Question

As I’ve been feeling more fatigued than usual, my GP arranged some routine blood tests.

Everything was normal – apart from having a low neutrophil count. My GP didn’t seem too worried and is going to repeat the test.

What are neutrophils and can ME cause them to decrease?

Answer

Neutrophils are the most common type of white blood cell and form a key part of the immune system orchestra. They are produced in the bone marrow and are present in the blood, tissues and lymph nodes – where they play an important ‘first line of defence’ role in fighting infections and helping to heal injuries.
There have been occasional reports of people with ME/ CFS having a reduced level of neutrophils. However, there isn’t any sound research evidence to indicate that ME/CFS routinely affects the production of this type of white blood cell or causes a significant reduction.
If the level is just below normal, and there aren’t any symptoms to suggest a significant underlying cause, then repeating the blood test (as your GP is doing) is a sensible way forward.

There are, however, a number of medical conditions that can causes a more significant and/or persistent fall in the neutrophil count – which is known as neutropenia. These include :

• Autoimmune disease – e.g. Crohn’s disease lupus/SLE
• Chronic infections – e.g. hepatitis, Lyme disease
• Bone marrow disorders such as leukaemia
• Drugs – such as chemotherapy for cancer
• Vitamin deficiency – vitamin B12, folate

Not surprisingly, people with neutropenia have more difficulty in dealing with infections and slow wound healing. Having a neutropenia is also more likely to increase fatigue levels. So further investigations, and possibly a referral to a hospital blood specialist (haematologist)for a bone marrow biopsy, would be required if there is a significant or persisting neutropenia.