Leukopenia vs. Neutropenia: What Are the Differences?

They have similarities and some differences

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Leukopenia and neutropenia are similar blood conditions, but they are not exactly the same. Leukopenia is a low number of leukocytes (white blood cells), and neutropenia is a low number of neutrophils, which are the most common type of white blood cell.

Sometimes neutropenia is referred to as leukopenia because it can cause the total number of white blood cells to be low. The effects and diagnostic testing of leukopenia and neutropenia are similar. It is important for healthcare providers to identify which one you have since the causes and treatments are not always the same.

This article will discuss how leukopenia and neutropenia are similar or different in their symptoms, causes, diagnosis, treatment, and prevention.

All white blood cells are leukocytes

Callista Images / Getty Images

Symptoms 

Leukocytes include all of the white blood cells that help your body fight infections, disease, and cancer. Neutrophils comprise approximately 40%–60% of your leukocytes. They help fight bacterial infections and they are involved in healing. 

There are many overlapping symptoms of leukopenia and neutropenia, but some are more common with neutropenia, while others are more common with leukopenia. For example, a high fever is more common with neutropenia, and this is described as a neutropenic fever.

Symptoms of Leukopenia vs. Neutropenia
Symptom Leukopenia or Neutropenia
Frequent infections Both
Severe infections Both
Mouth sores Both
Feeling run down Both
A risk of abscesses Both
Fevers Leukopenia
A risk of high fevers Neutropenia
Bacterial infections Neutropenia
Viral infections Leukopenia
Frequent sore throat Both
Risk of secondary cancer Leukopenia

Causes 

The main difference in the development of neutropenia and leukopenia is that some medical issues or medications can interfere with the production, growth, or survival specifically of neutrophils, while some conditions and medications can affect leukocytes more broadly.

Situations that can cause neutropenia, leukopenia, or both include:

  • Hereditary causes, such as congenital neutropenia (present from birth)
  • As a side effect of medication, especially chemotherapy
  • Cancer that affects the bone marrow
  • Radiation therapy
  • Immune diseases
  • Treatments for immune diseases
  • Nutritional deficits
  • Immune suppression to prevent transplant rejection
  • After a surgical procedure
  • Infections

Most conditions that cause neutropenia also cause leukopenia because a low neutrophil count usually causes a low overall white blood cell count. Also, most conditions that interfere with neutrophil production or survival can also affect other types of white blood cells.

Some conditions can cause leukopenia without neutropenia if they preferentially affect white blood cells that are not neutrophils. One example is human immunodeficiency virus (HIV), which causes leukopenia without substantial neutropenia because the condition affects T cells, a type of leukocyte.

Effects of Medications

Medications that cause low white blood cells usually affect one or more types. The specific type of white blood cells affected will be listed as a side effect on the medication label.

Diagnosis 

You might know that you are at risk of neutropenia or leukopenia if you are taking a medical treatment known to cause it or if you have been diagnosed with a condition that causes it. Sometimes, having leukopenia or neutropenia is an early sign of a medical problem. 

The diagnosis of neutropenia or leukopenia is made with a blood test called a complete blood count (CBC). It can be found in these circumstances:

  • You might have a CBC for surveillance after chemotherapy or radiation treatment to identify leukopenia or neutropenia.
  • Sometimes the diagnosis is made when you’ve had a CBC to evaluate symptoms, such as fatigue or fevers.
  • You might have an incidental diagnosis of leukopenia or neutropenia due to a routine CBC. 

Normal values of leukocytes and neutrophils may vary slightly between laboratories, and standard accepted values are listed. (Band neutrophils are immature neutrophils, and this number provides an idea of how many new neutrophils are being produced by the body.)

Normal Range for Leukocytes and Neutrophils in a Blood Sample
  Cells per cubic millimeter Percent of white blood cells
 Leukocytes  5,000–10,000  100%
 Neutrophils  2,500–6,000  40%–60%
 Band neutrophils  0–500  0%–5%

These values can fluctuate with changes in medication or with disease improvement or progression. One type of inherited neutropenia, cyclic neutropenia, is characterized by cycles of low neutrophil counts.

After a diagnosis of neutropenia or leukopenia, you might need further testing to establish the cause. Additional tests can include a bone marrow biopsy (a sample of bone marrow is removed and analyzed in a lab), imaging tests, a blood smear, or kidney or liver function tests. 

Treatment 

If you have leukopenia or neutropenia, you might need treatment for complications (such as an infection), as well as treatment to help correct your blood cell deficiency. 

Treatments for complications can include: 

  • Antibiotics for a bacterial infection
  • Medications to reduce your fever
  • Intravenous fluids for dehydration, a common complication of infections 
  • Drainage of an abscess (a walled-off area of infection)

Sometimes, antibiotics may be prescribed for a limited amount of time when the risk of a bacterial infection is especially high due to neutropenia.

Additionally, you may need treatment to help correct your low blood cells. This can include stopping treatment that’s causing the problem, or getting treated for cancer.

Treatments to increase white blood cells, such as Neulasta (pegfilgrastim) and Neupogen (filgrastim), which are granulocyte colony-stimulating factor medications, are used sometimes as well.

You might also have other associated problems, such as anemia (low red blood cells) or thrombocytopenia (low platelets). These issues can also cause complications and need to be treated.

Summary 

Neutrophils are a type of leukocyte (white blood cell). Leukopenia and neutropenia are similar conditions in which white blood cells are too low. Some medical conditions and treatments specifically affect neutrophils, and some may affect more than one type of white blood cell.

The consequences include a risk of frequent and severe infections. Neutropenia is associated with bacterial infections and a high fever, while leukopenia tends to be associated with viral infections, although these effects can occur with either condition.

These conditions are diagnosed with a CBC blood test that measures the different types of white blood cells. Treatment involves managing effects of any infections, antibiotics if a bacterial infection is diagnosed, treating the cause, and possibly medication to increase white blood cell count. 

A Word From Verywell 

Having neutropenia or leukopenia could be a sign of a serious medical problem or a side effect of medication. The low white blood cells can put you at an increased risk of infections. You will need close medical attention to manage your white blood cell counts, any complications, and the cause.

Often, white blood cell counts return to normal after treatment, and the infection risk will decrease as the count improves to normal levels. 

Frequently Asked Questions

  • What causes leukopenia and neutropenia?

    Leukopenia occurs when the body doesn't have enough white blood cells, and neutropenia occurs when the body doesn't have enough neutrophils—a specific type of white blood cell.

    These conditions have many possible causes, including medication use, bone marrow disorders, blood cancer, other types of cancer, infections, and genetics.

  • Can you have leukopenia without neutropenia?

    Usually, neutropenia accompanies leukopenia, but sometimes leukopenia may affect other types of white blood cells without causing neutropenia. For example, HIV can cause lymphopenia (low lymphocytes) due to low T-cell lymphocytes, without necessarily causing neutropenia.

  • What is the most common reason for low white blood cell count?

    The most common causes of leukopenia are chemotherapy and radiation therapy, which impair production of blood cells in the bone marrow.

  • What foods should you avoid if you have low white blood cells?

    There is no solid evidence regarding a leukopenia diet or a neutropenia diet. In general, it is safest to avoid infections by washing food, cooking thoroughly, and avoiding undercooked or raw meat or seafood.

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