labs

Absolute Neutrophil Count (ANC)

Sources

Absolute Neutrophil Count (ANC)

Longitudinal Data

Date Value Flag WBC Context/Notes Source
2026-06-06 1240 L 2500 KIMS — Polymorphs 49.3%. Bill L042743426. RECOVERY FROM SEVERE NADIR +250 from June 1. Moderate neutropenia — exited severe range (<1000). ALC 890 (L), AMC 230 (N — normalized), AEC 90 (N), ABC 60 (N). Hb 12.1 (N — RECOVERED), Plt 241 (N). Dr. Bijay. Collected 10:50 AM. raw/labs/2026-06-07_Ishamma_T_M_1.pdf
2026-06-01 990 L 2200 KIMS — Polymorphs 46% (lowest on record). Bill L041256126. SEVERE NEUTROPENIA (Grade 3, <1000) — deepest nadir since treatment stabilization. −470 from May 27. Relative lymphocytosis 42.8%. ALC 920 (L), AMC 120 (L), AEC 80 (L), ABC 40 (L). Hb 11.3 (L — dropped), Plt 252 (N — fully recovered). CRITICALLY ELEVATED infection risk. Dr. Bijay. Collected 11:11 AM. raw/labs/2026-06-01_Ishamma_T_M.pdf
2026-05-27 1460 L 2400 KIMS — Polymorphs 61.3%. Bill L040020926. Moderate neutropenia — nadir reached. ALC 740 (L), AMC 130 (L). Hb 12.0 (N — first normal), Plt 107 (L). Dr. Bijay. raw/labs/20260527_Ishamma T M 1 5-27-2.pdf
2026-05-23 2430 N (borderline) 3500 KIMS — Polymorphs 68.8%. Bill L038904126. Low-normal; −970 from May 17. Plt 117 (L), Hb 11.6 (L). Smear checked. Dr. Bijay. raw/labs/20260527_Ishamma T M 5-27-1.pdf
2026-05-17 3400 N 4600 KIMS — Polymorphs 74.7%. Bill L037179526. Decreased −550 from May 11, still normal. Concurrent Plt 103 (L), Hb 9.9 (severe drop). Dr. Bijay. raw/labs/2026-05-17_Ishamma_T_M_1.pdf
2026-05-11 3950 N 5700 KIMS — Polymorphs 69.3%. Bill L035372426. Continued normal, +1590 from May 4. Concurrent Plt 113 (L — dropped). Dr. Bijay. raw/labs/2026-05-11_Ishamma_T_M_A.pdf
2026-05-04 2360 N 4000 KIMS — Polymorphs 59.0%. Bill L033433126. Recovered to normal from 1990 (Apr 27). Concurrent Plt 213, Hb 11.9. raw/assets/2026-05-04_Ishamma_T_M.pdf
2026-04-27 1990 L 3000 KIMS — Polymorphs 66.9%. Bill L031606726. Mild neutropenia. Plt simultaneously recovered to 196K. raw/labs/20260427_Ishamma T M 1 ok.pdf
2026-04-20 2970 N 4100 KIMS — Polymorphs 72.6%. Bill L029731026. 20260420_Ishamma T M today.pdf
2026-04-13 2590 N 3500 KIMS Ishamma T M 1.pdf
2026-04-06 4020 N 5400 KIMS Ishamma T M.pdf
2026-03-30 2610 N 4300 KIMS Ishamma T M 2.pdf
2026-03-25 3740 N 5400 KIMS Ishamma T M 1 2.pdf
2026-03-18 4560 N 6000 KIMS Ishamma T M 1 3.pdf
2026-03-12 5650 N 7100 KIMS Ishamma T M 1 4.pdf
2026-03-05 2320 N 3500 KIMS Ishamma T M 3.pdf
2026-03-02 1840 L 3000 KIMS — below normal Ishamma T M 4.pdf
2026-02-25 1270 L 2400 KIMS — neutropenic Ishamma T M 5.pdf
2026-02-23 1290 L 2300 DDRC — neutropenic Report For Accession No 4170ZB001398.pdf
2026-02-20 880 L 1600 DDRC — severe neutropenia 4170ZB0011814170_849900t.pdf
2026-02-17 610 L 1600 KIMS — severe neutropenia Ishamma 1.pdf
2026-02-10 680 L 1300 KIMS — nadir, severe neutropenia Ishamma T M 6.pdf
2026-02-04 3520 N 4100 KIMS Ishamma T M 1 5.pdf
2026-01-31 2860 N 4200 KIMS Ishamma T M 7.pdf
2026-01-28 3220 N 4000 KIMS Ishamma T M 1 6.pdf
2026-01-25 4670 N 5900 KIMS Ishamma T M 8.pdf
2026-01-22 5410 N 6800 KIMS Ishamma T M 9.pdf
2026-01-19 3260 N 5000 KIMS Ishamma T M 1 7.pdf
2026-01-16 3620 N 5400 KIMS Ishamma T M 10.pdf
2025-11-28 1240 L 2500 KIMS — at AML diagnosis File1000384802.pdf
2025-11-19 1090 L 2320 DDRC — pre-diagnosis, neutropenic 4182YK0075724182_686599v.pdf

Trend Analysis

ANC (cells/cumm)     Reference Range: 2000–7000
                      Neutropenic threshold: <1500
                      Severe neutropenia: <500

7000 ┤·····························································  ← upper normal
     │
5650 ┤                        ■                                        12-Mar
5410 ┤                                    ■                            22-Jan
4670 ┤                                  ■                              25-Jan
4560 ┤                       ■                                         18-Mar
4020 ┤  ■                                                              06-Apr
3740 ┤     ■                                                           25-Mar
3620 ┤                                         ■                       16-Jan
3520 ┤                  ■                                              04-Feb
3260 ┤                                       ■                         19-Jan
3220 ┤                                ■                                28-Jan
2860 ┤                         ■                                       31-Jan
2610 ┤       ■                                                         30-Mar
2590 ┤■                                                                13-Apr
2320 ┤            ■                                                    05-Mar
2000 ┤·····························································  ← lower normal
1840 ┤             ■                                                   02-Mar
1500 ┤- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -  NEUTROPENIC
1290 ┤              ■                                                  23-Feb
1270 ┤               ■                                                 25-Feb
1240 ┤                                                          ■      28-Nov
 880 ┤                ■                                                20-Feb
 680 ┤                  ■                                              10-Feb
 610 ┤                 ■                                               17-Feb
     └──────────────────────────────────────────────────────────────→
     Apr   Mar        Feb        Jan 2026        Nov 2025
     2026

Key Observations

Baseline (Nov 2025): ANC was already neutropenic at the DDRC labs drawn 2025-11-19 (1,090 cells/cumm) — even before the AML diagnosis. By 2025-11-28, ANC was 1,240 cells/cumm. Both values reflect marrow infiltration by leukemic blasts.

Treatment Phase — Cycle 1 (Jan 2026): After initiating Azacitidine-Venetoclax, ANC recovered into the normal range (3,260–5,410) through January, peaking at 5,410 on Jan 22. This likely reflects initial treatment response with restoration of normal granulopoiesis.

Myelosuppressive Nadir (Feb 2026): A profound treatment-related nadir occurred in February:
- ANC dropped from 3,520 (Feb 4) to 610 (Feb 17) — a >80% decline in 13 days
- Severe neutropenia (ANC <1000) persisted for ~2 weeks (Feb 10–23)
- Absolute nadir: 610 cells/cumm on Feb 17 (KIMS) and 680 on Feb 10

The February nadir represented a period of high infection risk. ANC <500 is classified as severe neutropenia / agranulocytosis.

Recovery (late Feb – Mar 2026): ANC recovered gradually:
- Crossed 1,500 (neutropenic threshold) by ~Feb 28
- Crossed 2,000 (normal) by ~Mar 5
- Peaked at 5,650 on Mar 12 — the highest ANC on record

Current (Apr–May 2026): ANC has been oscillating in the borderline range. After dipping to 2,590 (Apr 13), recovering briefly to 2,970 (Apr 20), it dropped to 1,990 cells/cumm (Apr 27) — mild neutropenia. ANC recovered to 2,360 cells/cumm (May 4), then further improved to 3,950 cells/cumm (May 11) — solidly within normal range. However, platelets dropped sharply from 213K → 113K (May 4 → May 11), demonstrating dissociated lineage kinetics typical of early Aza-Ven myelosuppression — platelet nadir precedes neutrophil nadir by several days.

May-June 2026 nadir (confirmed and deepened): The ANC/WBC nadir extended beyond initial predictions:
- May 17: ANC 3400 (N, declining)
- May 23: ANC 2430 (N borderline, −970 from May 17)
- May 27: ANC 1460 (L — moderate neutropenia, −970 from May 23)
- June 1: ANC 990 (L — SEVERE NEUTROPENIA, −470 from May 27)

[!success] ANC NADIR RESOLVED: RECOVERY CONFIRMED (June 6)
ANC has increased to 1240 cells/cumm (+250 from June 1) — the June 1 severe neutropenia nadir (990 cells/cumm, Grade 3 <1000) has resolved. ANC is now in the moderate neutropenia range (1000-1500) and exited the critical severe threshold.

Recovery trajectory:
- June 1: ANC 990 (severe neutropenia, Grade 3)
- June 6: ANC 1240 (+250, +25% increase — MODERATE NEUTROPENIA)
- Expected continued rise to >1500 (mild neutropenia) by ~June 9-11
- Expected normalization (>2000) by ~June 11-15 based on prior cycle patterns

Clinical improvements:
- Polymorphs 49.3% — increased from 46% (June 1), differential normalizing
- Relative lymphocytosis resolving — lymphs 35.5% (down from 42.8%)
- Monocytes 9.2% — normalized from 5.6% (June 1)
- Concurrent Hb 12.1 g/dL (N) — RECOVERED TO NORMAL from 11.3 (June 1)
- Platelets 241K (N) — stable normal

Infection risk: DOWNGRADED from critically elevated to elevated. ANC >1000 significantly reduces risk of life-threatening infections. Continue acyclovir and posaconazole prophylaxis through recovery. Standard neutropenic precautions remain (hand hygiene, avoid sick contacts, monitor for fever). Repeat CBC in 3-5 days to confirm continued recovery. See Wbc, Hemoglobin, Platelet Count, Aml.

Clinical Significance

ANC is the most important marker for infection risk in patients on myelosuppressive chemotherapy. The cyclical pattern seen here — normal ANC in between cycles, with nadirs during active treatment — is expected with Aza-Ven. The depth and duration of neutropenia during the February nadir was significant but manageable.

Related Pages

  • Wbc — Total WBC trend (ANC is the major component)
  • Aml — Underlying diagnosis
  • Pancytopenia — Part of the broader cytopenia picture
  • Active Medications — Azacitidine + Venetoclax causing cyclical myelosuppression
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