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Chapter 26. Blood: III. The White Blood Cells

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The peripheral blood contains white blood cells of several types in numbers and proportions that vary between quite narrow limits in health but more widely in disease.

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Normal White Blood Count & Differential

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As with many biologic parameters, there is no strict definition of normal; however, normal ranges are established by laboratories for their population group. Table 26-1 shows a typical set of normal laboratory values for the United States.

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Table 26–1. White Blood Cell Count (WBC), Differential: Normal Values.
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Table 26–1. White Blood Cell Count (WBC), Differential: Normal Values.
Total white blood cell count Adult 4000–11,000/μL
Child (3–11 years) 6000–15,000/μL
Infant 8000–20,000/μL
Differential White Cell Count (Adult) 1 Total Number 2 Percentage 2
Neutrophils 2500–7500/μL 40–75%
Lymphocytes 1500–3500/μL 20–50%
Monocytes 200–800/μL 2–10%
Eosinophils 60–600/μL 1–5%
Basophils 0–100/μL < 1%

1 In infancy and childhood, the proportion of lymphocytes is higher; in the first hours after birth, a lymphocyte count of 8000/μL is considered normal.

2 In general, changes in absolute numbers are of more significance than changes in percentages.

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Variations in these parameters, along with changes in leukocyte morphology as seen in blood smears, are important indicators of disease (Table 26-2).

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Table 26–2. Broad Categories of Variation in Leukocyte Number and Morphology. 1
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Table 26–2. Broad Categories of Variation in Leukocyte Number and Morphology. 1
Increased Count Decreased Count Important Morphologic Changes
Neutrophils Neutrophil leukocytosis (Table 26–5) Neutropenia (Table 26–7) Changes in maturity, staining, or granules (Table 26–5)
Eosinophils Eosinophilia — —
Basophils Basophilia (rare) — —
Lymphocytes Lymphocytosis (Table 26–3) Lymphopenia (Table 26–3) Changes in maturity or changes of lymphocyte transformation (Table 26–3)
Monocytes Monocytosis (Table 26–4) — Changes in maturity

1 Individual categories are discussed in the text and expanded in further tables as indicated.

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Abnormalities in Lymphocyte Count

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Lymphocyte and monocyte origin and function have been considered with the immune system (Chapter 4: The Immune Response).

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Lymphocytosis—increased lymphocyte count in peripheral blood—is best considered in relationship to other lymphoproliferative diseases (Chapter 28: The Lymphoid System: I. Structure & Function; Infections & Reactive Proliferations). It may occur as (1) an acute immune response, with many activated or transformed lymphocytes circulating in the blood; (2) a chronic immune response, in which most of the circulating lymphocytes resemble resting small lymphocytes; or (3) neoplastic proliferation (Table 26-3).

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Table 26–3. Variation in Lymphocyte Parameters in Peripheral Blood.
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Table 26–3. Variation in Lymphocyte Parameters in Peripheral Blood.
Major Conditions Immunology
Lymphocytosis
With features of lymphocyte transformation, ie, medium and large lymphocytes and plasmacytoid cells ...

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