Absolute neutrophil count (ANC)
Neutrophils per litre from the white cell count and differential, with neutropenia grade
Sources last checked: 2026-10-13
Absolute neutrophil count (ANC)
Neutrophils per litre from the white cell count and differential, with neutropenia grade
Thresholds are for adults. People with the Duffy-null phenotype (common with African or Middle Eastern ancestry) have lower normal counts without added infection risk. Oncology protocols may use CTCAE grades instead.
Interpretation
| < 0.2 — agranulocytosis | ANC below 0.2 × 10⁹/L; usually accompanied by fever. |
|---|---|
| 0.2–< 0.5 — severe neutropenia | Severe neutropenia (ANC < 0.5 × 10⁹/L). |
| 0.5–< 1.0 — moderate neutropenia | Moderate neutropenia. |
| 1.0–< 1.8 — mild neutropenia | Mild neutropenia; reference limits differ by ancestry (Duffy-null phenotype). |
| ≥ 1.8 — no neutropenia | At or above the adult lower limit of 1.8 × 10⁹/L used in the source review. |
What is the Absolute neutrophil count (ANC)?
The absolute neutrophil count (ANC) is the number of mature neutrophils — segmented plus band forms — per litre of blood. It is the figure that defines neutropenia and its severity. This calculator uses the severity grades and adult lower limit (1.8 × 10⁹/L) from a 2025 review by Njue and colleagues at Bern University Hospital.
When to use it
- A full blood count with a manual or automated differential reported in percent
- Fever during chemotherapy or with drugs that can cause agranulocytosis (metamizole, clozapine, thyrostatics)
- Follow-up of known chronic neutropenia
When not to use it
- Children and neonates, whose reference limits differ
- When the analyser already reports an absolute neutrophil count — use that directly
How it is calculated
ANC (× 10⁹/L) = WBC (× 10⁹/L) × (segmented % + band %) / 100
Clinical pearls and limitations
- Thresholds are for adults. People with the Duffy-null phenotype (common with African or Middle Eastern ancestry) have lower normal counts without added infection risk. Oncology protocols may use CTCAE grades instead.
- Only mature granulocytes count; metamyelocytes and earlier precursors are excluded.
- Duffy-null individuals (common with African or Middle Eastern ancestry) often have ANC between 1.0 and 1.8 × 10⁹/L without increased infection risk.
- × 10⁹/L, × 10³/µL and G/L are numerically identical; cells/µL are 1000 times larger.
Frequently asked questions
How do you calculate the absolute neutrophil count?
ANC = WBC × (segmented % + band %) / 100. With WBC 4.0 × 10⁹/L and 50 % neutrophils, ANC is 2.0 × 10⁹/L.
What ANC counts as severe neutropenia?
Below 0.5 × 10⁹/L (500/µL). Below 0.2 × 10⁹/L is called agranulocytosis.
Is an ANC of 1.5 normal?
It is mild neutropenia by the adult limit of 1.8 × 10⁹/L used here, but may be normal for people with the Duffy-null phenotype.
Evidence and guidelines
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