What Vitamin Deficiencies Cause Neutropenia? Understanding the Nutritional Link

November 15, 2025 •

4 min read

Nutritional deficiencies are a known cause of hematologic problems that affect blood cell production. In particular, specific vitamin and mineral shortfalls can cause neutropenia by disrupting the bone marrow's ability to properly produce new white blood cells.

Quick Summary

A lack of essential nutrients, specifically vitamin B12, folate, and copper, can cause neutropenia. This nutritional deficit hampers the bone marrow's blood cell production, leading to low neutrophil counts.

Key Points

Vitamin B12 Deficiency: Impairs DNA synthesis, leading to ineffective bone marrow production of all blood cells, including neutrophils, a condition known as megaloblastic anemia.
Folate Deficiency: Similar to B12, a lack of folate disrupts DNA synthesis and can cause neutropenia, often alongside other cytopenias like anemia.
Copper Deficiency: This lesser-known cause can lead to neutropenia and anemia by affecting key enzymes needed for neutrophil production, sometimes mimicking myelodysplastic syndrome.
Associated Symptoms: Nutritional neutropenia is often accompanied by other hematologic issues, such as anemia, and can have neurological side effects, particularly with B12 and copper deficiencies.
Effective Treatment: Once diagnosed through blood tests, nutritional neutropenia is reversible with targeted supplementation of the deficient nutrient. Recovery of neutrophil counts can occur within days to weeks.

The Core Nutritional Causes of Neutropenia

Neutropenia, a condition characterized by an abnormally low number of neutrophils (a type of white blood cell), can stem from a variety of causes, including infections, genetic disorders, and autoimmune diseases. However, a less-known but equally critical cause is a deficiency in certain key nutrients. These nutritional neutropenias occur when the bone marrow, the factory for all blood cells, lacks the necessary building blocks to produce neutrophils effectively. The most prominent vitamins involved are B12, folate (B9), and the mineral copper.

Vitamin B12 and Folate Deficiencies

Deficiencies in vitamin B12 and folate are two of the most commonly recognized nutritional causes of neutropenia. These vitamins are crucial cofactors in DNA synthesis and cell division, processes that are fundamental to the rapid production of blood cells in the bone marrow. When levels of B12 or folate are insufficient, the maturation process of blood cell precursors, including those that become neutrophils, is hindered. This leads to a condition called megaloblastic anemia, where red blood cells are abnormally large and immature. Critically, this ineffective blood cell production isn't limited to red cells but also affects other cell lines, including white blood cells and platelets, resulting in pancytopenia (a deficiency of all three major blood cell types).

Common causes of B12 deficiency include:

Dietary insufficiency: Especially prevalent in those following a strict vegan or vegetarian diet, as B12 is primarily found in animal products.
Malabsorption issues: Conditions like pernicious anemia, celiac disease, and gastric bypass surgery can prevent the proper absorption of B12 from the gut.
Lack of Intrinsic Factor: In pernicious anemia, the stomach fails to produce intrinsic factor, a protein essential for B12 absorption.

Common causes of folate deficiency include:

Inadequate dietary intake: While common in the past, food fortification has made this less common today. However, poor diet can still be a factor.
Increased requirements: Pregnancy, certain cancers, and chronic hemolytic anemias increase the body's need for folate.
Malabsorption: Inflammatory bowel diseases like Crohn's can impair folate absorption.

Copper Deficiency

While less common than B12 and folate deficiencies, copper deficiency is another significant nutritional cause of neutropenia that can often be overlooked. Copper is essential for the function of several enzymes involved in hematopoiesis (the formation of blood cellular components). A lack of copper can cause ineffective production of white blood cells, which can be misdiagnosed as more serious conditions like myelodysplastic syndrome (MDS). Prompt diagnosis and treatment with copper supplementation can rapidly reverse the hematologic abnormalities.

Causes of copper deficiency include:

Excessive Zinc Intake: High doses of zinc can interfere with copper absorption by upregulating metallothionein, a protein that binds copper in the intestine, leading to a deficiency state.
Malabsorption: Gastric surgeries, celiac disease, or long-term total parenteral nutrition (TPN) without proper copper supplementation are known risk factors.
Poor Diet: While rare, severe malnutrition or restrictive diets can lead to a deficiency.

Diagnostic Approach for Nutritional Neutropenia

Diagnosing the root cause of neutropenia is a multi-step process that starts with a complete blood count (CBC). If the CBC shows neutropenia, and especially if other cytopenias (anemia or thrombocytopenia) are present, nutritional causes should be considered.

A typical diagnostic pathway includes:

Detailed History: A thorough dietary and medical history, including any previous surgeries or medications, is crucial for identifying risk factors.
Blood Tests: Measuring serum levels of vitamin B12, folate, and copper is a standard next step. Additional markers like methylmalonic acid (MMA) and homocysteine can help confirm a B12 deficiency. Serum ceruloplasmin levels can also be checked to assess copper status.
Bone Marrow Evaluation: In cases where the cause remains unclear, or if there is concern for more serious conditions like MDS, a bone marrow biopsy may be necessary. This can reveal characteristic features of megaloblastic changes or myelodysplasia, which can help differentiate nutritional deficiencies from other hematologic disorders.

Comparison of Key Nutritional Deficiencies and Neutropenia


Feature	Vitamin B12 Deficiency	Folate Deficiency	Copper Deficiency
Mechanism	Impaired DNA synthesis leads to ineffective hematopoiesis in the bone marrow, affecting all blood cell lines.	Same mechanism as Vitamin B12, impairing DNA synthesis and blood cell production.	Inactivation of copper-dependent enzymes essential for myeloid cell production and maturation.
Common Associated Condition	Megaloblastic anemia; can present with other cytopenias, including neutropenia.	Megaloblastic anemia; also associated with pancytopenia.	Anemia (often normocytic or macrocytic), neutropenia, and can mimic MDS.
Associated Neurological Symptoms	Can cause progressive and irreversible neurological damage if untreated.	Typically does not cause neurological issues in the absence of a B12 deficiency.	Neurological deficits, including myelopathy and peripheral neuropathy.
Speed of Recovery	Hematologic abnormalities resolve with B12 supplementation, with neutropenia and thrombocytopenia improving within 7-10 days.	Hematologic parameters normalize relatively quickly with folate supplementation.	Neutropenia can improve within weeks of copper repletion.

Conclusion: The Path to Resolution

Understanding which vitamin deficiencies cause neutropenia is the critical first step toward effective treatment. Deficiencies in vitamin B12, folate, and copper can all disrupt the bone marrow's function, leading to low neutrophil counts. The key to resolving nutritional neutropenia lies in proper diagnosis and supplementation. For B12 deficiency, this may involve injections or high-dose oral supplements, especially for those with malabsorption. Folate deficiency is often treated with oral folic acid supplements. In cases of copper deficiency, supplementation with oral or intravenous copper is necessary. Timely intervention can effectively reverse the hematologic abnormalities and prevent more severe, long-term complications. For a comprehensive overview of blood disorders, including neutropenia, the National Institutes of Health provides detailed resources on hematologic conditions.(https://emedicine.medscape.com/article/204821-overview)

Frequently Asked Questions

Neutropenia is a blood condition characterized by an abnormally low number of neutrophils, a specific type of white blood cell. Because neutrophils are essential for fighting off bacterial infections, neutropenia increases the risk of serious infections.

Yes, deficiencies in nutrients like vitamin B12, folate, and copper can lead to severe neutropenia, especially if the deficiency is prolonged. In these cases, the body's ability to produce new neutrophils is significantly impaired.

Diagnosis typically involves a complete blood count (CBC) to measure neutrophil levels, followed by specific blood tests to check serum levels of vitamin B12, folate, and copper. A medical history is also critical to identify potential risk factors, and in some cases, a bone marrow biopsy may be performed.

Yes, nutritional neutropenia is reversible with treatment. Correcting the deficiency with appropriate supplementation of vitamin B12, folate, or copper can resolve the low neutrophil counts. The hematological recovery can occur in weeks.

While vitamin B12 deficiency can cause neutropenia, it often presents with other symptoms first, most commonly megaloblastic anemia. Neutropenia in these cases is rarely isolated and usually occurs with other blood cell abnormalities.

High and prolonged zinc intake can interfere with the body's ability to absorb copper. This can cause a secondary copper deficiency, which may then lead to neutropenia and anemia.

You should not take supplements without consulting a doctor first. It is important to diagnose the underlying cause of any neutropenia. If a nutritional deficiency is confirmed, a doctor can prescribe the correct and most effective dosage of supplements.