Neutrophilia

Borders Ref Help Toolkit
NHS Borders

Definition

Increase in neutrophils on FBC differential. 

Neutrophilia is frequently ‘reactive’, associated with acute infection/active inflammation or acute stress eg acute bleed.  Haematological causes possible with significant persistent increase over 1-2 months in the absence of underlying reactive cause.  Blood film comments may show circulating immature forms eg myelocytes/nucleated red cells or aniso/poikilocytosis.

Who to refer, who not to refer, how to refer

Who to refer:

Patients with significant persistent neutrophilia >15 after 4-6 weeks with any of the following:

  • no obvious cause such as inflammation
  • additional abnormalities on blood film comments, eg presence of myelocytes or nucleated red cells or significant poikilocytosis
  • significant anaemia or thrombocytosis/thrombocytopenia
  • blood count/film reported as suggestive of chronic myeloid leukaemia
  • splenomegaly.

Who not to refer:

Transient neutrophilia or persistent mild neutrophilia <15.  This is most likely caused by chronic inflammatory or infective processes.

May be associated with smoking.

How to refer:

SCI Gateway to the Department of Haematology, BGH

Primary care management

Primary care investigations

  • FBC + blood film
  • Biochemistry including renal function, liver function, LDH calcium, albumin, urate
  • Inflammatory markers, ESR, CRP
  • Check smoking history including e-cigarettes.

Editorial Information

Last reviewed: 09/07/2025

Next review date: 09/07/2027

Author(s): Charlotte Robertson.

Author email(s): HaematologyConsultants@borders.scot.nhs.uk.