White Blood Cell Counts and Differentials
Definition
- WBC counts refer to numerical reporting of the total number of WBCs as well as to describing and classifying the white cell components: neutrophils (which include bands), lymphocytes, monocytes, eosinophils, and basophils (Table 16.88).
- Normal range (adults): 4.3 " пїЅ10.3 пїЅ пїЅ 103 cells/ пїЅ пїЅL. Different values are reported for infants and children, separated by age groups. Automated counters report results in percentages or as absolute counts of each WBC population. The absolute differential counts are considered more relevant in evaluating WBC abnormalities.
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TABLE 16 " пїЅ88Normal Values for White Blood Cell Counts*View LargeTABLE 16 " пїЅ88Normal Values for White Blood Cell Counts* White Cells % of 100 White Cells Absolute Count пїЅ пїЅ 103 cells/mL Neutrophils 43 " пїЅ72 1.6 " пїЅ7.5 Lymphocytes 18 " пїЅ43 0.9 " пїЅ3.4 Reactive lymphocytes 0 " пїЅ6 (manual differentials only) Monocytes 4 " пїЅ12 0.0 " пїЅ1.2 Eosinophils 0 " пїЅ8 0.0 " пїЅ0.6 Basophils 0 " пїЅ2 0.0 " пїЅ0.3 *Note that the normal values described in the table do not reflect differences related to age or race.
Use
- Most automated WBC counters separate the white cells into five categories. Immature white cells are flagged as abnormal, requiring direct examination of the peripheral blood smears. Recent machines do a six-part differential, the sixth parameter being "immature fraction. " пїЅ
- Abnormalities are discussed separately for each population (see Leukocytosis and Leukopenia and Leukemoid).
Limitations
- Poorly prepared stains (mostly the manual ones) may corrupt the ability of the technician to report accurate differentials.
- Because in most laboratories the technician examines only 100 randomly selected cells, there is an inherent bias in the report, and rare, but important, abnormal WBCs may be missed, especially in leukopenic conditions. With the recent introduction of automated equipment for reporting differential counts this bias is minimized.