Pediatric Neutropenia: Low White Blood Cell Count in Babies and Children

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Within the first year or two of life, your child may have a routine blood test that could reveal a condition known as pediatric neutropenia, which means your child has a deficiency of neutrophils, white blood cells that fight bacteria.

While the words "deficiency" and "blood cells" often call to mind anemia, that's a different blood disorder. Anemia is related to low red blood cells or low hemoglobin. In a 1-year-old, as in an adult, these disorders can be related to low iron levels.

The most common reason for pediatric neutropenia is a viral infection since the body uses up white blood cells to fight the infection. This is a temporary condition. White blood cell levels should return to normal once the child recovers.

However, a low white blood cell count in babies may be caused by an autoimmune condition, pediatric neutropenia. Autoimmune neutropenia is often diagnosed around 7 to 9 months of age, and fortunately, it disappears in most children on its own within two years.

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Prevalence

Rates of neutropenia vary based on a child's ethnicity and where they live in the world. Globally, the condition is most prevalent among children in North Africa and Arab nations, affecting about 15.4% of children under 6 years of age. Neutropenia is more common in infancy and early childhood with rates dropping as a child grows.

In the United States, the rate of neutropenia is 7.2% for children under 2 years old and 3.7% for those aged 3 to 5. It drops to 2.3% for 6 to 8-year-olds.

Overview

Pediatric autoimmune neutropenia may also be called chronic benign neutropenia of childhood. This condition is similar to immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA). 

Despite the fact that the bone marrow makes the neutrophils normally, the body incorrectly makes antibodies to neutrophils that mark them for destruction, leading to neutropenia.

Pediatric autoimmune neutropenia typically presents in infants 6 to 15 months of age but can occur at any age, even into adulthood. Autoimmune neutropenia in combination with ITP or AIHA is called Evans Syndrome.

Symptoms

Most children with autoimmune neutropenia have no symptoms. That is because, despite the exceptionally low neutrophil count, serious infections are rare.

The neutropenia may be discovered on a CBC draw secondary to an ear or respiratory infection. Some children might experience mouth sores or skin infections.

Diagnosis

As with other forms of neutropenia, the first diagnostic test is a complete blood count (CBC). The absolute neutrophil count (ANC) is typically below 1000 cells per microliter and can be below 500. Usually, the hemoglobin and platelet count are normal.

A peripheral blood smear, an examination of the blood cells under a microscope, may also be drawn. Although the number of neutrophils is low, they have a normal appearance.

Next, your physician will likely obtain CBCs twice weekly for at least 6 weeks to ensure that your child does not have cyclic neutropenia (a condition where the neutrophils are only low for a couple of days every 21 days).

Your physician may send for testing to determine if there are antibodies to the neutrophils, marking them from destruction. If this test is positive, it confirms the diagnosis. Unfortunately, if the test is negative it doesn't rule out autoimmune neutropenia.

In some patients, anti-neutrophil antibodies are never identified. In these cases, if the age and presentation fit the picture of autoimmune neutropenia, the diagnosis is presumed.

In rare cases, a bone marrow examination might be necessary to rule out other causes of neutropenia. This typically occurs in children whose presentation and infections don't fit the typical picture of pediatric autoimmune neutropenia.

Treatment

There is no specific treatment for autoimmune neutropenia of childhood. The anti-neutrophil antibodies will spontaneously disappear and the neutrophil count will return to normal. Spontaneous recovery occurs by 5 years of age, with neutropenia lasting on average 20 months.

Because neutropenia increases the risk of infection, all fevers require medical evaluation.

If he develops a fever, your child will typically undergo a CBC, blood culture (placing blood in glass bottles to look for bacteria), and at least one dose of antibiotics. If the ANC is less than 500 cells/mL, your child will likely be admitted to the hospital on IV antibiotics for observation.

If your child looks well and the ANC is greater than 1,000 cell/mL, you will likely be discharged home for outpatient follow-up.

Medications used for other immune blood disorders (ITP, AIHA) like steroids and intravenous immune globulin (IVIG) are not as successful in autoimmune neutropenia. Sometimes filgrastim (G-CSF) can be used during active infections to stimulate the release of neutrophils from bone marrow to blood circulation.

Frequently Asked Questions

  • What causes low hemoglobin in toddlers?

    The most common reason young children have low hemoglobin and anemia is that they do not get enough iron in their diet. Growth spurts, gastrointestinal problems, and blood loss can also cause this.

  • Do cancers cause low white blood cell count in children?

    Yes. Cancers that affect bone marrow such as lymphomas and leukemia can cause low white blood cell counts. Chemotherapy or radiation can as well because they prevent white cells from being made in the bone marrow.

  • Can neutropenia turn into leukemia?

    In very rare instances, a treatment for severe chronic neutropenia known as G-CSF (a synthetic version of a hormone that stimulates bone marrow to produce neutrophils) has been associated with a small risk of pre-leukemia or leukemia.

  • Are there foods one should avoid if they have neutropenia?

    Because the immune system may be weakened, some healthcare providers recommend avoiding foods that carry a risk of bacteria or foodborne illness. These include:

    • Raw or undercooked meat
    • Cured meats
    • Smoked seafood
    • Raw fish and shellfish
    • Unpasteurized dairy products
    • Packaged food with an expired "use by" date
    • Food that has been left out (including salad bar buffets)
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Denic S, Narchi H, Al Mekaini LA, Al-Hammadi S, Al Jabri ON, Souid AK. Prevalence of neutropenia in children by nationality. BMC Hematol. 2016;16(1):15. doi:10.1186%2Fs12878-016-0054-8

  3. Newburger P. Autoimmune and other acquired neutropenias. Hematology Am Soc Hematol Educ Program. 2016;2016(1):38-42. doi:10.1182/asheducation-2016.1.38

  4. Jaime-pérez J, Aguilar-calderón P, Salazar-cavazos L, Gómez-almaguer D. Evans syndrome: clinical perspectives, biological insights and treatment modalities. J Blood Med. 2018;9:171-184. doi:10.2147/JBM.S176144

  5. Farruggia P, Dufour C. Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians. Ther Adv Hematol. 2015;6(1):15-24. doi:10.1177/2040620714556642

  6. Dale D, Bolyard A. An update on the diagnosis and treatment of chronic idiopathic neutropenia. Curr Opin Hematol. 2017;24(1):46-53. doi:10.1097/MOH.0000000000000305

  7. Cedar-Sinai Medical Center. Iron-Deficiency Anemia in Children.

  8. Lustberg MB. Management of neutropenia in cancer patients. Clin Adv Hematol Oncol. 2012;10(12):825-826.

  9. National Organization for Rare Disorders. Severe Chronic Neutropenia.

  10. Memorial Sloan Kettering Cancer Center. Neutropenic Diet.

Additional Reading
  • Coates TD. Immune neutropenia. In UpToDate, Post TW (Ed), UpToDate, Waltham, MA.

By Amber Yates, MD
Amber Yates, MD, is a board-certified pediatric hematologist and a practicing physician at Baylor College of Medicine.