Absolute neutrophil recovery (ANC) recovery is defined as an ANC of ≥ 500/mm3 (or ≥ 0.5 × 109/L) for three consecutive laboratory values obtained on different days.* Date of ANC recovery is the date of the first of three consecutive laboratory values where the ANC is ≥ 500/mm3. 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 500/mm3, the actual ANC value should be calculated from the manual differential if available. The calculated value from the manual differential will determine ANC recovery. If your institution’s laboratory reports do not display the ANC value, use the following calculation to determine the ANC:

Example 1: Calculating Absolute Neutrophil Count (ANC)

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 ≥ 500/mm3 for several days immediately post-HCT and then fall below ≥ 500/mm3. Do not begin counting ANC values of ≥ 500/mm3 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 ≥ 500/mm3. If this is the case, an ANC recovery date will not be reported, and the “not applicable” option should be chosen. However, if the recipient’s ANC drops below ≥ 500/mm3 for even one day, this should be considered the nadir and “not applicable” should not be chosen. See the following example for more information regarding tracking the date of ANC recovery.

To report dates in this section, use the first of 3 consecutive laboratory values obtained on different days.

Example 2: Tracking ANC Recovery

Transplant Date = May 6
Contact Date = August 15

Date WBC %Neutrophils ANC
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 initial recovery: ANC ≥ 500/mm3 (report this date in question 7)
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-August 14 ANC ≥ 500/mm3) for timeframe
August 15 (contact date) 2250 0.43 968

Example 3: Initial Recovery with Subsequent Decline and Recovery

Transplant Date = May 6
Contact Date = August 15

Date WBC %Neutrophils ANC
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 initial recovery: ANC ≥ 500/mm3 (report this date in question 7)
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
May 23 800 0.6 480 Date of first decline: ANC ≤ 500/mm3 (report this date in question 9)
May 24 850 0.41 349
May 25 720 0.53 382
May 26 500 0.45 225
May 27 490 0.3 147
May 28 650 0.7 455
May 29 800 0.8 640 Date of recovery: ANC ≥ 500/mm3 (report this date in question 12)
May 30-August 14 ANC ≥ 500/mm3 for timeframe
August 15 (contact date) 2245 0.72 1616

Question 6: Was there evidence of initial hematopoietic recovery?

Indicate whether or not there was evidence of initial ANC recovery following this HCT.

Check only one response:

  • If “yes, ANC ≥ 500/mm3 (or ≥ 0.5 × 109/L) achieved and sustained for 3 laboratory values,” continue with question 7.
  • If “no, ANC ≥ 500/mm3 (or ≥ 0.5 × 109/L) was not achieved,” continue with question 13.
  • Check “not applicable” if the recipient’s ANC never dropped below 500/mm3 (or ≥ 0.5 × 109/L) at any time after the start of the preparative regimen. Continue with question 8.
  • Check “previously reported,” if the recipient’s initial hematopoietic recovery was recorded on a previous report. Continue with question 13.

Question 7: Date ANC ≥ 500/mm3 (first of 3 lab values):

Enter the first date of the three consecutive laboratory values obtained on different days where the ANC was ≥ 500/mm3 (or ≥ 0.5 × 109/L). For an example of tracking ANC, see Example 2 and Example 3 above.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 8: Following the initial hematopoietic recovery, was there subsequent decline in ANC to < 500/mm3 for ≥ 3 days since the date of last report?

Report if there was subsequent decline in ANC < 500/mm3 (or < 0.5 × 109/L) (three consecutive laboratory values obtained on different days where the ANC declined to < 500/mm3. If “yes,” continue with question 9. If “no,” continue with question 13.

Question 9: Date of decline in ANC < 500/mm3 for ≥ 3 days (first of 3 days that the ANC declined):

Enter the first date of the three consecutive laboratory values obtained on different days where the ANC declined to < 500/mm3 (or < 0.5 × 109/L).

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 10: Did recipient recover and maintain ANC ≥ 500/mm3 following the decline?

Indicate whether there was evidence of ANC recovery following the decline (three consecutive laboratory values obtained on different days where the ANC was ≥ 500/mm3 (or ≥ 0.5 × 109/L). If “yes,” continue with question 11. If “no,” continue with question 13.

Question 11-12: Date of ANC recovery:

Report if the date of ANC recovery following the decline is “known” or “unknown.” If the date of recovery is “known,” continue with question 12 and enter the first date of the three consecutive laboratory values obtained on different days where the ANC recovered to ≥ 500/mm3 (or ≥ 0.5 × 109/L) following the decline. See Example 3 above. If the date of recovery following decline is “unknown,” continue with question 13.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Last modified: Jan 31, 2017

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