WHITE BLOOD CELL DIFFERENTIAL COUNT LOW WBC COUNT

• A low number of WBCs is called leukopenia.

White blood cells (WBC) • Neutrophils - are important for fighting
➢are a heterogeneous group of nucleated cells infections.
that can be found in circulation for at least a • A lower than normal WBC count may be due
period of their life. to:
➢They play a most important role in Bone marrow deficiency or failure (for
phagocytosis and immunity and therefore in example, due to infection or tumor)
defense against infection. • Certain autoimmune disorders such as lupus
There are 5 major types of white (SLE)
blood cells: • Disease of the liver or spleen
• Neutrophils • Radiation treatment for cancer
• Eosinophils • Certain viral illnesses, such as infectious
• Basophils mononucleosis
• Lymphocytes (T cells, B cells, and Natural Killer • Cancers that damage the bone marrow
cells) • Very severe bacterial infections
• Monocytes • Severe emotional or physical stress (such as
from an injury or surgery)
Test is Performed to help diagnose conditions such Hodgkin disease is a typeof lymphoma.
as: • An infection Lymphoma is a cancer of a part of the immune
• Allergic reaction system called the lymph system.
• Inflammation The first sign of Hodgkin disease is often an enlarged
• Blood cancer such as leukemia or lymphoma lymph node. The disease can spread to nearby
• Side effects caused by medicines lymph nodes. Later it may spread to the lungs, liver,
or bone marrow.
Normal Results DIFFERENTIAL COUNTING
• The normal number of WBCs in the blood is
4,500 to 11,000 WBC per microliter (4.5 to 5 different and diverse types of leukocytes exist
11.0 × 109
/L). Granulocytes Nongranulocytes
• Normal value ranges may vary slightly among • Neutrophils Monocytes
different labs. • Eosinophils Lymphocytes
• Some labs use different measurements or may • Basophils
test different specimens. Polymorphonuclear Mononuclear
• Leukocytosis - increase in the number of • Neutrophils Monocytes
leukocytes over the upper limits. • Eosinophils Lymphocytes
• Leukopenia - decrease below the lower limit. • Basophils
Phagocytes Immunocytes
HIGH WBC COUNT • Neutrophils Lymphocytes
A higher than normal WBC count is called • Eosinophils
leukocytosis. It may be due to: • Basophils
• Cigarette smoking • Monocytes
• After spleen removal surgery.
• Infections, most often those caused by bacteria
• Inflammatory disease (such as rheumatoid
arthritis or allergy)
• Leukemia or Hodgkin disease
• Tissue damage (for example, burns)
 OVERVIEW

Type Diagram Blood Main Targets Granules Lifespan

Values
Neutrophil 62% • Bacteria Fine, faintly pink (H&E 6 hours–few days
↓- neutropenia • Fungi stain) (days in spleen and
other tissue)
↑- neutrophilia

Eosinophil 2.3% • Larger parasites Full of pink-orange 8–12 days (circulate

↓=eosinopenia • Modulate allergic (H&E stain) for 4–5 hours)
↑- eosinophilia inflammatory responses
Basophil 0.4% • Release histamine for Large blue A few hours to a few
↓-basopenia ↑- inflammatory responses days
basophilia

Lymphocyte 30% • B cells: releases antibodies • NK-cells and Years for memory
↓- lymphopenia and assists activation of T cells cytotoxic (CD8+) T-cells cells, weeks for all
↑- lymphocytosis else.
• T cells:
a. CD4+ Th (T helper) cells
b. CD8+ cytotoxic T cells
Monocyte 5.3% Migrate from the bloodstream None Hours to days
to other tissues and
↓-monocytopenia differentiate into tissue
↑- monocytosis resident macrophages,
Kupffer cells in the liver.

↑-basophilia
.
RETICULOCYTE COUNT RBC MATURATION GUIDELINES
1. They exhibit progressive decrease in size as cell
matures.
2. They exhibit a progressive decrease in the degree
of cytoplasmic basophilia.
3. The nuclei are round / oval in the blast stage,
becoming very round thereafter.
4. There is a gradual increase in the coarseness and
condensation of chromatin. fine – early stage
pyknotic – stage just before nuclear extrusion 6
Nomenclatures of Erythrocytic Stages of Maturation

HOW CELLS ARE RELEASED FROM THE BONE

MARROW INTO THE CIRCULATION
• RBC – by hypoxia and erythropoietin
• WBC – by the presence of chemotaxins
• Platelets – by shedding of megakaryocytic
cytoplasm RUBRIBLAST (Proerythroblast / Pronormoblast)
- 5 to 10 % of the total nucleated cells in the bone
ERYTHROPOIESIS marrow earliest blood cell precursor
- 12 to 25 um in diameter
- has a high nucleus: cytoplasm ratio
- gives rise to 2 Prorubricytes
A. Nucleus:
- occupy >80 % of the cell
- round or slightly oval
- thin nuclear membrane and maybe central /
eccentric
- has 1 to 2 nucleoli, very faint and pale blue
- chromatin varies from finely to coarsely granular
B. Cytoplasm:
- small amount, homogenous and opaque
- basophilic (intense dark blue) because of high RNA
content

PRORUBRICYTE (Basophilic Erythroblast / Basophilic

normoblast) )
- slightly smaller than rubriblast (12-17 um) (10-15
um)
- divides 2 times – giving rise to 4 rubricytes
ERYTHROPOIESIS
• A process by which erythroid precursor cells A. Nucleus:
differentiate to become mature RBC. - occupies 75 % of the cytoplasm
• The primary regulator of this process is - generally round and slightly eccentric with a thin
erythropoietin. nuclear membrane
• It normally takes 3-5 days for the production of - chromatin – coarse and irregular and more clumped
reticulocytes from pronormoblasts. The reticulocytes - usually nuclei are no longer visible (0-1 nucleolus)
remain in the bone marrow for 1-2 days before being NOTE: the absence of nucleoli and coarser
released in the circulation. chromatin – most helpful criteria
• In the peripheral circulation, the reticulocyte B. Cytoplasm:
continues to mature for one more day. -varies from intense moderate basophilic and is royal
blue and opaque.
 RUBRICYTE (Polychromatophilic Erythroblast / RETICULOCYTE
Polychromatophilic normoblast) Reticulocyte Count
-characterized by first appearance of hemoglobin • Reticulocyte count or percentage is a good indicator
-12-15 um (8-12 um) in size of the bone marrow’s ability to produce enough red
-each rubricyte gives rise to 2 metarubricytes blood cells. Importance of reticulocyte count:
-the last cell division during maturation • Help find out the cause of anemia, after an
abnormal blood test
A. Nucleus: • Find out whether bone marrow is functioning
-round and smaller than prorubricyte and usually properly
eccentric • Monitor response to a treatment, such as treatment
-thick nuclear membrane for specific types of anemia
-chromatin is coarse and irregular • Check bone marrow function after chemo or
-no nucleolus radiation therapy
B. Cytoplasm: • Monitor the function of bone marrow after a bone
-more abundant marrow transplant
-varied spectrum of blue color as hemoglobin is -after nuclear expulsion, retics are retained in the
synthesized bone marrow for 2- 3 days before release to the
-polychromasia (opaque violet blue color) peripheral blood circulation
-8-10 um in size
A. Cytoplasm:
METARUBRICYTE (Orthochromatophilic Erythroblast / -pinkish and reddish brown
Orthochromatic or Orthochromatophilic normoblast) -contains residual RNA which can be stained
-the last nucleated erythrocyte stage supravitally using Methylene blue/Brilliant Cresyl blue
-fully hemoglobinated cell -demonstrable as network of bluish granules
-constitutes 50% of nucleated cells in the bone (RETICULUM NETWORK)
marrow
A. Nucleus: MATURE ERYTHROCYTE
-small and shrunken -mature RBC
-pyknotic (dense mass of degenerated chromatin) -6.2-8.2 um (average 7.2) in size
-round and usually eccentric 18 -cytoplasm – assumes biconcave disc shape
B. Cytoplasm: (biconcave)
-pale-blue-gray-violet polychromatophilic to pinkish -central pallor – central pale area corresponding to
(distinguishing feature) the indentation of biconcave disc
-hemoglobin is the main constituent -life span – 100 ± 20 days
-becomes orange red as in adult erythrocytes -contains no mitochondria (neither CHONS nor Hb is
synthesized)