White blood cell Types

White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of Overview
the immune system that are involved in protecting the body against both infectious All white blood cells are nucleated, which distinguishes them from the anucleated red
disease and foreign invaders. All white blood cells are produced and derived blood cells and platelets. Types of leukocytes can be classified in standard ways. Two
frommultipotent cells in the bone marrow known as hematopoietic stem cells. Leukocytes are pairs of broadest categories classify them either by structure
found throughout the body, including theblood and lymphatic system. (granulocytes or agranulocytes) or by cell lineage (myeloid cells or lymphoid cells). These
All white blood cells have nuclei, which distinguishes them from the other blood cells, the broadest categories can be further divided into the five main
anucleated red blood cells (RBCs) andplatelets. Types of white blood cells can be classified types: neutrophils,eosinophils, basophils, lymphocytes, and monocytes. These types are
in standard ways. Two pairs of broadest categories classify them either by structure distinguished by their physical and functional characteristics. Monocytes and neutrophils
(granulocytes or agranulocytes) or by cell division lineage (myeloid cells or lymphoid cells). are phagocytic. Further subtypes can be classified.
These broadest categories can be further divided into the five main
types: neutrophils, eosinophils, basophils, lymphocytes, and monocytes. These types are Granulocytes are distinguished from agranulocytes by their nucleus shape (lobed versus
distinguished by their physical and functional characteristics. Monocytes and neutrophils round, that is, polymorphonuclear versus mononuclear) and by their
are phagocytic. Further subtypes can be classified; for example, among lymphocytes, there cytoplasm granules (present or absent, or more precisely, visible on light microscopy or
are B cells, T cells, and NK cells. not thus visible). The other dichotomy is by lineage: Myeloid cells
(neutrophils, monocytes, eosinophils and basophils) are distinguished from lymphoid cells
The number of leukocytes in the blood is often an indicator of disease, and thus the WBC (lymphocytes) by hematopoietic lineage (cellular
count is an important subset of thecomplete blood count. The normal white cell count is differentiation lineage). Lymphocytes can be further classified as T cells, B cells, and
usually between 4 and 11 109/L. In the US this is usually expressed as 4,00011,000 white natural killer cells.
blood cells per microliter of blood. They make up approximately 1% of the total blood volume
in a healthy adult, making them substantially less numerous than the RBCs at 40% to 45%.
However, this 1% of the blood makes a large difference to health, because immunity depends
on it. An increase in the number of leukocytes over the upper limits is called leukocytosis. It is Neutrophil
normal when it is part of healthy immune responses, which happen frequently. It is occasionally
abnormal, when it is neoplastic orautoimmune in origin. A decrease below the lower limit is
called leukopenia. It weakens the immune system. Neutrophils are the most abundant white blood cell, constituting 60-70% of the
circulating leukocytes. They defend against bacterial orfungal infection. They are usually
first responders to microbial infection; their activity and death in large numbers forms pus.
They are commonly referred to as polymorphonuclear (PMN) leukocytes, although, in the
Etymology technical sense, PMN refers to all granulocytes. They have a multi-lobed nucleus, which
consists of three to five lobes connected by slender strands. This gives the neutrophils the
The name "white blood cell" derives from the physical appearance of a blood sample appearance of having multiple nuclei, hence the name polymorphonuclear leukocyte. The
after centrifugation. White cells are found in the buff, a thin, typically white layer of nucleated cytoplasm may look transparent because of fine granules that are pale lilac when stained.
cells between the sediment red blood cells and the blood plasma. The scientific Neutrophils are active in phagocytosing bacteria and are present in large amount in the
term leukocyte directly reflects its description. It is derived from the Greek roots leuk- meaning pus of wounds. These cells are not able to renew their lysosomes (used in digesting
"white" and cyt- meaning "cell". The buffy coat may sometimes be green if there are large microbes) and die after having phagocytosed a few pathogens. Neutrophils are the most
amounts of neutrophils in the sample, due to the heme-containing enzyme common cell type seen in the early stages of acute inflammation. The life span of a
myeloperoxidase that they produce. circulating human neutrophil is about 5.4 days.

Eosinophil
Eosinophil compose about 2-4% of the WBC total. This count fluctuates
throughout the day, seasonally, and during menstruation. It rises in response to allergies,
parasitic infections, collagen diseases, and disease of the spleen and central nervous
system. They are rare in the blood, but numerous in the mucous membranes of the
respiratory, digestive, and lower urinary tracts.
They primarily deal with parasitic infections. Eosinophil are also the predominant inflammatory
cells in allergic reactions. The most important causes of eosinophilia include allergies such as
asthma, hay fever, and hives; and also parasitic infections. They secrete chemicals that
destroy these large parasites, such as hook worms and tapeworms that are too big for any
one WBC to phagocytize. In general, their nucleus is bi-lobed. The lobes are connected by a
thin strand. The cytoplasm is full of granules that assume a characteristic pink-orange colour
with eosin staining.
Basophil
Basophils are chiefly responsible for allergic and antigen response by releasing the
chemical histamine causing the dilation of blood vessels. Because they are the rarest of the
white blood cells (less than 0.5% of the total count) and share physicochemical properties with
other blood cells, they are difficult to study. They can be recognized by several coarse, dark
violet granules, giving them a blue hue. The nucleus is bi- or tri-lobed, but it is hard to see
because of the number of coarse granules that hide it.
They excrete two chemicals that aid in the body's defences: histamine and heparin. Histamine
is responsible for widening blood vessels and increasing the flow of blood to injured tissue. It
also makes blood vessels more permeable so neutrophils and clotting proteins can get into
connective tissue more easily. Heparin is an anticoagulant that inhibits blood clotting and
promotes the movement of white blood cells into an area. Basophils can also release chemical
signals that attract eosinophil and neutrophils to an infection site.
Lymphocyte
Lymphocytes are much more common in the lymphatic system than in blood.
Lymphocytes are distinguished by having a deeply staining nucleus that may be eccentric in
location, and a relatively small amount of cytoplasm. Lymphocytes include:
B cells make antibodies that can bind to pathogens, block pathogen invasion, activate
the complement system, and enhance pathogen destruction.
T cells:
CD4+ helper T cells: T cells displaying co-receptor CD4 are known as CD4+ T
cells. These cells have T-cell receptors and CD4 molecules that, in combination,
bindantigenic peptides presented on major histocompatibility complex (MHC)
class II molecules on antigen-presenting cells. Helper T cells make cytokines and
perform other functions that help coordinate the immune response.
In HIV infection, these T cells are the main index to identify the individual's
immune system integrity.
CD8+ cytotoxic T cells: T cells displaying co-receptor CD8 are known as CD8+
T cells. These cells bind antigens presented on MHC I complex of virus-infected
or tumour cells and kill them. Nearly all nucleated cells display MHC I.
T cells possess an alternative T cell receptor (different from the TCR found
on conventional CD4+ and CD8+ T cells). Found in tissue more commonly than
in blood, T cells share characteristics of helper T cells, cytotoxic T cells, and
natural killer cells.
Natural killer cells are able to kill cells of the body that do not display MHC class
I molecules, or display stress markers such as MHC class I polypeptide-related
sequence A(MIC-A). Decreased expression of MHC class I and up-regulation of MIC-
A can happen when cells are infected by a virus or become cancerous.
Monocyte
Monocytes, the largest type of WBCs, share the "vacuum cleaner" (phagocytosis)
function of neutrophils, but are much longer lived as they have an extra role: they present
pieces of pathogens to T cells so that the pathogens may be recognized again and killed.
This causes an antibody response to be mounted. Monocytes eventually leave the
bloodstream and become tissue macrophages, which remove dead cell debris as well as
attack microorganisms. Neither dead cell debris nor attacking microorganisms can be dealt
with effectively by the neutrophils. Unlike neutrophils, monocytes are able to replace
their lysosomal contents and are thought to have a much longer active life. They have the
kidney shaped nucleus and are typically a granulated. They also possess abundant
cytoplasm.
Once monocytes move from the bloodstream out into the body tissues, they undergo
changes (differentiate) allowing phagocytosis and are then known as macrophages.
Fixed leucocytes Neutropenia
Neutropenia can be acquired or intrinsic. A decrease in levels of neutrophils
on lab tests is due to either decreased production of neutrophils or increased removal
Some leucocytes migrate into the tissues of the body to take up a permanent from the blood.The following list of causes is not complete.
residence at that location rather than remaining in the blood. Often these cells have
specific names depending upon which tissue they settle in, such as fixed macrophages in
Medications - chemotherapy, sulfas or other antibiotics,
the liver, which become known as Kupffer cells. These cells still serve a role in the immune
phenothiazenes, benzodiazepines, antithyroids, anticonvulsants, quinine, quinidine,
system.
indomethacin, procainamide, thiazides
Radiation
Histiocytes
Toxins - alcohol, benzenes
Dendritic cells (Although these will often migrate to local lymph nodes upon
Intrinsic disorders - Fanconi's, Kostmann's, cyclic neutropenia, Chediak-Higashi
ingesting antigens)
Immune dysfunction - disorders of collagen, AIDS, rheumatoid arthritis
Mast cells
Blood cell dysfunction - megaloblastic anemia, myelodysplasia, marrow failure,
Microglia
marrow replacement, acute leukemia
Any major infection
Disorders Miscellaneous - starvation, hypersplenism
The two commonly used categories of white blood cell disorders divide
them quantitatively into those causing excessive numbers (proliferative disorders) and those
causing insufficient numbers (leukopenias).[12] Leukocytosis is usually healthy (e.g., fighting Symptoms of neutropenia are associated with the underlying cause of the decrease in
an infection), but it also may be dysfunctionally proliferative. WBC proliferative disorders can neutrophils. For example, the most common cause of acquired neutropenia is drug-
be classed as myeloproliferative andlymphoproliferative. Some are autoimmune, but many induced, so an individual may have symptoms of medication overdose or toxicity.
are neoplastic. Treatment is also aimed at the underlying cause of the neutropenia. One severe
Another way to categorize disorders of white blood cells is qualitatively. There are various consequence of neutropenia is that it can increase the risk of infection.
disorders in which the number of white blood cells is normal but the cells do not function
normally.[13]
Neoplasia of WBCs can be benign but is often malignant. Of the various tumors of the blood
Lymphocytopenia
and lymph,cancers of WBCs can be broadly classified as leukemias and lymphomas, although Defined as total lymphocyte count below 1.0x10 9/L, the cells most commonly
those categories overlap and are often grouped as a pair. affected are CD4+ T cells. Like neutropenia, lymphocytopenia may be acquired or intrinsic
and there are many causes. This is not a complete list.
Leucopenias
A range of disorders can cause decreases in white blood cells. This type of white blood Inherited immune deficiency - severe combined immunodeficiency, common variable
cell decreased is usually the neutrophil. In this case the decrease may be calledneutropenia or immune deficiency, ataxia-telangiectasia, Wiskott-Aldrich syndrome,
granulocytopenia. Less commonly, a decrease in lymphocytes (called lymphocytopenia or immunodeficiency with short-limbed dwarfism, immunodeficiency with
lymphopenia) may be seen. thymoma, purine nucleoside phosphorylase deficiency, genetic polymorphism
Blood cell dysfunction - aplastic anemia
 Infectious diseases - viral (AIDS, SARS, West Nile Conditions with normally functioning neutrophils hereditary neutrophilia,
encephalitis, hepatitis, herpes, measles, chronic idiopathic neutrophilia
others), bacterial (TB, typhoid, pneumonia, rickettsiosis, ehrlichiosis, sepsis),parasiti PelgerHuet anomaly
c (acute phase of malaria) Down syndrome
Medications - chemotherapy (antilymphocyte globulin Leukocyte adhesion deficiency
therapy, alemtuzumab, glucocorticoids)
Familial cold urticaria
Radiation
Leukemia (chronic myelogenous (CML)) and other myeloproliferative disorders
Major surgery
Surgical removal of spleen
Miscellaneous - ECMO, kidney or bone marrow transplant, hemodialysis, kidney
failure, severe burn, celiac disease, severe acute pancreatitis, sarcoidosis, protein-
losing enteropathy, strenuous exercise, carcinoma
Immune dysfunction - arthritis, systemic lupus erythematosus, Sjogren Secondary causes
syndrome, myasthenia gravis, systemic vasculitis, Behcet-like
syndrome, dermatomyositis,granulomatosis with polyangiitis Infection
Nutritional/Dietary - alcohol abuse, zinc deficiency Chronic inflammation especially juvenile rheumatoid arthritis, rheumatoid
Like neutropenia, symptoms and treatment of lymphocytopenia are directed at the arthritis, Still's disease, Crohn's disease, ulcerative colitis, granulomatous infections
underlying cause of the change in cell counts. (for example,tuberculosis), and chronic hepatitis
Cigarette smoking occurs in 2550% of chronic smokers and can last up to 5 years
Proliferative disorders after quitting
Stress exercise, surgery, general stress
An increase in the number of white blood cells in circulation is
called leukocytosis. This increase is most commonly caused by inflammation.[12] There Medication induced corticosteroids (for example, prednisone, -agonists, lithium)
are four major causes: increase of production in bone marrow, increased release from Cancer either by growth factors secreted by the tumor or invasion of bone marrow
storage in bone marrow, decreased attachment to veins and arteries, decreased uptake by the cancer
by tissues.[12]Leukocytosis may affect one or more cell lines and can be neutrophilic, Increased destruction of cells in peripheral circulation can stimulate bone marrow.
eosinophilic, basophilic, monocytosis, or lymphocytosis. This can occur in hemolytic anemia and idiopathic thrombocytopenic purpura

Neutrophilia
Neutrophilia is an increase in the absolute neutrophil count in the peripheral
circulation. Normal blood values vary by age. Neutrophilia can be caused by a direct problem
with blood cells (primary disease). It can also occur as a consequence of an underlying disease
(secondary). Most cases of neutrophilia are secondary to inflammation.

Primary causes
Eosinophilia
A normal eosinophil count is considered to be less than 0.65109/L.Eosinophil counts
are higher in newborns and vary with age, time (lower in the morning and higher at night),
exercise, environment, and exposure to allergens. Eosinophilia is never a normal lab finding.
Efforts should always be made to discover the underlying cause, though the cause may not
always be found.

Counting and reference ranges

The complete blood cell count is a blood panel that includes the overall WBC
count and various subsets such as the absolute neutrophil count. Tests specify the typical
counts in healthy people.
 The symptoms of a UTI include:
What are leukocytes?
a frequent urge to urinate
A complete blood cell (CBC) test often includes a measurement of the level of leukocytes, or
a burning sensation when urinating
white blood cells (WBCs). Higher levels of leukocytes in the bloodstream may indicate an
cloudy or pink-tinted urine
infection. This is because WBCs are part of the immune system, and they help fight off disease
and infection. strong smelling urine
pelvic pain, especially in women
Leukocytes may also be found in a urinalysis, or a urine test. High levels of WBCs in your urine
also suggest that you have an infection. In this case, your body is trying to fight off an infection
somewhere in your urinary tract. Usually, that means the bladder or the urethra, which is the Obstructions in the urinary tract can cause a range of symptoms depending on the location
tube that carries urine from the bladder. Leukocytes in the urine could also suggest a kidney and type of obstruction. In most cases, the main symptom is pain on one or both sides of
infection. the abdomen. Kidney stones may cause similar symptoms as a UTI but may also include
nausea, vomiting, and intense pain.
Why do they appear?
Infections or obstruction in the urinary tract or bladder may cause you to have an increased
Who is at an increased risk?
amount of leukocytes in your urine. Women tend to be a greater risk for urinary tract infections, and, therefore, more likely to
Infections may be more severe if youre pregnant, which increases the odds of developing have leukocytes in their urine. Pregnant women have an even higher risk. Men can
problems such as urinary tract infections (UTIs). If youre pregnant and have an infection in develop these infections, too. Having an enlarged prostate, for example, raises the risk of
your urinary tract, its important to receive treatment because it could complicate your UTIs in men.
pregnancy. Anyone who has a compromised immune system may also be at higher risk for any type
Youre at risk for developing a bacterial infection in your bladder if you hold your urine too long of infection.
before relieving yourself. Repeatedly holding in urine can stretch the bladder too much. Over
time, that makes your bladder less likely to empty fully when you go to the bathroom. When Diagnosis
urine remains in the bladder, it raises the chances that bacteria will increase in number, which
If youre healthy, you can still have elevated leukocytes in your bloodstream and urine. A
may lead to a bladder infection. Uncomplicated cystitis is another name for a urinary infection
normal range in the bloodstream is between 4,500-11,000 WBCs per microliter. A normal
thats limited to the bladder in healthy people who arent pregnant.
range in the urine is lower than in the blood, and may be from 0-5 WBCs per high power
Kidney stones, a tumour in the pelvis, or some other type of blockage in the urinary tract may field (wbc/hpf).
also cause more leukocytes to appear.
If your doctor suspects you have a UTI, theyll likely ask you to provide a urine sample.
Theyll test the urine sample for:
Symptoms
WBCs
Leukocytes in urine dont necessarily cause symptoms on their own. If you do have
red blood cells
leukocytes in your urine, your symptoms will vary depending on the condition that is causing
bacteria
the leukocytes to build up in your urine.
other substances
Youre bound to have a few WBCs in your urine even when youre healthy, but if a urine
test identifies levels above 5 wbc/hpf, its likely you have an infection. If bacteria are
detected, your doctor may perform a urine culture to diagnose the type of bacterial
infection you have.
A urine test can also aid in the diagnosis of kidney stones. An X-ray or CT scan can help
your doctor see the stones.
If the blockage occurs due to a tumor, treatment options may also include surgery,
chemotherapy, or radiation.
Outlook
If diagnosed early and treated thoroughly, UTIs usually clear up in a short amount of time.
Kidney stones are also treatable. Benign tumors or other growths in the urinary tract may
also be treated, but they may require surgery and recovery time.

Cancerous growths may require longer-term treatment, as well as monitoring to watch for
Treatment the spread of cancer to other parts of the body.

Your treatment will depend on the cause of your elevated leukocyte levels in your urine. Prevention
Treatment for urinary tract infections One of the easiest ways to help keep your urinary tract free of infections or kidney stones
is to stay hydrated. Drink several glasses of water per day, but talk with your doctor about
If youre diagnosed with any type of bacterial infection, your doctor will most likely advise
what amount of water is best for you. If youre frail or you have a condition such as heart
you to take antibiotics. If this is the first time youve had a UTI or if you get UTIs
failure, your doctor may recommend that you limit your fluid intake. If youre active or
infrequently, then a short-term course of antibiotics is appropriate.
pregnant, you may need to drink more water every day.
If you get recurrent UTIs, your doctor may prescribe a longer course of antibiotics and further
Eating cranberries and drinking cranberry juice may help lower your risk of developing
testing to see if there are specific reasons for repeat infections. For women, taking an antibiotic
UTIs. That is because a substance in cranberries may help protect your bladder and make
after sexual intercourse may be helpful, but you should only take prescription medications as
it more difficult for certain bacteria to stick to your urinary tract.
recommended by your doctor.

In addition to antibiotics, increasing your fluid intake can help flush out a UTI. Drinking more
water may seem unappealing if urinating is painful, but it can help speed up the healing
process.

Obstructions
If an obstruction, such as a tumor or kidney stone, is causing the high leukocyte levels, you
may need a surgical procedure.

If you have small kidney stones, increasing the amount of water you drink can help flush them
out of your system. Passing stones is often painful.

Sometimes, larger stones are broken up using sound waves. Surgery may also be necessary
to remove large kidney stones.
Causes of Leukocytes in Urine
It is common to find white blood cells and protein in the urine when pregnant. There
may be increased leukocyte counts as well as proteins entering from the vagina. It
may be a bladder infection if high levels are persistent.
Kidney infections may increase the number or leukocytes in urine. These infections
begin in a persons urinary tract before spreading to the kidneys. This is more common
in those who use catheters or have weak immune systems.
Excess leukocyte secretion may be due to cystitis (inflammation) or bladder
infections.
Urinary system blockage can lead to blood in urine (hematuria), because of
unwanted foreign bodies within the urinary tract or prostate hypertrophy, bladder or
kidney stones, pelvic tumors, or trauma.
Bacteria may also be transferred to a persons urethra via sexual intercourse,
leading to infection and presence of white blood cells.
If you hold your urine too long, your bladder can overstretch and weaken. This may
lead to the inability to completely empty the bladder and a bacterial infection.
Treatments for Leukocytes in Urine
Begin by drinking more fluids so the infection flushes out of the system. Even if you
are experiencing pain during urination, take steps to avoid dehydration as it will only
worsen the problem. Instead, aim to drink at least 2 liters (or 5 large glasses) each
day.
In cases where antibiotics are necessary, your doctor will pick one the infection is
sensitive to. The antibiotic selected will depend on your medical history and local
guidelines as well as any allergies or side effects youve previously experienced from
antibiotics.
You will take the antibiotics for three to seven days based on the infection severity and
a history of diabetes or kidney disease. In some severe cases, intravenous antibiotics
are necessary.
Leukocytes in a Stool
Your doctor will use your stools as an important diagnostic tool for diagnosing digestive
tract disorders. Most of the time, stools should not contain blood cells of any kind. The
presence of leukocytes in stool samples may indicate a problem of the gastrointestinal
tract. The lab usually quantifies the number of leukocytes in stool as few, moderate, or
many, with specific values varying slightly between labs.
Few Leukocytes
In most cases, a lack of leukocytes in a stool sample indicates diarrhea caused by a
virus, such as the infectious Norovirus. It is also possible to see no leukocytes in cases
of diarrhea and cholera from E. coli or other parasites. If there are red blood cells, but no
white blood cells in the stool, then the patient may have amebiasis.
Moderate Leukocytes
Moderate numbers of white blood cells can indicate a pathogenic infection in the
digestive tract. Bacillary dysentery, or shigellosis, is one common cause for leukocytes
in stools or watery diarrhea and this is typically due to contamination of a feco-oral nature.
Symptoms include diarrhea, vomiting, body ache, stomach cramps, and fever.
Many Leukocytes
If there are many leukocytes, this typically indicates a severe infection of the intestinal
tract, such as typhoid. In the case of typhoid fever, you will mostly find monocytes in the
stool and experience fever as well as abdominal pain. Untreated shigellosis and invasive
E. coli infections may also lead to high leukocyte levels. Frequently, a count between
moderate and many will lead to a temporary diagnosis of salmonellosis or shigellosis.
Gastroenteritis may also be a cause.