Thursday, September 23, 2010

3.3e White Blood Cells, Types & Count & Percent in Disease

Physician's Notebooks 3  - - See Homepage

Continues 3.3, The White Blood Cells and Disease - Update 25 November 2018
The White Blood Cells (WBC) defend against infections; they are part of the immune response against foreign materials in blood. But they can badly affect by hyperimmune diseases like rheumatoid arthritis or eosinophilic pneumonia. And they are responsible for hives and severe swellings in mouth and throat. And the WBC become malignant in leukemia and lymphoma.
    The WBC are normally 0.1% (one in a thousand) of blood cells. In a centrifuged (spun-down) tube of non-clotted blood, the packed WBC is seen as a thin white line between lower dark red, column of red blood cells and transparent yellow fluid column of blood plasma. In leukemia, the WBC count may increase hugely. and then its thin white column lengthens to equal the length of the RBC column.
     The types of leukemia are based on the white blood cell type (neutro-, lympho-, mono-cyte) and whether acute (high immature WBCs) or chronic (well developed WBCs). Leukemia is due to inherited DNA factors and x-ray or gamma-ray or cosmic ray exposure or toxins like benzene. It is usually discovered on routine blood examination but may first show as anemia or bleeding. Always seek top opinions (Mayo Clinic et al.) before deciding on treatment. (For a study case, click 
The white blood cell count (WBC Ct) is reported as number cells per microLiter (cu. mm) of blood.  Moderately low WBC Ct, between 3- and 4.5-thousand, only rarely of significance, is seen with virus illness like cold or flu. Patient receiving cancer chemotherapy usually has and tolerates between 2- and 3-thousand WBC Ct. But a below 4000 WBC Ct should excite worry, and if below 3-thousand, high anxiety. Risk of such low count is serious infection. Also it may be a sign of blood cancer. The normal WBC count is 5- to 8-thousand. A WBC Ct 10 to 20-thousand may be seen with bacterial infection and it helps diagnosis - as in appendicitis. Higher than 20,000 suggests severe infection and above 50-thousand, leukemia.

The White Blood Cells are made up of neutrophils (neutros a.k.a. polys), lymphocytes (lymphos), monocytes (monos), eosinophils (eos), and basophils (basos), in order of numbers. A WBC examination that specifies the percentages (a “Differential”) is not routine but should be requested if the WBC Count is reported abnormal. In the differential, the following relative percents suggest diagnosis: High percent neutros suggest bacterial infection like appendicitis. Immature neutros have a distinctive look and are called "bands" or "stabs". They should not normally be seen on the micro exam; when they are reported more than 1% or 2%, it is usually a sign of response to severe infection. With high numbers of very immature neutros or other immature WBC suspect leukemia.
   Lymphos percent may be abnormally low or high, seen usually with a low to normal total WBC count with virus infection; and a high percent lymphos is typical for cancer of lymph gland (Hodgkin disease and lymphoma and in the lymphocytic leukemias).
   High monos percent typify infectious mononucleosis due to Epstein-Barr virus, and high count also seen in malaria, tuberculosis and lymphoma.
   High eosinophil percent is marker for parasitic and allergic disease. Eos percent rises in failure of adrenal (Addison disease) and goes high in cancer and lymphoma. With overdose of corticosteroids, the eos drop to near zero.
   High basophil percent is due to drug sensitivity and seen with hives.
                             CHAPTER CONTINUES IN NEXT SECTION. Click

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