White Blood Cells
Interpreting Lab Values
With Professor Rhonda Lawes
White Blood Cells
Monocyte Lymphocyte Neutrophil Eosinophil Basophil
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White Blood Cells
Low white blood cell count (leukopenia) High white blood cell count (leukocytosis)
• May be caused by a medical • May be caused by an infection or
condition (i.e. autoimmune disorder inflammation
that destroys white blood cells, bone • Could indicate that you have an
marrow problems or cancer) immune system disorder or a bone
• Certain medications can cause drop marrow disease
in WBC count • Can also be a reaction to medication
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White Blood Cell Example of Adult Values
Type of cell Sample Value Units Example of normal
description reference range
WBC Blood 5.6 (5,600 per units) x103/mcL (5 10)
Neutrophils Blood 52.1 % (55 75)
Lymphocytes Blood 31.8 % (15 41)
Monocytes Blood 13.5 % (1 10)
Eosinophils Blood 2.2 % (0 4)
Basophils Blood 0.4 % (0 2)
White Blood Cell and Lifespan
Example of Normal WBC (x103/mcL) across the lifespan
• Newborn 13 38
• Infant at 2 weeks 5 20
• Adult 5 10
• Pregnant 3 trimester 5.8 13.2
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White Blood Cell and Lifespan
The numbers of leukocytes changes with age
and during pregnancy.
White Blood Cell and Lifespan
• Newborn on day of birth: high white blood cell % Total WBC
count, ranging from 9,000 to 30,000 leukocytes
→ number falls to adult levels within two weeks
Lymphocyte
• First few weeks after birth: high percentage of
neutrophils → later lymphocyte predominance
%
• Until about 8 years: lymphocytes more
predominant than neutrophils
• In the elderly: slight decrease of total WBC
%
• Pregnancy: leukocytosis, primarily due to
increase in neutrophils with a slight increase in Neutrophils
lymphocytes
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Review Critical Values!
Examples of normal WBC (x103/mcL):
Newborn: 13 38 Adult: 5 10
Infant at 2 weeks: 5 20 Pregnant 3 trimester: 5.8 13.2
• Leukopenia with WBC < 4,000
• Can be caused by a viral infection, overwhelming
bacterial infections, autoimmune disorders, bone
marrow disorders and medications.
• Requires special precautions immune system
ineffective
Review Critical Values!
Examples of normal WBC (x103/mcL):
Newborn: 13 38 Adult: 5 10
Infant at 2 weeks: 5 20 Pregnant 3 trimester: 5.8 13.2
Critical values!
WBC < 500 (severe leukopenia)
Patient at risk for fatal infection
WBC > 30,000 (leukocytosis)
Indicates massive infection or
serious disease like leukemia
Leukocytosis
Leukocytosis, a WBC above 10,000, is usually
due to an increase in one of the five types of
white blood cells and is given the name of the
cell that shows the primary increase.
Leukocytosis
Neutrophilic leukocytosis = neutrophilia
Lymphocytic leukocytosis = lymphocytosis
Eosinophilic leukocytosis = eosinophilia
Monocytic leukocytosis = monocytosis
Basophilic leukocytosis = basophilia
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WBC Response to Attack
CSF stimulates bone marrow to
increase WBC production.
CSF
CSF CSF
CSF
CSF
WBC
x2
WBC release colony- Normal bone marrow can double
stimulating factor (CSF). WBC count within hours.
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WBC Response to Attack
Leukocytosis is not usually increased in all 5 types of WBC,
if all 5 Increased consider dehydration and hemoconcentration.
Dramatic WBC increase?
• Severe infections
• Appears similar to leukemia
(permanent and progressive)
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Corticosteroids modify leukocytosis response!
Corticosteroids
Inflammatory cells
Eosinophil T-lymphocyte Mast cell Macrophage Dendritic cell
If given healthy person If given to a person with
severe infection
WBC will increase Infection can spread significantly
(predominantly neutrophils) without WBC rising
Corticosteroids
Inflammatory cells
Eosinophil T-lymphocyte Mast cell Macrophage Dendritic cell
to the impact of the WBC count not rising.
Polymorphonuclear Cells (PMNs) or Granulocytes
Polymorphonuclear cells have multiple nuclei.
Neutrophils Eosinophils Basophils
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Meaning of Suffixes: -philia and -penia
-philia -penia
Origin: Origin:
• Greek philos (to love) • Greek penía (poverty or need)
Meaning: Meaning:
• Someone or something that loves • To lack or to have a deficiency
or has a fondness of, attraction to, • Often indicates a specific type of
or affection for something deficiency, when added to the end
• To have a tendency toward of a word
something
• Related terms include:
-philic, -philia, and -philo
Source: [Link]
Neutrophils
• Largest percentage of WBCs (Normal 55 75%)
• Key players in acute phase of inflammation
• Bacterial infection
• Purulent drainage predominantly neutrophils
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Neutrophils
Neutrophilia Neutropenia
• Acute bacterial infection • Immunosuppression
• Acute stress (e.g., post-op) • Bone marrow failure/
• Burns aplastic anemia
• Leukemia • Folate/vitamin B12 deficiency
• Corticosteroid use • Chemotherapy
• Rheumatoid arthritis • Chloramphenicol/sulfonamides
• Chronic inflammation
• Intense exercise
Eosinophils
• Smaller percentage of WBCs (Normal 0 4%)
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Eosinophils
Eosinophilia Eosinopenia
• Allergic reaction (e.g., food allergy • Generally not a concern, but:
or bee stings) • Nutritional deficiency
• Parasitic infections • Excessive glucocorticoids
• Leukemia
• Marrow hyperactivity Note: 0% is still within normal range for
• Autoimmune disease some labs!
• Polyarteritis nodosa (causes
vasculitis)
Basophils
• Smaller percentage of WBCs (Normal 0 2%)
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Basophils
Basophilia Basopenia
• Allergic reaction • Generally not a concern, but:
• Chronic myeloid leukemia • Nutritional deficiency
• • Excessive glucocorticoids
Note: 0% is still within normal range for
some labs!
Monocytes
• Largest of the white blood cells
• Up to 3x the diameter of a red blood cell
• Percentage of WBCs (Normal 1 10%)
• One-half stored in spleen released with infection
• Motile get into tissue
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Monocytes
Function of monocytes:
• Phagocytosis bacteria
• Antigen presentation to T cells
• Produce cytokines
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Monocytes
Monocytosis Monocytopenia
• Chronic inflammation • Chronic infections
• Stress • Autoimmune disease
• • Leukemia/AML
• Viral infection • Aplastic anemia
• Sarcoidosis • Excessive glucocorticoids
• Myelotoxic drugs
Lymphocytes
3 types of lymphocytes
T B NK
Mature in Formed in
Thymus Bone
Helper help other cells Plasma produce large
mature, activate, and function amounts of antibodies
virus-infected cells
Cytotoxic destroy cells Memory remember and tumor cells
infected with viruses past infections (cancer)
Memory remember
antigens from past infections
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Lymphocytes
• 3 types of cells: T, B, and NK
• Percentage of WBCs (Normal 15 41%)
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Lymphocytes
Lymphocytosis Lymphocytopenia
• Viral infection • HIV destroys T cells (CD4+)
• Neutrophils respond initially • Bone marrow failure/aplastic
to bacterial more anemia
• Leukemias: CLL, ALL • Excessive glucocorticoids
• SLE
• RA
• Chemotherapy
• Immunosuppression
In a Nutshell
✓ There are 5 types of white blood cells:
neutrophils, lymphocytes, monocytes,
eosinophils, and basophils.
✓ The normal range for total WBC count
changes over the lifespan and in
pregnancy.
✓ White blood cells are critical responders
when the body is under attack.
In a Nutshell
✓ Leukopenia puts the patient at risk for not
being able to fight off infection.
✓ Leukocytosis is an increase in WBC above
10,000, and not all 5 types of WBCs will be
elevated at the same time except in
dehydration or hemoconcentration.
✓ The cell type that is increased names the
condition (example: neutrophilic
leukocytosis = neutrophilia).
In a Nutshell
✓ There are different possible clinical causes
for elevation or decreases in each of the 5
different WBCs.
✓ The lab results are only as valuable as the
health care team who looks at the results
medications, symptoms, and hands-on
physical assessment.
