EYE ON DIAGNOSTICS: Does a high WBC count signal infection?

January 2005 
Volume 35  Number 1
Pages 20 - 21
  PDF Version Available!


  • Normal or not?

  • The bands march in

  • Which patient has an infection?

  • The end of the story



  • Table. A closer look...

    THE WHITE BLOOD CELL (WBC) count can indicate disorders such as an infection or inflammation. But taken alone, the WBC count may have little value unless you correlate it to the patient's clinical condition and analyze the WBC differential—the percentage of different WBC types. (See A closer look at white blood cells .) Here, we'll discuss how the WBC differential helps you assess your patient's condition.

    Normal or not?

    Normally the total WBC count for an adult ranges from 5,000 to 10,000/mm 3 . Leukocytosis (WBC > 10,000/mm 3 ) can indicate infection, inflammation (possibly from allergies), tissue damage or burns, dehydration, thyroid storm, leukemia, stress, or steroid use. The degree of leukocytosis depends on the severity of the disorder, the patient's age and general health, and bone marrow health.

    In contrast, leukopenia (WBC < 4,000/mm 3 ) can indicate a viral infection or some bacterial infections, including overwhelming ones; bone marrow failure; collagen or vascular diseases such as lupus; liver or spleen disease; radiation; drug toxicity; autoimmune disease; or dietary deficiency, such as vitamin B 12 deficiency.

    But the total WBC count tells only part of the story. To get the full picture, you must also evaluate the differential count, which varies during the course of an infection.

    The bands march in

    When the body responds to an acute infection, many immature WBCs, called bands , develop. Normally making up 3% to 5% of WBCs, bands circulate for about 6 hours before they mature to segmented neutrophils (segs), so-called because of the appearance of their nuclei.

    Early in an infection, ...

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