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Calculate ANC to assess infection risk in cancer patients receiving chemotherapy
Normal: 4,000-11,000
Segmented neutrophils %
Band neutrophils %
ANC = WBC × (% Neutrophils + % Bands) / 100
| ANC (cells/μL) | Category | Grade | Infection Risk |
|---|---|---|---|
| >1500 | Normal | None | Low |
| 1000-1500 | Mild Neutropenia | 1-2 | Mild |
| 500-1000 | Moderate Neutropenia | 3 | Moderate-High |
| 100-500 | Severe Neutropenia | 4 | High |
| <100 | Profound Neutropenia | 4 | Very High |
The Absolute Neutrophil Count (ANC) is a measure of the number of neutrophil granulocytes (also known as polymorphonuclear cells, PMNs, or segs) present in the blood. Neutrophils are the body's primary defense against bacterial and fungal infections. The ANC is calculated by multiplying the total white blood cell count by the percentage of neutrophils (including both segmented neutrophils and band forms).
ANC is crucial in cancer care because chemotherapy commonly causes neutropenia:
Febrile neutropenia is a medical emergency defined as:
When ANC is low, patients should follow these precautions:
Granulocyte colony-stimulating factors (G-CSF) may be used to:
ANC influences chemotherapy scheduling:
WBC (white blood cell count) includes all types of white blood cells: neutrophils, lymphocytes, monocytes, eosinophils, and basophils. ANC specifically measures only neutrophils, which are the primary defense against bacterial infections. A normal WBC with a low neutrophil percentage can result in low ANC.
Yes, bands (immature neutrophils) should be included in the ANC calculation. The formula is: ANC = WBC × (% neutrophils + % bands) / 100. Including bands provides a more complete picture of neutrophil availability, especially during recovery from chemotherapy.
The nadir (lowest point) of neutrophil count typically occurs 7-14 days after chemotherapy administration, depending on the specific agents used. Most regimens cause nadirs around day 10-12. ANC usually recovers by day 21, but timing varies by regimen intensity and patient factors.
Live vaccines should be avoided during chemotherapy and neutropenia. Inactivated vaccines (flu, pneumococcal) can be given but may be less effective during immunosuppression. Timing of vaccination should be discussed with your oncologist. Family members should receive flu shots.
Neutropenic diet recommendations include avoiding raw or undercooked meats, eggs, and seafood; unwashed raw fruits and vegetables; unpasteurized dairy products; deli meats; and foods from salad bars or buffets. All food should be thoroughly cooked and properly stored. The extent of restriction depends on ANC severity.
G-CSF typically increases ANC within 24-48 hours of administration, with peak effect at 3-5 days. However, if bone marrow is severely depleted from chemotherapy, response may be slower. Pegfilgrastim (long-acting G-CSF) is given once per chemotherapy cycle and provides sustained stimulation.
Acute stress can cause a temporary increase in neutrophil count (stress demargination), but chronic stress doesn't significantly affect ANC. The primary factors affecting ANC in cancer patients are chemotherapy, radiation, disease involvement of bone marrow, and medications. Focus on infection prevention rather than stress management for ANC concerns.
With ANC <500, call immediately for any fever: single oral temperature ≥38.3°C (101°F) or sustained temperature ≥38°C (100.4°F) for 1 hour. Don't wait - febrile neutropenia is an emergency requiring prompt evaluation and antibiotics. Also call for chills, rigors, or feeling generally unwell even without documented fever.