White blood cell count and differential



Definition

A white blood cell (WBC) count determines the concentration of white blood cells in the patient's blood. A differential determines the percentage of each of the five types of mature white blood cells.


Purpose

This test is included in general health examinations and to help investigate a variety of illnesses. An elevated WBC count occurs in infection, allergy, systemic illness, inflammation, tissue injury, and leukemia. A low WBC count may occur in some viral infections, immunodeficiency states, and bone marrow failure. The WBC count provides clues about certain illnesses, and helps physicians monitor a patient's recovery from others. Abnormal counts which return to normal indicate that the condition is improving, while counts that become more abnormal indicate that the condition is worsening. The differential will reveal which WBC types are affected most. For example, an elevated WBC count with an absolute increase in lymphocytes having an atypical appearance is most often caused by infectious mononucleosis. The differential will also identify early WBCs which may be reactive (e.g., a response to acute infection) or the result of a leukemia.


Precautions

Many medications affect the WBC count. Both prescription and non-prescription drugs including herbal supplements should be noted. Normal values for both the WBC count and differential are age-related.

Sources of error in manual WBC counting are due largely to variance in the dilution of the sample and the distribution of cells in the chamber, as well as the small number of WBCs that are counted. For electronic WBC counts and differentials, interference may be caused by small fibrin clots, nucleated red blood cells (RBCs), platelet clumping, and unlysed RBCs. Immature WBCs and nucleated RBCs may cause interference with the automated differential count. Automated cell counters may not be acceptable for counting WBCs in other body fluids, especially when the number of WBCs is less than 1000/μL or when other nucleated cell types are present.


Description

White cell counts are usually performed using an automated instrument, but may be done manually using a microscope and a counting chamber, especially when counts are very low, or if the patient has a condition known to interfere with an automated WBC count.

An automated differential may be performed by an electronic cell counter or by an image analysis instrument. When the electronic WBC count is abnormal or a cell population is flagged, meaning that one or more of the results is atypical, a manual differential is performed. The WBC differential is performed manually by microscopic examination of a blood sample that is spread in a thin film on a glass slide. White blood cells are identified by their size, shape, and texture.

The manual WBC differential involves a thorough evaluation of a stained blood film. In addition to determining the percentage of each mature white blood cell, the following tests are preformed as part of the differential:

Preparation

This test requires a 3.5 mL sample of blood. Vein puncture with a needle is usually performed by a nurse or phlebotomist, a person trained to draw blood. There is no restriction on diet or physical activity.


Aftercare

Discomfort or bruising may occur at the puncture site. Pressure to the puncture site until the bleeding stops reduces bruising; warm packs relieve discomfort. Some people feel dizzy or faint after blood has been drawn and should be allowed to lie down and relax until they are stable.

Risks

Other than potential bruising at the puncture site, and/or dizziness, there are no complications associated with this test.


Normal results

Normal values vary with age. White blood cell counts are highest in children under one year of age and then decrease somewhat until adulthood. The increase is largely in the lymphocyte population. Adult normal values are shown below.

Resources

books

Chernecky, Cynthia C., and Barbara J. Berger. Laboratory Tests and Diagnostic Procedures, 3rd ed. Philadelphia, PA: W. B. Saunders Company, 2001.

Henry, J. B. Clinical Diagnosis and Management by Laboratory Methods, 20th ed. Philadelphia, PA: W.B. Saunders Company, 2001.

Kee, Joyce LeFever. Handbook of Laboratory and Diagnostic Tests, 4th ed. Upper Saddle River, NJ: Prentice Hall, 2001.

Wallach, Jacques. Interpretation of Diagnostic Tests, 7th ed. Philadelphia, PA: Lippincott Williams & Wilkens, 2000.

other

National Institutes of Health. [cited April 5, 2003] http://www.nlm.nih.gov/medlineplus/encyclopedia.html .


Victoria E. DeMoranville Mark A. Best

User Contributions:

1
sunee masasso
I would like to know how to compaired WBC automatic analyzer differential and WBC manual differential that it can be as same as in normal case or not? And if I would like to compaired how many and which parameter I can use to compaired?


thank you
Sunee
2
Cadee
It'd be nice if there were some pictures to go along with this article.
3
Sanjay Chouhan
I like the way you gave defination and description and precaution...
I wold like to know how method of counting in laboratry and is any instrument envented for this calculation. Please give me answer..
Thank you,
Sanjay Chouhan
biomedical engg.
4
DIANA
I would like to know what 962 monocytes mean? Is is considered high for child after long time of cold? Please send me your answer.
Thank you
Diana
5
NKENGACHA M.A.
I like this online service. It educates and equip many to better handle challanges in laboratories.

Thanks!!
6
ross
what does it mean the value of wbc is increase? my sister wbc count is 18.35,,, i know its too high. my idea why she got increase wbc because of medications intake. because she suffer cough with whitish to yellowish phlegm and fever. that's why she intake different medications.
7
francisco gomez-Paris
Interesting but I did not get my question answered. My WBC count is 3.5
I am 74 yrs old is it low high or what. Am I at risk. What is the normal wbc count.


Thank you

Francisco Gomez-Paris
8
Rod
Hi Francisco,

I just got my cbc back from kaiser and i am a 50 year old male. and Kaiser says that normal wbc count is 4.0-11.00/ Yours a little low, but not by much.
I found the material very well intrpretated ut lacked one thing, the children's normal or abnormal levels of the dfferetail results. My boy had N= 46%, L= 48% Mo = 03% and E=03%, what
would this mean, the Dr simply gave drugs without expaining much
my niece white blood cell count is 15,000/μL and she's only 5 years old.will she gonna be okay?.she is in the hospital at the moment.will she gonna be alright?any information is really much appreciated.thank you
11
Connie
My blood test indicates a 2 for META%. The range is (0). What does/could this indicate?
Hi Iwant ask about the changing ofthe number of neutrophils to be high than normal range so same to others ( L.M.E.B ) and thanks
13
rizaan
kindly give me the precautions of increasing the white blood cells
I have recently gone through my body check-ups and my white blood cells reading has appreared 11900. Please advise as is this the danger level. Please also advise as how to reduce these cells within rabge (4500-11000).

Thankyou.
Hello,
My son who is 5, just received test results showing a low white count and his lymphocytes were only 1.45 (from I think the normal range of around 6-7.0). He has not been feeling 'well' for a while and has had swollen lymph nodes for over 6 mths. He is pale, has dark circle under his eyes, gets very tired now and has recently been complaining of pains in his legs a lot and nausea/sore belly. He also just can't seem to shake his cold and it keeps returning, whereas before now - he wasn't sick for longer than a day. We've taken him to the GP a few times and they finally just did these blood tests. How concerned should we be and is there anything we can do now while waiting our next appt? Thanks for you help
I would like to know if an increased white cell count in a 5day old babies blood is a definite sign of infection.
If not what are the chances of it being an infection and what else could it possibly indicate. Could stress cause the increased level?
Thank you very much,
James.
Hello everyone, I would like to know what it means if your white blood cell counts is 2,700? I understand that the normal values / count is btn 4,500 - 10,000. Another question; if someone had a normal white blood cell count, how long will it take to drop down? considering that this person was infected with HIV in last 8 months, how long will take for white cells to drop?

Many thanks
I am 66 years old and recently had a test and my wbc was 11000. Is that high and what do I do to get it down
19
jennifer criado
i am a 30 year old woman and had a wbc of 15,ooo. i am checking myself every six months for cervical cancer, and also have lyme disease, among 3 different arthritis. my question is...are any of my medical conditions any connection to my wbc.
Hi, I am 23 years age,my WBS count test is 1200 cmm, does it means I have leukemia?

Thanks
21
harsh patel
I would like to know how to compaired WBC automatic analyzer differential and WBC manual differential that it can be as same as in normal case or not? And if I would like to compaired how many and which parameter I can use to compaire
Dear, Dr. this day I brought my 1 year and 9 month kids , and the doctor told me that WBC count of my kids shows 10,700. Please I would like to know what does this mean ? Is it normal range ? , what is a normal range of WBC at this age for male child ? Please help me !
23
Amol
i had sex in Feb-2011, in May-2011 i had my HIV tri-dot as Negative. Also my WBC count is 7900,
does that mean i dont have any HIV infection ? ? ?
Ok, so i stumbled upon this article by pure chance while i was searching for something else.
Ill try to answer some general questions in easy terms:
-wbc count will Normally Increase incase of an infection, like the common cold for instance, because wbcs fight foreign bodies/germs/antigens. So when antigens enter our body, the wbcs recognise them as foreign and a threat, and they start multiplying to combat it, hence the increase in wbc count.
-wbcs are not just One kind of cell. They have different types which perform different special functions. E.g neutrophils/macrophages are big cells and they literally eat clumps of foreign organisms. Lymphocytes produce antibodies, substances to counter the toxins produced by the antigens.
-the percentages written at the bottom of the article indicate the percentage of a specific cell type. Like neutrophils make up for almost half of our total wbcs while eosinophils and basophils make up very little.

Ok i hope that much helped. And everyone, get well soon. :-)
25
Brid
Ifound this information very helpful, i suffer from autoimmune uveitis, i am taking prednesolone, and cellcept, as i am immunesuppressed i get a lot of infections, my white blood cell count at the moment is 22000,
26
hemangi
Sir,
i want to know that what precautions or what to eat for decresing WBC(Neutrophils)?
27
crystal
Jc please have your child checked for leukemia... I don't want to scare you because it very well may be something else but those are some symptoms of leukemia... My son is also 5 ass experiencing don't if those symptoms and sad diagnosed with all leukemia 2 weeks ago
28
Alpesh
My baby only 8 months old. I tested her blood report, WBC count is 22000. is it danger stage ?
please give me feedback.
29
EDWARDS, J
MY WBC RESULTS WAS 11 AND THE RANGE FOR MY AGE ACCORDING TO THE HOSPITAL LAB IS 0-6. IT THIS A POSSIBILITY THAT I MAY HAVE HAD AN INFECTION. THE SYNPTOMS OF WEAKNESS AND BEING TIRED HAS PASSED AND NOT LONGER EXIST
30
nour
Hi i made a blood test and everything is in normal range except the lymphocytes the range of my hospital is 1.0-3.0 10^3/ml (me: 4.12) or in % normal range is 25-34% (me:45.4%).. shall i be worry or its ok cause others WBC , PLATELETS AND OTHERS OR OK.
31
princess
what are the limitations of manual white blood cell count?
32
hassan kanaan
hi i made a blood test and everthing in normal range excepte the lymphocytes the range of my results is 53% ( upper limit ) and the neutrophils count 37% (lower limit) thx you
33
JuJu
Getting very confused.My doctor said white blood cell count should be 0-10, mine is 19.As i didnt have anything else raised ie rheumatoid - there was no need to worry.I am always very very hot even in winter and suffer from alot of arthritis (osteo) so thought there might be something else going on. Can anyone help!
34
vijay
MY 11 MONTH YEAR OLD DAUGHTER HAVE HGB COUNT 8.0 , TLC COUNT 15,400, DLC COUNT 20, LYMPHOCYTES COUNT 74 ,IS IT SERIOUS. WHATS THE MEANING AND EFFECT OF THIS
35
Debby
My 24 y/o daughter has a history of melanoma. Her WBC has always been normal. Today it is 22,000. Should this raise a concern? We are very worried that it is cancer. She has been feeling fatigued. Flu-like symptoms that do not go away.
Wonderful this article must be helpful to clarify with the doctors by a patient who may made blood test thanq
37
raj saini
My TLC is 17000 and my age is 71. Pls advise treatment. Thanks
38
kamran
My daughters age is eighteen months and white blood cells are increased to 21 what may be the reason
39
prateek
I would like to know whether 21800 leucocyte count indicates a risk ...or it can easily be medicated ...
Pls reply...
i am 33 years old and my tlc is 13500 what does this means, is this any risk or nor plz reply my question who may know ? Thanks
41
sushanta mallick
on 22/09/2014 the WBC count of my 16 Month baby was 10,800 per cmm & on 08/10/2014 it was 12,500 per cmm & yesterday it was 12,000 per cmm. Please give me the medical advice about the safe range of WBC & how it will be curable.
42
lynette
My wbc count is 11800 n edr is 83 ... Wat does this indicate.. hv nt been well since 5 days getting fever n headache on n off
43
casey
my granddaughter dr said her wbc is 4 and that's on a boarderline she is ten yrs old dr said it range from 2 on up could this be another infection at that rate than cancer
44
deepthi
I have my monocyte count is 07c/cmm is this a normal value
45
Narinder
Regularly getting pimple on my body due to increase my TLC 11900.
46
Jill
My mom has a count of 19 and its supposed to be 4? What does thid mean?
47
Atul
Hii my wbc is 13500 hemoglobin 13.3 is any problem with me
48
anjum
Hello..wbc 51000 & plot 89 HB 14.2 smudge cell seen I am unable to get properly what it actually signifies n suggest me best doctor if itz cancer along with stage and chances of recovery
49
faisal
my white blood cell count is 11200, what can i do? and is it dangerious?
50
zule
My sis is having blast in wbc morphology tht is 22%.. wat does tht mean.. is it dangerous plz le5 mee knw
51
Mamatha
Hello sir,
my son is 14 years old his white blood cells counting is 2,600. is it any dangerous and what is the correct range of WBC for a male child .please give me advice
52
Louie
My 70 year old sister has just been diagnosed with acute pancreatas n now her white blood cell count is very high at 25. She also has not had a bowel movement for over 3 weeks and she is in extreme pain in her abdominal area. What does this mean and what can be done to help her?? Please help
53
R C NAIR
My wife's WBC count is 11000. Is there any risk? Please advise any precaution to be taken
54
jodi
What does it meant to have a low neutrophils instrument with a high lymphocytes instrument? Some background, I appear to be a healthy 52 year old woman going thru menopause.
55
Sagar sonawane
My daughter WCB count is 14700 so plz advice me about the treatment and precautions
56
Kathy Henslee
My husband is 71. His monocytes is 19. What does that mean?
57
Daz
My WBC is 80'000. Doctor said I must have an infection somewhere and gave me antibiotics. Looking at this board, I'm a bit worried now that it might be something more serious as it seems very high compared to what other people are worrying about! Can anyone reassure me that a simple infection would cause WBC of 80,000?
58
Aswathi
I am 45 years old woman. .leucocyte count in my blood is 11900cells/cumm. Is it leukemia?
59
S.Mallesh
My WCB count is 12900 so plz advice me about the treatment and precautions
60
manju
sir i am wbc 12500 any advice with me treatment and prexaution
61
Anisur Mullick
My 16 months old son is getting infected with cold/cough/fever very easily and regularly. He got acute attack twice when he was 5 months old and 10 months old. My son took Montelukast LCD Kid regularly in this winter. I have allergy and need Levokast myself. The recent blood test reveals WBC total count of 12500 and Esonophils count of 12%. Doctor has prescribed Diethylcarbamazine Citrate - 50 mg. We searched and found that Diethylcarbamazine Citrate has severe side effects and my son too young and still cannot speak. Can we give him the prescribed Diethylcarbamazine Citrate (50 mg), or should we consult another paediatrician, please advice.
62
Bulgan
My son is 8 years old. We did blood test because he caught cold and took some medicines for 5 days. Test showed that his wbc is 3.97 /4.0-8.0/ , lymph 56.4 /18-40/. Do we have to worry about that?
63
Armis khan
A man of 55 years with wbc count 16, 000 is at any risk?
Eosinophils are also increased.
64
S vijaya rao
My grand daughter is only 5days old. Her white cells count is 100% heigh. She took long time in her mothers womb I.e delivery after 48 hours after water break. Normal delivery. What is reason. Is she safe enough at the moment.
65
mirana
I got my blood report today and my WBC around 22000,its too high from standard value.i want to know what can b causes or result of this higher wbc?why its too high?
66
Adarsh chandra
my white blood cell is 3.5×10^3. is it low. I have been visiting hospital since 1month now but my white blood cell is not increasing
67
Darlene Ross
My WBC count is7.2 is this something to be concerned about
68
Sachin
Hi, All of you(who is reading) my wbc are 17600. I am 16 years old and I want to know that what should I have to do for become it normal.
Hi
Age 57 ,wbc count 14700/cu mm is high or low and this is due to why?
70
atul jagtap
I did blood test and got WBC count 11,100.
Is it ok ? Or is it needful to get hospitalized for few days ?? How can I reduce WBC count at normal level? Thanks
71
SHEULY AKHTER
my age 35. I m unmarried. my WBC result 8.37 x 10^3/uL reference range 4.00-11.00 x 10^3/ul. so what is the meaning for possibility disease? please ans me
72
surbhi
my wbc are 11900 .everything else is OK.do I have any disease
73
kasthuri
I did blood test and got WBC count 11,100. it is normal or abnormal
74
Rohan
My age is 19
Total leucocyte count is 15300
Neutrophils 79%
My body is paining and I feel like iching if I touch it its becoming little more bigger wt 2 do
75
Sachin Sharma
I am a 19 year old boy. My leucocyte count is 12600.
Is it normal or not? If not, what should I do. Please suggest me.
76
Tony
Hi my WBC is 18400 and I have an atypical lymphocytes my age is 50.please advise
77
Naveed
Hi Sir,

My WBC count is 12200 in march 2016 & 11200 in Dec 2014 & 8600 in 2013 and I am now 40 years of age please advise
78
Kazi Benazir
I checked my WBC and found 9800/cmm though the value is in between the range 4500-10800. My question is that, how I reduce the WBC and if I found low and high WBC what would be causes, Can you guys tell me.
79
Derrick
Hi, my daughter is 13 months old, she has had a fever of 103 the past 2 weeks, we had her to the hospital, they did some blood work, an her white cell count is 54000, an now has been admitted to the hospital, should we be worried, or think nothing of it, all i know is they are going to be running a bunch of test,
80
Donna
I had a white blood count 7.63 before surgery for breast cancer. After surgery and sick in ER my WBC was 2.99. I tested positive for TYPE B flu and pneumonia is left lung. Would fighting a virus and infection cause my WBC to drop so drastically. What risk do I have?
81
Ilkin
My lymphocytes were 17.5% and 1500 absolute. Have any risk factors about my lymphocytes? I don't complain about my other hemogram results
I have child having 3 years old and a wbc -7800 and lymphocytes-65 percentage. Is it any risk factor.
83
jenelle
what is the meaning if wbc is elevated into 13.0 x10^9/L but all differentials are all normal.??
84
Ammu
Iam 22years old.. I test my blood..paltelet 197000.TC-4000,neotrophil-50,Eeosinophil-03 and lymphicyte-48..here is any problem in my blood?
My son who is 19 month old. His TWBC is 17000, what this indicates???...Is he fit ???
86
Satish
Dear dr.
Iam satish from Vizag. Ihave one small problem
In my blood wcb. Cell count 3,900.
And platelet. Count1.5 lakhs if it this what is problem? If any problems?
So plz give me clarification
87
Khadeer
Hi ,
I am constantly having Lymphocytes count high around 44% of 7600 total WBC count for past 4+ years, but my white blood cell count is Normal (Normal in morphology,maturity and distribution).
Please do suggest me whats happening
88
Amber Juarez
Hello my 3 year old daughter has been sick with a rash that comes and goes now for 9 months she gets low grade fevers and mouth ulcers with outbreaks,and always says her legs hurt,scared because she is having high nucleated RBC/100 WBC her levels are 0.5 they told us it should be 0.0 she also has high absolute auto,lymphocytes,eosinophils,and Basophils please help has anyone had this happen and what could this mean?
89
Sibongile
Hi my neutrophils is 129 i always get flu what must i do. Because i get sick so easy and shaky from the inside
90
Glynn
Hi I'm a 68 year old male. I just received the results from my blood work. My WBC value came back at 3.5. Is this something to be concerned about?
91
Anil
My son' WBC is 2700. What is the reason? He is having fever & cough and cold.
92
Hema
My child is 9yrs old . His latest bllod report displays having 2200% of wbc in blood cell. what us that mean and what precaution and medicine we should use
93
Bindu lata
My age is 62. My TLC is 28000 and neutro is 85%.
Is a danger stage ?.and how many months i was recorvered from this problems
94
Madhusmita Das
My husband age 43. His white blood cell count is 11500 and his himoglobin is 10. Is it dangerous for him?
95
Zaineb
Hi
My baby girl of w year old having cervical lymphidities and little sweling on right of belly.last day i have CBC test and it show 15400 wbc ..is it easily treated and ends up with medication antibiotic or any thing serious?
96
siva
my sister son age of 8 months .he is suffering from fever .white blood cells count is 17000. is it daingers stage ?
97
Stacy LeClair
My wbc, absolute lymp cpunt abd absolute neutro count is high. Dr has me going in for blood work every week and im not changing. What are they looking for and why am i not getting answers from my dr.
98
Pampa Sandeep Sarkar
My daughter is 8 years old. She was admitted I hospital due to recurring fevers and chills on 19th January. She is still in hospital. Her WBC count is varying from 2300 to 2800 to 3000. Her fever spikes were 104 - 105. Now it has come down to 100 - 101. Till now 5 CBCs have been done all showing low WBC.
99
Ravi chand chauhan
My TLC no is 19600 should I know any problem in my body, in future plz suggested what can we do to take normal range my age is 23 year
100
Swanil
My WBC count is 11500 what reasons behind and is serieus
101
SUHEEL
good morning my son age 7 years he has 14700 cbc count , what is cause for that, he has dry cough from last 5 days , every year he has same problem . we admitted him for same reason .
102
Nusrat Jahan
My age is 19.My WBC count is 10,600.Is it dangerous for me?
103
Indira s s
Hello my leukocyte count is 15.000 cells /cumm any diseases do i have. Because i am tired and feel like fever bodypain and joint pains. Pl inform me
104
Adedayo Adebajo Fatima
Pls ma 9month old baby White blood cell is 12,200mm³ is it high or low?
105
okenna Ikechukwu Charles
my daughter is 27 months and her lab test shows that her wbc is 9800. she has been under treatment for infection but she is now stooling and vomiting. a doctor friend that the disentry is side effect of the drug she has been taken. but she is still very weak. what do we do.
106
Sal Mourad
My doctor ordered a blood smear test and all my results came back normal. My only question is why did I only receive a RBC MORPHOLOGY result and not WBC MORPHOLOGY? Is it normal to only have a RBC MORPHOLOGY and not a WBC MORPHOLOGY?
i have done ablood test
red cell count is 5.42
total wbc is 12800
neutrophil is 74
is this report is harmful

Comment about this article, ask questions, or add new information about this topic: