Your Absolute Neutrophil Count (ANC) is an estimate of the number of infection-fighting white blood cells in your blood. Knowing your ANC can help you and your doctor assess your risk of infection.

Your ANC, also called your Absolute Granulocyte Count (AGC), is a measure of the number of neutrophils in a cubic millimeter of your blood. The units are cells per microliter.

The Marrowforums ANC Calculator will compute your ANC from the results shown on your differential lab report.

White blood cells (WBCs), also called leukocytes, defend your body against infections and foreign material. There are five types of WBCs:

• neutrophils
• eosinophils
• basophils
• lymphocytes
• monocytes

Neutrophils, which fight infections, come in two types: segmented neutrophils and bands. The other types of white blood cells manage allergic responses, kill parasites, and recycle worn-out cells.

When your doctor orders a blood test called a Complete Blood Count (CBC), the results will include your White Blood Count (WBC). More detailed information about the components of your WBC is obtained when the doctor orders a CBC with differential, or simply a differential. In this case, the lab also measures the different types of white blood cells in your blood sample and itemizes them on your lab report.

Your ANC is not measured directly; it is computed from your White Blood Count and the percentage of neutrophils in your differential.

Your ANC is a more accurate measure of your risk of infection than your WBC alone. Your ANC can indicate whether or not you are a candidate for specific treatments, including growth factors (also called granulocyte-colony stimulating factors or G-CSFs) such as Neupogen, Neulasta, or Granocyte, which stimulate the production of white blood cells. If you are undergoing radiation, chemotherapy, or a bone marrow or stem cell transplant, your ANC is used to measure the status of your immune system.

If your ANC is low, i.e., you do not have enough neutrophils, you are said to be neutropenic or experiencing neutropenia. Neutropenia is classified as mild, moderate, or severe. The more serious the neutropenia, the more important it is to avoid any possible sources of infection.

If you haven't been receiving copies of your lab reports after each CBC, ask your doctor or treatment center to share them with you. Marrowforums recommends that all patients do this regularly.

There are four ways to learn your ANC:

1. At your next appointment, ask your doctor to look up your ANC from your last differential. Your doctor can also interpret the results for you.
2. Look for your ANC on your lab report. Most labs report only your measured blood count values, but some include your computed ANC too.
3. Compute your ANC from the numbers shown on your lab report. The computation isn't hard but it can be difficult to determine which formula to use. See Computing Your ANC.
4. Use the Marrowforums ANC Calculator.

ANC values are classified differently by different treatment centers. Normal ANC values vary by age and sex. The classifications below are the most common.

ANC Range	Classification	Notes
0 to 500	severe neutropenia
500 to 1000	moderate neutropenia
1000 to 1500	mild neutropenia	Some treatment centers consider 1000 to 1500 "below normal" and others "normal".
1500 to 1800	no neutropenia	Most treatment centers consider 1500 to 1800 "normal" while a few consider it "below normal".
1800 and above	no neutropenia	"Normal" range

What these classifications mean for you depends on your specific situation. You should consult your doctor about the appropriate cautions to take when you are neutropenic. In some cases, common sense and an awareness of sources of infection are all that's required. In other cases, your doctor may recommend that you be restricted to a neutropenic diet, limit travel, or avoid crowded malls and theaters. For the most severe neutropenia, isolation may be necessary, as often occurs when ANC reaches 0 during a bone marrow or stem cell transplant.

Your lab report shows the normal range (sometimes called reference range) for each blood count, and it probably indicates if any of your counts are Low (below that range) or High (above that range).

Different labs and different treatment centers use different reference ranges, both because the ranges reflect the testing methods of the lab and because not all treatment centers agree on the "normal" range for a given blood count.

The normal ranges of differential counts depend on your age, sex, population group, and other factors. Examples: Children normally have higher neutrophils and lower lymphocytes than adults. Pregnant women normally have higher neutrophils and higher lymphocytes than other women. Higher neutrophils can also result from an infection or inflammation.

In addition, counts typical of an aplastic anemia, MDS or PNH patient may not be what are normal for the general population. For example, it may be a sign of successful treatment for an aplastic anemia, MDS, or PNH patient to have red cell, white cell, or platelet counts just below the normal range.

For all of these reasons, only your doctor can interpret what your counts mean in terms of your disease and treatment. You and your doctor can watch your blood counts, differential results, and ANC over time in order to recognize your progress.