Absolute Neutrophil Count (ANC)

Methodology

ANC; CTCAE v5.0 'neutrophil count decreased' grades

ANC = WBC × (neutrophils % + bands %) ÷ 100

Grade 1 is below the laboratory's lower limit down to 1.5 ×10⁹/L; grades 2–4 use fixed thresholds.

Who it is for

Adults and children with a differential white cell count.

Version

1.0.1

How this calculator works

Where the formula comes from

• The ANC is conventionally calculated from a manual differential as white cell count × (segmented neutrophils % + band neutrophils %) ÷ 100; there is no single derivation study for this arithmetic.^[1]
• Automated ANC is generally calculated as the white cell count multiplied by the reported neutrophil fraction; a separately reported band percentage is not normally added when the automated differential already includes that neutrophil population.^[1]

Versions and alternatives

• CTCAE is an adverse-event grading system used in cancer care and trials; its grades describe severity and do not identify the cause of a low count.^[2]

Where accuracy falls (published evidence)

• Duffy-null-associated neutrophil count, historically called benign ethnic neutropenia, is more prevalent in some populations with African or Middle Eastern ancestry and is associated with lower circulating neutrophil counts; studies have not found an increased infection risk in the populations examined.^[3][4]
• Standard neutrophil reference ranges can classify healthy Duffy-null people as neutropenic.^[5][6]
• Ancestry alone does not establish whether a person is Duffy-null.^[4]

What guidelines say

• CTCAE version 5.0 grades 'neutrophil count decreased' as: grade 1 below the laboratory lower limit to 1.5 ×10⁹/L, grade 2 below 1.5 to 1.0, grade 3 below 1.0 to 0.5, and grade 4 below 0.5 ×10⁹/L.^[2]

Sources

1. Hijiya N, Onciu M, Howard SC, et al. Utility of automated counting to determine absolute neutrophil counts and absolute phagocyte counts for pediatric cancer treatment protocols. Cancer. 2005;103(2):391–397. doi:10.1002/cncr.20677
2. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. 2017. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm
3. Atallah-Yunes SA, Ready A, Newburger PE. Benign ethnic neutropenia. Blood Rev. 2019;37:100586. doi:10.1016/j.blre.2019.06.003
4. Legge SE, et al. The Duffy-null genotype and risk of infection. Hum Mol Genet. 2020. doi:10.1093/hmg/ddaa208
5. Hibbs et al. Multinational assessment of absolute neutrophil counts and white blood cell counts among healthy Duffy-null adults. Blood. 2026. doi:10.1182/blood.2025029359
6. Suresh A, et al. Disparities in the diagnostic evaluation of asymptomatic 'neutropenia' and identification of Duffy-null phenotype. Blood. 2024;144(Suppl 1):2325. doi:10.1182/blood-2024-209489

Compiled from the published sources above. Every statement was agreed independently by three AI research tools (Claude, ChatGPT, DeepSeek) and its source verified in PubMed or Crossref by the Hakeemly editorial team. Not reviewed by a doctor unless stated. Agreed on 2026-10-11

Worked example: how to calculate ANC

Calculation:

6 × 0.60 = 3.6

An illustration with sample values, worked out with the same method the tool above uses.

Limitations

• Duffy-null-associated neutrophil count (formerly benign ethnic neutropenia), common in people of African and Middle Eastern ancestry, gives lower counts without higher infection risk; standard thresholds may label these people neutropenic.
• CTCAE grades describe severity, not the cause of a low count.

References

1. U.S. Department of Health and Human Services, National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. 2017. https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc.htm