ANC recovery is defined as an absolute neutrophil count (ANC) of ≥ 0.5 × 109/L (500/mm3) for three consecutive laboratory values obtained on different days. The date of ANC recovery is the date of the first of three consecutive laboratory values where the ANC is ≥ 0.5 × 109/L.
At some institutions, the laboratory reports display the ANC value once there are sufficient white blood cells to perform a differential count. At other institutions, the laboratory reports do not display the ANC, and it must be calculated from the white blood cell count (WBC) and the percent of segmented and band neutrophils (if the differential was performed on a machine, the percent neutrophils will include both segmented and band neutrophils).
If the laboratory report displays an automated ANC value of exactly 0.5, the actual ANC value must be calculated from the manual differential if available. The calculated value from the manual differential will determine ANC recovery. If the center’s laboratory reports do not display the ANC value, use the following calculation to determine the ANC:
Calculating Absolute Neutrophil Count (ANC)1
1 Traditionally, the definition of ANC recovery required selecting the first date of three consecutive days in which the recipient’s ANC was ≥ 0.5×109/L (500/mm3). For various reasons it may not be possible to obtain daily laboratory values. Under those circumstances, report ANC recovery based upon three consecutive laboratory values (drawn more than a day apart) as long as the ANC remains ≥ 0.5×109/L (500/mm3).
Tracking the date of ANC recovery may not always be straightforward. In some cases, the ANC may fluctuate for a period of time before the recipient fully recovers. In other cases, the ANC may remain above 0.5 × 109/L for several days immediately post-HCT and then fall below 0.5 ×109/L. Do not begin counting ANC values of ≥ 0.5 × 109/L towards recovery until the ANC has dropped to the lowest level (nadir) post-HCT. If the recipient was transplanted using a non-myeloablative (NST) or reduced intensity (RIC) regimen, or was transplanted for an immunodeficiency (e.g., SCID, WAS), the recipient’s ANC may never drop below 0.5 × 109/L. If this is the case, an ANC recovery date will not be reported, and the “never below” option should be chosen. However, if the recipient’s ANC drops below 0.5×109/L for even one day, this should be considered the nadir and “never below” should not be chosen. See the following example for more information regarding tracking the date of ANC recovery.
Tracking ANC Recovery
- Transplant Date is May 6
| Date | WBC | %Neutrophils | ANC | Notes |
|---|---|---|---|---|
| May 7 | 900 | 0.6 | 540 | |
| May 8 | 850 | 0.59 | 502 | |
| May 9 | 720 | 0.7 | 504 | |
| May 10 | 300 | 0.45 | 135 | |
| May 11 | 15 | No differential | — | |
| May 12 | 30 | No differential | — | |
| May 13 | 50 | No differential | — | |
| May 14 | 250 | 0.4 | 100 | |
| May 15 | 800 | 0.7 | 560 | Date of first recovery: ANC ≥ 0.5×109/L |
| May 16 | 1050 | 0.8 | 840 | |
| May 17 | 1000 | 0.7 | 700 | |
| May 18 | 1800 | 0.6 | 1080 | |
| May 19 | 2000 | 0.55 | 1100 | |
| May 20 | 2500 | 0.53 | 1325 | |
| May 21 | 2250 | 0.43 | 968 | |
| May 22 | 1500 | 0.45 | 675 |
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