The Different Types of White Blood Cells

White blood cells (WBCs) circulate in the blood to help protect the body against infections, but also have a role in inflammation and allergic responses. There are various types of white blood cells and each of them can give us a lot of information around whether the infection or inflammatory response is bacterial, viral, auto-immune, allergic, acute or chronic.

White blood cells make up approximately 1% of total blood volume in a healthy adult with a normal range of approximately 4 – 11 x 10^9/L. There are 5 types of white blood cells:

  • Neutrophils
    • Accounts for approximately 50 – 70% of WBCs with a normal range of 2.5 – 7.5 x 10^9/L
  • Lymphocytes
    • Accounts for approximately 20 – 40% of WBCs with a normal range of 1.0 – 3.0 x 10^9/L
  • Monocytes
    • Accounts for approximately 2 – 10% of WBCs with a normal range of 0.2 – 1.0 x 10^9/L
  • Eosinophils
    • Accounts for approximately 1 – 6% of WBCs with a normal range of 0.02 – 0.5 x 10^9/L
  • Basophils
    • Accounts for approximately <1 – 2% of WBCs with a normal range of 0.02 – 0.1 x 10^9/L

WhiteBloodCells

The easiest way to remember the order of these white bloods cells from most abundant to least abundant within our body, is to remember this simple phrase: Never Let Monkeys Eat Bananas. In terms of normal values for each of these white blood cells? Pick a number somewhere in the middle of the normal percentage range that forms a pattern that is easy to remember, such as: 60% (Neutrophils), 30% (Lymphocytes), 6% (Monocytes), 3% (Eosinophils) and 1% (Basophils).

The different types of white blood cells are normally reported as percentages, because an increased percentage of one type will always result in a decreased percentage of another type. What does that mean? Let’s take a patient that has a white blood cell count of 10 x 10^9/L with the following breakdown:

  • Neutrophil count is 60%
  • Lymphocyte count is 30%
  • Monocyte, eosinophil and basophil count combined are 10%

These percentages are known as a differential count. When the actual number of each type of white blood cell is deduced from these percentages, it is known as an absolute count. Therefore, the patient in this example would have an absolute count of approximately:

  • 6 x 10^9/L neutrophils
  • 3 x 10^9/L lymphocytes
  • 1 x 10^9/L monocytes, eosinophils and basophils combined

The patient gets an infection and the white blood cell count increases to 20 x 10^9/L with the following breakdown:

  • Neutrophil count is 80% which would equate 16 x 10^9/L
  • Lymphocyte count is 15% which would equate 3 x 10^9/L
  • Monocyte, eosinophil and basophil count is 5% which would equate 1 x 10^9/L

The important thing to note here is that a decreased percentage for the lymphocytes, monocytes, eosinophils and basophils does not mean that the absolute count for each of these have decreased. It simply means that the increase in the overall white blood cell count is attributed purely to a rise in the absolute count of the neutrophils. As each type of white blood cell is related to a specific type of process within the body, this understanding allows us to gain further supportive evidence for a patient’s presentation.

Neutrophils are the first responders in acute inflammatory processes and can be altered as a result of:

Elevated Neutrophils

Decreased Neutrophils

  • Acute infections
    • Cocci, bacilli, fungi, viruses, parasites
    • Abscesses, tonsillitis, appendicitis, osteomyelitis, cholecystitis, meningitis, peritonitis
  • Severe, overwhelming infection in sepsis/septic shock

 

  • Non-infectious inflammation
    • Postoperative state, cardiopulmonary bypass, burns, trauma, acute asthma, myocardial infarction, acute gout, rheumatic fever, hypersensitivity reactions
  • Cancer or chemotherapy

 

  • Metabolic processes
    • Diabetic ketoacidosis, pre-eclampsia, uraemia
  • Autoimmune disorders

 

Lymphocytes consist of B cells, T cells and natural killer cells and can be altered as a result of:

Elevated Lymphocytes

Decreased Lymphocytes

  • Acute viral infections
    • Hepatitis, chicken pox, rubella, herpes, cytomegalovirus (CMV)
  • Infections
    • HIV, tuberculosis, influenza
  • Certain bacterial infections
    • Whooping cough
  • Bone marrow damage and immune deficiency
  • Cancer
  • Autoimmune disorders
    • Lupus, rheumatoid arthritis

Monocytes can differentiate in tissues to form macrophages, which are involved in phagocytosis similar to neutrophils. Elevated monocytes are usually associated with chronic rather than acute infections, such as tuberculosis, but can also be a result of:

  • Chronic inflammatory diseases
  • Parasitic infections
  • Viral infections
  • Auto immune disorders such as lupus and rheumatoid arthritis
  • Cancer

Eosinophils can be elevated as a result of:

  • Allergic reactions such as hay fever
  • Asthma
  • Skin inflammation such as eczema, dermatitis
  • Parasitic infections
  • Cancer

Basophils can be elevated as a result of:

  • Rare allergic reactions such as hives
  • Inflammatory conditions such as rheumatoid arthritis or ulcerative colitis
  • Cancer

So as you can see, each type of white blood cell will increase or decrease according to a specific process occurring within the body. By having an understanding of these relationships, we can get a lot more out of each white blood cell count we look at!

References

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3 thoughts on “The Different Types of White Blood Cells

  1. Hi!
    Good to see some new posts. Really enjoy reading and learning from them.

    Best regards
    Henrik Åberg
    ICU-nurse in a cardiothoracic ICU
    Sweden

    Like

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