasculitis and which type. You may have symptoms including fatigue, fever, general aches and pains, loss of appetite, weight loss, and the ANCA test helps in detecting if the symptoms are due to autoimmune vasculitis
• To diagnose inflammatory bowel diseases, such as Ulcerative colitis or Crohn’s disease
• For monitoring treatment for autoimmune vasculitis

‍

What conditions cause a change in the count of neutrophils and antineutrophil cytoplasmic antibodies?

Absolute neutrophil count

The neutrophils are produced in the bone marrow and start circulating in the blood once they are mature.  An increase in absolute neutrophil count is termed as neutrophilia, which can be primary or secondary. A decrease in absolute neutrophil count, or low neutrophil count, is known as neutropenia.

Primary Neutrophilia: The increase in neutrophil levels occurs because of abnormal increased production of neutrophils by the bone marrow. The regulation of neutrophil production is impaired in the following conditions:

•  Cancer
• Genetic disorders and inherited conditions

Secondary Neutrophilia: This type of increase in neutrophil levels is also known as reactive neutrophilia. It can occur due to infections, inflammation, and various stimuli:

• Bacterial infections usually cause an increase in neutrophil levels
• Inflammatory conditions include rheumatoid arthritis, inflammatory bowel disease, hepatitis, and vasculitis
• Multiple stimuli, including physical or emotional stress, intense exercise, changes in temperature, seizure activity, cigarette smoking, surgery, obesity, reduction in the size of the spleen

Neutropenia: A decrease in neutrophil levels in the blood is called neutropenia. A drop in neutrophil count typically occurs when the production of neutrophils from the bone marrow is slower than destruction or there is a malfunction in the production process. Causes of a low neutrophil count include:                                                                                                                                              

• Severe or chronic bacterial and viral infections
• Allergic disorders
•  Specific drug treatments
• Autoimmune disorders cause a low neutrophil count
• Severe congenital neutropenia is a group of disorders characterised by the immaturity of neutrophils
• Cyclic neutropenia causes cell levels to fluctuate
• Chronic benign neutropenia results in a persistently low neutrophil count with no apparent cause

Antineutrophil cytoplasmic antibodies

Neutrophils act as soldiers against infections and inflammation in your body. They contain granules that contain enzymes, which help them in their job. These enzymes are also associated with ANCA tests, which aid in the diagnosis of various types of autoimmune vasculitis. The different kinds of autoimmune vasculitis include Granulomatosis with Polyangiitis and Eosinophilic Granulomatosis with Polyangiitis.

ANCA is positive in:

• 90% of people with Granulomatosis with Polyangiitis (GPA)
• 30% of those with Eosinophilic Granulomatosis with Polyangiitis
• 15–20% of people with systemic lupus erythematosus (SLE), especially those who have lupus affecting the kidneys (lupus nephritis)

How are the Neutrophil blood tests done?

Absolute neutrophil count

Your blood sample is required for the neutrophils absolute test. A blood sample is evaluated using:

• An automated cell counter: Counts the number of each type of cell
• A peripheral blood smear: Manually reviewed under a microscope to assess cell types and abnormalities. The automated differential is confirmed through a manual review of the peripheral blood smear.

Antineutrophil cytoplasmic antibodies test

A blood sample is typically taken from your vein for the ANCA lab test. The specimen is analysed using:

• Indirect immunofluorescence (IIF): Identifies the presence or absence of ANCA autoantibodies by the staining pattern within the cytoplasm of neutrophils. If the test is positive, it is followed by an ELISA test. In the c-ANCA pattern, the staining is throughout the cytoplasm. In the p-ANCA pattern, staining is typically limited to the area around the nucleus.
• Enzyme-linked immunosorbent assay (ELISA): An ELISA test determines the levels of antibodies.

How to prepare for the tests?

No special preparation is necessary for the neutrophil absolute test and the ANCA blood test. Both tests require blood to be drawn from the veins.

• Hydration: Drink enough water so that an adequate amount of blood sample can be collected for testing.
• Nutrition: These tests do not require fasting for 8-10 hours. However, check with your doctor if you have other tests that require fasting. In either case, maintain a healthy balanced diet.

‍

What are the risks involved with the tests?

Risks are minimal and similar to standard blood tests. You might experience:

• Brief pain or stinging during the needle insertion
• Mild bruising or soreness
• Rare fainting (notify staff if you’ve fainted before)

Interpretation of test results

Absolute neutrophil count

The normal range of white blood cell count in adults is estimated to be 4-11x10⁹/Litre (L), with 60% to 70% of these cells being mature neutrophils circulating in the peripheral blood. An absolute neutrophil count, which indicates the percentage of neutrophils in the bloodstream, typically ranges from 2-7.5 x10⁹/L.

An elevated WBC count above 11x10⁹/L is termed leukocytosis. Neutrophilia is the most common type of leukocytosis. It occurs when the absolute neutrophil count exceeds 7.5 x10⁹/L, which represents a value two standard deviations above the mean in a neutrophil blood test. On the other hand, neutropenia occurs when the neutrophil count decreases below 2x10⁹/L.

‍

White Blood Cell Count

Neutrophil

 The different types of white blood cells differ in their structure, function, and percentages in the blood. They are broadly classified based on the presence or absence of granules in the cells into granulocytes and agranulocytes.

• Granulocytes: Neutrophils, Eosinophils, Basophils
• Agranulocytes: Lymphocytes, Monocytes

Cell type

• Neutrophils
  
  • Normal percentage: 60%-70%
  • Normal range: 2-7.5x10⁹/L
• Lymphocytes
  
  • Normal percentage: 20%-40%
  • Normal range: 1.5-4x10⁹/L
• Monocytes
  
  • Normal percentage: 2%-8%
  • Normal range: 0.2-0.8x10⁹/L
• Eosinophils
  
  • Normal percentage: 1%-4%
  • Normal range: 0-0.4x10⁹/L
• Basophils
  
  • Normal percentage: 0.5%-1%
  • Normal range: 0-0.1x10⁹/L

Antineutrophil cytoplasmic antibodies test

If a test was performed for the detection of autoimmune vasculitis: When the IIF result is negative, ANCA is not detected, and the findings are normal. However, a positive IIF result implies that ANCA is detected; hence, the findings are abnormal. The fluorescence pattern detects the presence of c-ANCA or p-ANCA, which facilitates the diagnosis of the type of vasculitis.

p-ANCA

• Positive: >5.0 IU/ml
• Equivocal: 3.5-5 IU/ml
• Negative: <3.5 IU/ml

c-ANCA

• Positive: > 3 IU/ml
• Equivocal: 2-3 IU/ml
• Negative: < 2IU/ml

• Positive results for c-ANCA are mostly consistent with granulomatosis with polyangiitis
• Positive results with p-ANCA are most observed in microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis

If a test was performed for monitoring treatment for autoimmune vasculitis: ANCA test results may indicate whether your treatment is effective.

If a test was performed for inflammatory bowel disease (IBD): Your doctor will consider your ANCA test results in conjunction with the results from another antibody blood test called anti-Saccharomyces cerevisiae antibodies (ASCA).                                                                                                                         

For IBD diagnosis:

• Ulcerative colitis: ANCA positive, ASCA negative
• Crohn’s disease: ANCA negative, ASCA positive

What can you do if the neutrophil blood tests are abnormal?

For high counts

The initial management for elevated values on the absolute neutrophil count and ANCA test is based on working on diet and lifestyle.

• Anti-inflammatory diet: Emphasise vegetables, berries, whole grains, and omega-3s (e.g., fish, flaxseed)
•  Exercise: Include aerobic and resistance training
• Stress management: Use mindfulness practices like meditation and yoga
• Quit smoking: Reduces neutrophil overproduction and inflammation

Your doctor may also prescribe medications or natural supplements if the elevation is due to infections, autoimmune diseases, or bone marrow issues.

For low counts

Depending on the cause, your doctor may recommend:

• Repeating the test
• Additional blood work or imaging
•  Monitoring for infections
• Specialised treatments or bone marrow evaluation

‍

Sources:

1. Rosales C. Neutrophil: A Cell with Many Roles in Inflammation or Several Cell Types?. Front Physiol. 2018;9:113. Published 2018 Feb 20. doi:10.3389/fphys.2018.00113

2. Tahir N, Zahra F. Neutrophilia. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570571/

3. Khalid N, Aeddula NR. Antineutrophil Cytoplasmic Antibodies (ANCA) Test. [Updated 2024 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562339/

4. Menni C, Louca P, Berry SE, et al. High intake of vegetables is linked to lower white blood cell profile and the effect is mediated by the gut microbiome. BMC Med. 2021;19(1):37. doi:10.1186/s12916-021-01913-w