Which vitamin deficiency causes low neutrophils? Exploring nutritional neutropenia

October 7, 2025 •

4 min read

Affecting a significant portion of the population, nutritional deficiencies are a recognized cause of low neutrophils, or neutropenia. The question of which vitamin deficiency causes low neutrophils is critical for accurate diagnosis, as it can mimic more serious conditions like myelodysplastic syndrome and, when corrected, is often a reversible cause of ineffective blood cell production.

Quick Summary

Nutritional deficiencies like Vitamin B12, folate, and copper can cause neutropenia by impairing bone marrow function. Correcting these deficiencies, often with supplementation, typically resolves the condition. Prompt diagnosis is crucial to distinguish it from other blood disorders.

Key Points

Vitamin B12 and Folate are Primary Causes: Deficiencies in these B vitamins disrupt DNA synthesis, leading to the bone marrow's production of abnormal blood cells and resulting in neutropenia.
Copper Deficiency is a Key Factor: Low copper levels impair hematopoiesis and can cause neutropenia, which is sometimes triggered by excessive zinc intake.
Nutritional Neutropenia Often Isn't Isolated: Unlike some other causes, nutritional deficiencies commonly affect multiple blood cell lines, causing concurrent anemia and low platelet counts.
Reversibility with Supplementation: A key characteristic of nutritional neutropenia is that it often resolves quickly and completely once the underlying vitamin or mineral deficiency is corrected through diet or supplements.
Distinguishing Diagnosis is Crucial: Because bone marrow findings in nutritional neutropenia can mimic more severe conditions like myelodysplastic syndrome, accurate diagnosis via blood tests and history is vital to avoid unnecessary, aggressive treatments.
Dietary Review is a Necessary Step: A thorough review of a patient's diet and supplement use is an essential part of the diagnostic process for unexplained neutropenia.

Understanding Neutropenia and Its Causes

Neutropenia is a blood condition characterized by an abnormally low number of neutrophils, a type of white blood cell essential for fighting infections. While numerous factors can lead to neutropenia, including infections, medications, and autoimmune disorders, nutritional deficiencies are a significant, and often overlooked, cause. When caused by a nutrient shortfall, the bone marrow's ability to produce mature neutrophils is impaired, a process known as ineffective hematopoiesis.

The primary nutritional culprits behind low neutrophils

Several specific nutrients are vital for the proper function of the bone marrow and the maturation of blood cells. A lack of these key vitamins and minerals can directly interfere with neutrophil production.

Vitamin B12 Deficiency

Vitamin B12 is a critical player in DNA synthesis, and its deficiency can lead to a condition called megaloblastic anemia. The bone marrow produces abnormally large, immature cells (megaloblasts) because the cell division process is disrupted. This affects all blood cell lines, often causing macrocytic anemia (large red blood cells) along with neutropenia and thrombocytopenia (low platelets). Case reports have highlighted severe neutropenia secondary to Vitamin B12 deficiency, with rapid resolution after specific replacement therapy.

Folate (Folic Acid) Deficiency

Like Vitamin B12, folate is essential for DNA synthesis and cell division. A folate deficiency also causes megaloblastic anemia and can result in neutropenia. This is particularly notable in cases of dietary insufficiency, malabsorption issues, or increased folate turnover, such as during pregnancy. It is crucial to test for both Vitamin B12 and folate, as supplementing with folic acid alone in the presence of an undiagnosed B12 deficiency can correct the blood count issues but allow underlying neurological problems to progress unchecked.

Copper Deficiency

Copper deficiency is another rare but distinct cause of neutropenia. It is required as a cofactor for enzymes involved in hematopoiesis (blood cell formation). Copper deficiency can lead to anemia, neutropenia, and sometimes mimicking the bone marrow findings of myelodysplastic syndrome (MDS). Excessive zinc intake is a common cause of acquired copper deficiency, as zinc competes with copper for intestinal absorption. Resolution of the neutropenia typically occurs rapidly following copper supplementation.

The less common but noteworthy nutritional deficiencies

While B12, folate, and copper are the main actors, other nutrients can also play a role, particularly in complex cases or when multiple deficiencies are present.

Selenium Deficiency

Though less common, a link between selenium deficiency and chronic neutropenia has been observed. A case study showed a patient with chronic neutropenia who responded well to selenium replacement therapy, suggesting its importance in specific contexts of immune and bone marrow function.

Protein-Calorie Malnutrition

Severe protein-calorie malnutrition has also been shown to cause neutropenia and impaired immune function. In these cases, the overall lack of adequate nutrients severely compromises the bone marrow's ability to produce blood cells effectively.

Differential Diagnosis: Separating Nutritional from Other Causes

Diagnosing the cause of neutropenia requires a comprehensive approach. A key step is often a thorough clinical history and dietary review. A comparison can help distinguish nutritional neutropenia from other etiologies.


Feature	Nutritional Neutropenia (B12, Folate, Copper)	Other Causes (e.g., Infections, Autoimmune)
Associated Blood Abnormalities	Often presents with multiple cytopenias (low red blood cells, platelets). Macrocytic red cells common with B12/folate. Sideroblastic anemia with copper deficiency.	Can present as isolated neutropenia or with other specific changes depending on the cause.
Bone Marrow Findings	May show signs of ineffective hematopoiesis, such as ring sideroblasts or megaloblastic changes, sometimes mimicking MDS.	Reflective of the underlying pathology, e.g., suppression from infection or aplastic anemia, or infiltration by cancer.
Response to Treatment	Rapid and complete resolution of blood count abnormalities with specific nutrient replacement.	Dependent on treating the underlying condition; not responsive to nutrient supplementation.

The pathway to diagnosis and treatment

Diagnosis typically begins with a complete blood count (CBC) that reveals the low neutrophil count. Further blood tests, including serum levels of Vitamin B12, folate, copper, and zinc, are used to investigate nutritional deficiencies. A detailed dietary and medical history, including any medications or supplements, is crucial. If nutritional causes are suspected and confirmed, treatment involves correcting the deficiency through oral supplements, injections (for B12), or dietary changes. For instance, a patient with a confirmed Vitamin B12 deficiency may receive injections initially, followed by regular maintenance doses.

Conclusion: Prioritizing nutritional health for immune function

In summary, deficiencies in Vitamin B12, folate, and copper are distinct nutritional causes of low neutrophils. While other factors like infections and medications are more common, nutritional neutropenia is a reversible condition that highlights the profound link between diet and immune health. Timely diagnosis and appropriate supplementation can fully restore neutrophil counts and function, preventing potential infectious complications. Screening for these deficiencies is a key step in evaluating unexplained neutropenia, and patients experiencing related symptoms should consult a healthcare provider for proper diagnosis and treatment. The connection between nutrition and hematological health emphasizes that a balanced diet is a cornerstone of overall well-being. More information on the effects of vitamin deficiencies on blood health can be found on resources like the National Institutes of Health (NIH).

Frequently Asked Questions

The most common nutritional deficiencies causing low neutrophils (neutropenia) are typically Vitamin B12 and folate (folic acid) deficiencies, which disrupt normal blood cell production in the bone marrow.

Yes, excessive zinc intake can cause neutropenia indirectly. High zinc levels interfere with the body's absorption of copper, leading to a copper deficiency, which in turn can cause low neutrophils.

B12 and folate are essential for DNA synthesis. A deficiency impairs the division and maturation of blood cells in the bone marrow, leading to ineffective production of neutrophils and other blood cells.

Neurological symptoms, such as tingling, weakness, and confusion, are strongly associated with Vitamin B12 deficiency. If left untreated, these can become permanent, even if the neutropenia is corrected.

Treatment involves supplementing the deficient nutrient. For B12 deficiency, this may start with injections followed by oral supplements. For folate or copper deficiency, oral supplementation is often effective.

Yes, nutritional deficiencies can cause blood cell abnormalities and bone marrow findings that mimic myelodysplastic syndrome (MDS) or even leukemia, sometimes leading to misdiagnosis.

Diagnosis involves a complete blood count (CBC) to identify low neutrophil levels, followed by specific blood tests to measure Vitamin B12, folate, and copper levels. A detailed patient history regarding diet is also crucial.