May 24, 2023HematologyLab Tests
Table of Contents
Sample for White Blood Cells
- This is done on EDTA blood.
- The whole blood in EDTA is stable for 24 hours at 23° C and 48 hours at 4 °C.
- Don’t use heparin.
Indications forWhite Blood Cells
- This is the routine test in CBC.
- TLC differentiates acute and chronic infections.
- TLC diagnoses leukemias.
- TLC is done as a follow-up test in patients on chemotherapy.
- This will help a patient with an allergy.
Precautions for White Blood Cells:
- Physical activity and stress may cause an increase in WBCs and differential values.
- Pregnancy in the final months may cause an increase in WBC count.
- Patients with splenectomy have a persistent mild increase in the WBC count.
- Drugs that may increase the WBC county are:
- Drugs that will decrease the WBC count:
- Antithyroid drugs.
Pathophysiology of White Blood Cells
Definition of hematopoiesis:
- This is the dynamic process of blood cell production and development of the various cells of the blood.
- All these cells develop from the totipotent stem cells.
- This hematopoiesis is characterized by the constant turnover of the blood cells.
- The normal hematopoietic system maintains a cell population of erythrocytes, white blood cells, and platelets through a complex network of tissues, stem cells, organs, and regulatory factors.
Functions of the hematopoietic components (cells):
- It transports oxygen and excretes CO2 through RBCs.
- It fights infection by the WBCs.
- It performs the immune function (cellular and humoral immunity) through the lymphocytes.
- It maintains (hemostasis) the bleeding and the clotting process through the platelets.
Development of myeloid (myelopoiesis) /erythroid (erythropoiesis) cells:
- In the first few weeks of gestation, the yolk sac (mesoderm) is the hematopoiesis’s main site. The first stem cells for hemopoiesis are observed in the dorsal aorta, called an aorta-gonads-mesonephros region.
- These common precursors of endothelial and hematopoietic cells will seed the bone marrow, liver, and spleen from 6 weeks until 7 months of fetal life.
- The liver and the spleen are the major hematopoietic organs and produce blood cells until around 2 weeks after birth.
- During childhood and adulthood, marrow is the only source of new blood cells.
- In adult life, the marrow consists of approximately 50% of the fats.
- After 4 years of age, fat cells start appearing in the long bones.
- 18 to 20 years, hematopoiesis is only found in the sternum, ribs, pelvis, vertebra, and skull.
- After 40 years, the sternum, ribs, vertebra, and pelvis comprise 50% fat and 50% hematopoietic tissue.
Hematopoiesis in fetus
Bone marrow activity:
- Bone marrow hematopoietic activity is divided into two pools:
- Stem cells pool.
- Bone marrow pool.
- Eventually, these cells get mature and are released into the peripheral blood.
Hematopoiesis (Bone marrow)
- Hematopoiesis starts from the pluripotential stem cells.
- Hematopoietic stem cells are rare; these are 1 in every 20 million nucleated cells.
- There is self-renewal of the stem cells. So the bone marrow cellularity remains constant in a normal healthy person.
- There is an amplification of the stem cells, and one stem cell can produce about 106 mature blood cells after 20 subdivisions.
- There is various type of stem cells, and these cells develop from the totipotent cells.
- Totipotent cells, also called embryonic stem cells and gave rise to:
- Hematopoietic stem cells give rise to myeloid and lymphoid cells.
- Epithelial stem cells give rise to organs like the liver etc.
- Mesenchymal stem cells give rise to muscles, tendons, and cartilage.
- Neural stem cells give rise to neural tissue.
Differentiation of stem cell
- These parent stem cells have CD34+ and CD38– and have the appearance of small, medium-sized lymphocytes.
- These stem cells give rise to committed stem cells, and this process takes place under the influence of CFU (colony-forming unit).
- This whole process is shown in the following diagram.
Maturation of all bone marrow hematopoietic cells
White blood cells or leukocytes are divided into :
- Granulocytic series. These cells contain granules in their cytoplasm. Because of a multilobate nucleus, these are also called polymorphonuclear leukocytes (Polys or PMN). These are of the following type:
- Agranulocytic series is without any granules in their cytoplasm.These are also called mononuclear cells. These are :
White blood cells maturation
White blood cells can also be divided into:
- Phagocytic cells:
- Neutrophils (polymorphonuclear leucocytes, PMN).
- Immunocytic cells:
- Lymphocytes precursors.
- The Polys and lymphocytes comprise 75% to 90% of the total WBC count.
Polymorphonuclear leukocytes (PMN):
- The neutrophils develop from the myeloblast, transforming into promyelocytes, myelocytes, metamyelocytes, band forms, and neutrophils delivered into the peripheral blood.
WBC maturation cycle
The development of the neutrophils:
- These are also called segmented neutrophils or polymorphonuclear neutrophils (PMN).
- The neutrophils are of two types:
- Segmented neutrophils are found in the peripheral blood.
- Tissue neutrophils have ample cytoplasm having irregular, blunt pseudopodia that are often multi-pointed and may have hazy cytoplasmic streamers.
- These cells are not phagocytic and seldom have cytoplasmic vacuoles.
- The cytoplasm stains light blue and has a fine latticelike structure.
- Granules vary in number and stain, which will be red to blue.
- These cells have large, round, or oval nuclei with coarse chromatin.
- Nucleoli are conspicuous and stain light blue.
The cytokines involved are:
|Growth factors/cytokines||Target cells|
|The precursor of:|
- The leukocytes’ total lifespan is 13 to 20 days, and they are produced in 7 to 14 days from the myeloblastic cells.
- Their life in the peripheral blood is just 7 to 10 hours and migrates to the tissue and is replenished by other cells released from the marrow.
- The polys have a characteristic dense nucleus consisting of 2 to 5 lobes and pale cytoplasm, with many fine pink-blue (azurophilic granules) or grey-blue granules. These granules are present in the lysosomes.
White blood cells granules are divided into:
- Primary granules appear at the promyelocytic stage.
- These contain myeloperoxidase, acid phosphatase, and other hydrolases.
- Secondary (specific) granules appear at the myelocytic stage and predominate in the mature neutrophils.
- These granules contain collagenase, lactoferrin, and lysozyme.
The role of the lysosomal enzyme in the destruction of the bacteria by the neutrophils are:
- Bacteria are phagocytosed into cells and fuse with the primary lysosomes to form a phagosome.
- Primary granules attack the bacteria.
- Secondary granules fuse with the phagosomes, and secondary enzymes attack the bacteria.
- Activated oxygen generated by glucose metabolism will kill the bacteria.
- Undigested, killed residual bacterial products are excreted by exocytosis.
White blood cells’ Role in Bacterial Infection
The function of Poly (PMN) is:
- The poly (PMN) gives immunity by fighting against infections and reacting against foreign bodies by various methods:
- Phagocytosis is the killing and digestion of bacteria.
- Eosinophils are involved in allergic reactions.
- Eosinophils have a role in parasitic infestation.
- Basophils of the peripheral blood are also rich in histamine granules; they play a role in allergic reactions.
- Monocytic cells have the property of phagocytosis. They can kill bacteria and remove debris.
- Monocytes produced interferon.
- They have a longer life than neutrophils.
Summary of the difference between various types of granulocytic series (neutrophils) cells:
- Monocytes develop from the monoblast in the bone marrow.
- These macrophagic cells measure 25 to 80 µm with round or reniform nuclei and contain one or two nucleoli.
- There is clumped chromatin, abundant cytoplasm with vacuoles, and numerous azurophilic granules.
- These monocytes enter the circulation for a short time and then migrate to the tissue and transform into tissue macrophagic cells.
- Monocytes are also called histiocytes which means histio = tissue and cyte= cells.
Monocytes in the peripheral blood smear
- When these monocytes are mature, they become too large to pass readily through the capillaries, so these settle in the tissue and convert into tissue macrophages in many organs like:
- In the lungs are called pulmonary alveolar macrophages.
- In the peritoneum are called peritoneal macrophages.
- In the spleen are called splenic macrophages.
- In the liver are called Kupffer’s cells.
- In the connective tissue are called tissue macrophages.
- These are also phagocytic cells.
- Monocytes don’t enter the circulation but can go back to circulation in case of inflammation.
- The function of monocytes:
- Their function as phagocytosis is similar to neutrophils.
- Monocytes can produce more rapidly than neutrophils and spend a longer time than neutrophils.
- These cells all pass through the same stages as the neutrophils.
- These are also called mast cells when present in the tissue.
- The cells have large basophilic granules.
- The maturation of the basophils in the bone marrow takes more than 7 days.
- Basophils circulate in the peripheral blood for a few hours, then migrate to the tissue, skin, mucosa, and serosal surfaces.
Morphology of the Basophil
- Eosinophils spend 3 to 6 days developing in the bone marrow before appearing in the peripheral blood.
- These are stored in the bone marrow and released to the peripheral blood circulation when needed.
- The mean time in the circulation is about 8 hours.
- Eosinophils migrate from blood to bronchial mucosa, skin, GI tract, and vagina in about 12 days.
- Eosinophils can migrate back to blood and bone marrow.
- Eosinophils are motile and can migrate between the endothelial cells into tissue or area of inflammation.
- Granules of the eosinophils contain hydrolytic enzymes like:
- Acid phosphatase.
- Aryl sulfatase.
- But eosinophils lake the enzymes like:
- Alkaline phosphatase.
- Cationic proteins.
- There are tissue eosinophils, and these have prominent nucleoli.
Lymphocytes are of two types:
- B – lymphocytes give rise to antibody-dependent immunity.
- T – lymphocytes give cell-mediated immunity; their subtypes are:
- T – cytotoxic cell. (T – killer).
- T – suppressor cell.
- T – helper cell.
- The primary function of T–cells is to fight chronic bacterial and viral infections.
Normal Total leucocytes count
- Adult /child = 5000 to 10,000 /cmm
- Child≤2 years = 6200 to 17000 /cmm.
- Newborn = 9000 to 30,000 /cmm
- Adult and child = 5000 to 10,000/cmm.
- Child under 2 years = 6200 to 17,000/cmm.
- Newborn = 9000 to 30,000/cmm.
|Type of the cells||%||Absolute count|
|Neutrophils||55 to 70||2500 to 8000/cmm|
|Eosinophils||1 to 4||50 to 500/cmm|
|Monocytes||2 to 8||100 to 700/cmm|
|Basophils||0.5 to 1||25 to 100/cmm|
Increased TLC (Leucocytosis) is seen in:
- The TLC is >11000/cmm.
- Mostly in the case of infections that may be bacterial or viral.
- Localized infections are:
- Generalized infections:
- Acute rheumatic fever.
- Localized infections are:
- In the case of leukemias.
- After the strenuous exercise.
- Pain and anorexia.
- Epileptic seizures.
- Emotional reaction.
- Mild leucocytosis in pregnancy.
- Acute hemorrhage.
- Intoxications like:
- Poisoning by drugs, chemicals, and venoms (black widow spider).
- Metabolic diseases include uremia, acidosis, eclampsia, and acute gout.
- Parenteral proteins and vaccines.
- Acute hemolysis of red blood cells.
- Myeloproliferative diseases.
- Tissue necrosis:
- Necrosis of the tumor.
- Acute myocardial infarction.
- Necrosis due to bacteria.
- Physiologic conditions are:
- Emotional stress.
- Obstetrical labor.
Decreased leucocytosis (neutropenia) is seen in:
- The TLC is <4000/cmm.
- This may be seen in fever, malaise, and chills.
- Bacterial Infections.
- Miliary tuberculosis.
- Typhoid fever.
- Paratyphoid fever.
- Viral infections are:
- Infectious mononucleosis.
- Hematological diseases:
- Aleukemic leukemia.
- Pernicious anemia.
- Gaucher’s disease.
- Felty’s syndrome.
- Aplastic anemia.
- Deficiency of vitamin B12.
- Drugs and chemicals:
- Antithyroid drugs.
- Marrow depressant.
- Malignant infiltration of the bone marrow.
- Bone marrow aplasia.
- Bone marrow depression by radiations.
- Autoimmune diseases like SLE.
TLC counted inNeubauerchamber:
Neubauer chamber counting of white blood cells (TLC)
- Please always correlate TLC with the freshly prepared peripheral blood slide.
- Critical value = <2500 or >30,000 /cmm.
Questions and answers:
Question 1: Is there an effect of exercise on TLC?
Question 2: What is the target organ of IL-3?
- Please see more details in CBC part 1.
Possible References Used
Go Back to Hematology
White blood cells are part of the body's immune system. They help the body fight infection and other diseases. Types of white blood cells are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells).Is low white blood count serious? ›
A low white blood cell count is a consequence of serious diseases, and it can lead to harmful health problems—including infections, slow healing, and cancer. A low white blood cell count doesn't cause symptoms, but the complications of a low white blood cell count can cause many different symptoms.When should I be worried about high WBC? ›
“Generally, if a WBC count is above 20,000, it is important to take a look at the differential, to determine what kind of cells are seen,” Dr. McCarthy said. Even when a WBC count is just borderline high, looking at the type of cells (the differential) may be important to determine whether the results are significant.What does it mean when your white blood cells are low? ›
A low white blood cell count usually means your body is not making enough white blood cells. It can increase your risk of getting infections.What are the two main functions of WBC? ›
White blood cells (WBCs) are a part of the immune system. They help fight infection and defend the body against other foreign materials.What is white the function of blood? ›
transporting oxygen and nutrients to the lungs and tissues. forming blood clots to prevent excess blood loss. carrying cells and antibodies that fight infection. bringing waste products to the kidneys and liver, which filter and clean the blood.How do you fix low white blood cell count? ›
Some sources of quality protein are fish, eggs, poultry, beef, milk, Greek yogurt and beans. If your diet is poor, or you're having trouble eating, you can take a multivitamin or supplement with vitamin B12 and folate. The body uses vitamin B12 and folate to make WBCs.What viruses cause low WBC? ›
Diseases that can lower your white blood count include some types of cancer and HIV/AIDS, a viral disease that attacks white blood cells. Certain medicines, including chemotherapy, may also lower the number of your white blood cells.Does dehydration affect white blood cell count? ›
Yes, dehydration may cause homoconcentration which can double the white blood cells in healthy people. Though rarely but it is advised to get a retest done after being fully hydrated.What foods increase white blood cells? ›
Great plant based sources include lentils, beans and soy. Zinc is one of the best foods to increase white blood cells you can consume as it can help the body produce more WBCs and makes existing WBCs more aggressive. Foods rich in zinc include turkey meat, beef, crab, and oysters.
- Fever and chills.
- Swelling and redness.
- Mouth sores.
- Red or white patches in your mouth.
- Sore throat.
- Severe cough or shortness of breath.
- Painful urination or pee that smells bad.
Avoid raw milk, any yogurt or cheeses made with raw milk, and unpasteurized juice. Be sure to wash all fresh fruits and vegetables well. You may want to switch from fresh fruits and vegetables to cooked, canned, or frozen fruits and vegetables during treatment. Make sure that canned foods are safe.Can you recover from low white blood cell count? ›
Low white blood cell counts (WBC's) or leukopenia, can occur at certain times throughout chemotherapy. Most of the time, blood counts will return to normal before a person starts the next round of chemotherapy, and also after cancer therapy is completed.Can stress and anxiety cause low white blood count? ›
In addition, stress decreases the body's lymphocytes — the white blood cells that help fight off infection. The lower your lymphocyte level, the more at risk you are for viruses, including the common cold and cold sores.What happen if WBC is high? ›
Produced in your bone marrow, they defend your body against infections and disease. But, when there are too many white blood cells, it usually means you have infection or inflammation in your body. Less commonly, a high white blood cell count could indicate certain blood cancers or bone marrow disorders.How do white blood cells fight infection? ›
They are attracted towards the infective agents, then surround and engulf them. Once inside the cell, these white cells then release chemicals that break the organism down and destroy it. Other white cells, called lymphocytes, target attacks in another way, by making antibodies.What is the most common reason for high white blood cell count? ›
Overall, the most common cause for a high white blood cell count is response to infection. Another potential cause of an elevated white blood cell count is leukemia. This is effectively a cancerous change of the blood and bone marrow which causes significant overproduction of white blood cells.What 3 things do white blood cells do? ›
White blood cells carry out their defense activities by ingesting foreign materials and cellular debris, by destroying infectious agents and cancer cells, or by producing antibodies.What powers white blood cells? ›
Stem cells in the bone marrow are responsible for producing white blood cells. The bone marrow then stores an estimated 80–90% of white blood cells. When an infection or inflammatory condition occurs, the body releases white blood cells to help fight the infection.What is the meaning of WBC? ›
A WBC count is a blood test to measure the number of white blood cells (WBCs) in the blood. WBCs are also called leukocytes. They help fight infections.
Fruits Rich in Vitamin C
It is a widely known fact that vitamin C-rich foods can help in increasing white blood cell count among men and women alike. Guava, strawberries, papaya, kiwi, and several other citrus fruits help in creating pathogen-fighting WBCs and T-cells that protect the body from future infections.
Your body needs vitamin B12 to make healthy red blood cells, white blood cells, and platelets.How do I get my white blood cells back to normal? ›
Eating Vitamin C will help regulate the levels of white blood cells in your body. Fruits like lemons, oranges, and lime are rich in vitamin C, and so are papayas, berries, guavas, and pineapples. You can also get vitamin C from vegetables such as cauliflower, broccoli, carrots, and bell peppers. Antioxidants.What autoimmune disease affects white blood cells? ›
Autoimmune neutropenia (AIN) is a blood disorder where your immune system attacks white blood cells (neutrophils) that fight infection. AIN may be primary or secondary.What autoimmune disorders cause low WBC? ›
- Aplastic anemia: A rare condition in which the body stops producing enough new blood cells.
- Autoimmune neutropenia: A condition in which your immune system mistakenly attacks and destroys neutrophils.
- Congenital neutropenia: A genetic disorder in which the body doesn't make enough neutrophils.
Water Helps in the Production of Lymph
It carries white blood cells and other immune system cells from the thymus and the bone marrow, throughout the body.
A steady intake of water increases hemoglobin indices, such as the MCH and MCHC, and decreases the MPV. As shown in Table 1, at the end of the study period, WBC, RBC, and platelet counts increased in the experimental group, as did hematocrit and hemoglobin levels, although the increases were not significant ( p >0.05).Does drinking cold water increase white blood cells? ›
If that weren't enough, cold water immersion has also been shown to significantly increase white blood cell and platelet counts, which means an increase in our body's base ability to fight infection.Does apple cider vinegar help white blood cells? ›
The effect of apple cider vinegar on white blood cell clearance of microbes. Apple cider vinegar reduces the efficacy of bacteria and yeast to grow. this helps white blood cells such as macrophages to clear and engulf these microbes which will in turn reduce inflammation and harmful cytokine secretion.Does exercise increase white blood cells? ›
Exercise causes change in antibodies and white blood cells (WBC). WBCs are the body's immune system cells that fight disease. These antibodies or WBCs circulate more rapidly, so they could detect illnesses earlier than they might have before.
One of the main reasons people take vitamin C supplements is to boost their immunity, as vitamin C is involved in many parts of the immune system. First, vitamin C helps encourage the production of white blood cells known as lymphocytes and phagocytes, which help protect the body against infection ( 21 ).Does zinc increase white blood cells? ›
In the current study, zinc deficien- cy increased the number of WBCs and platelets in blood.What are the first signs of having leukemia? ›
- Fever or chills.
- Persistent fatigue, weakness.
- Frequent or severe infections.
- Losing weight without trying.
- Swollen lymph nodes, enlarged liver or spleen.
- Easy bleeding or bruising.
- Recurrent nosebleeds.
- Tiny red spots in your skin (petechiae)
Leukemia can also present with very low white blood cell counts, because the immature cells get trapped in the bone marrow and are not detected in blood tests. A decreasing number of blasts in the blood indicates that you're responding to treatment. A rising number of blasts may be an early sign of relapse.What cancers affect WBC? ›
Leukemia, a type of cancer found in your blood and bone marrow, is caused by the rapid production of abnormal white blood cells. The high number of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets.Can you live a normal life with low white blood cells? ›
It's possible for some people to have white blood cell counts that are lower than what's usually expected and still be healthy.Should I be worried about low white blood cells? ›
A truly low white blood cell count also puts you at higher risk for infections — typically bacterial infections. But viral infections also may be a concern. To help reduce your infection risk, your doctor may suggest you wear a face mask and avoid anyone with a cold or other illness.How long does it take to recover from low WBC count? ›
Once the WBC count drops, it remains low for 7–10 days. The lowest level that blood cell counts reach is called the nadir. During nadir, the body's resistance to infection is weakest.Can lack of sleep cause low WBC? ›
Conclusion: Sleep restriction affected WBC count, mainly neutrophils, considered as risk factor for cardiovascular disease. Stress induced by the short term sleep restriction could be involved in this observation.Can low WBC affect your mood? ›
Depression and anxiety symptoms are associated with white blood cell count and red cell distribution width: A sex-stratified analysis in a population-based study. Psychoneuroendocrinology.
Furthermore, among men, lower WBC levels showed a trend toward increased depressive symptoms, and higher WBC levels showed a trend toward increased irritability. Among women, both lower and higher WBC levels showed a trend toward increased irritability and manic symptoms (Supplementary Table 2).What are the 3 things white blood cells do? ›
White blood cells carry out their defense activities by ingesting foreign materials and cellular debris, by destroying infectious agents and cancer cells, or by producing antibodies.What is an alarming white blood cell count? ›
In general, for adults a count of more than 11,000 white blood cells in a microliter of blood is considered high.What is the function of white blood cell quizlet? ›
Leukocytes Function (or WBC) Form a protective, movable army that help defend the body against damage by bacteria, viruses, parasites, and tumor cells.What are the 4 functions of white blood cells? ›
Monocytes – main action against bacterial infections. Eosinophils – main action against parasitic infections. Basophils – responsible for responses to allergens. Lymphocytes – main action against viral infections.What are white blood cells made of? ›
WBC's are composed of granulocytes (neutrophils, eosinophils, and basophils) and non-granulocytes (lymphocytes and monocytes). White blood cells are a major component of the body's immune system. Indications for a WBC count include infectious and inflammatory diseases; leukemia and lymphoma; and bone marrow disorders.How do you fix low white blood cells? ›
Some sources of quality protein are fish, eggs, poultry, beef, milk, Greek yogurt and beans. If your diet is poor, or you're having trouble eating, you can take a multivitamin or supplement with vitamin B12 and folate. The body uses vitamin B12 and folate to make WBCs.Can stress cause high white blood cell count? ›
Stress—Finally, emotional or physical stress can also cause elevated white blood cell counts. The good news is that white blood cell levels will return to normal after the stress is gone.What is the function of white blood cells How are they classified? ›
Introduction: White blood cells are blood cells that fight infection and disease. Lymphocytes are a type of white blood cell. They can identify antigens (substances foreign to the body) and cause an immune response. There are three types of lymphocytes: T-cell, NK-cell, and B-cell.Do white blood cells carry oxygen? ›
White blood cells help in carrying oxygen to all organs of the body.
Platelets help prevent bleeding
Their primary function is to prevent and stop bleeding. If a blood vessel is damaged, the body sends signals to platelets which cause them to travel to the injured area. Once the platelets arrive at the site, they clump together to form a clot that helps stop bleeding.