Do You Know Your WBCs!
Know Your WBCs!
Part of the diagnosis, treatment, & management of patients' medical condition is the tally and examination of their WBCs. Incorporating such metrics offers valuable information about patients' status, condition, and response to treatment. This is especially true if infection, allergy, immunosuppression, or neoplasm is being considered. By collecting and examining bone marrow (the spongy tissue inside some of our larger bones), these two procedures can show whether our bone marrow is healthy and making normal amounts of blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases, including some cancers, as well as fevers of unknown origin.
Cells: All blood cells originate from a small number of "undeveloped, precursor cells called Pluripotent stem cells in the red bone marrow of the flat, irregular bones, ribs, vertebrae, sternum, and pelvis. In a differentiating process called hematopoiesis, these precursor cells will become any type of blood cell: red, white, and platelets.
WBCs: B and T Lymphocytes or Leukocytes accounts only for about 1% of the blood volume. From the original stem cell, there are five types of WBCs that develop and differentiate from the original one, the Granulocytes (Neutrophils, Eosinophils, Basophils), the Lymphocytes, & the Monocytes. Their major function is to fight infection, but each with a different and unique defining characteristics.
A. Granulocytes: WBCs with chemical containing granules in their cytoplasm. These granules contain powerful digestive enzymes capable of killing microorganisms and then catabolizing debris during phagocytosis. There are three types of granulocytes: Neutrophils, Eosinophils, and Basophils
A.1 - Neutrophils - Such leukocytes account for up to 60% - 70% of the total WBCs in circulation. These are the first responders to any tissue damage (infection, stressful event, or inflammatory reaction). Because of the shape of their nucleus, mature neutrophils are referred to as "segs", whereas immature neutrophils are called "bands". In severe acute infection or inflammation, the bone marrow cannot keep up with the body's need for segs, so it releases the bands. They must be quick since they live only for 4 days to phagocytize bacteria. Referred to as the "Left Shift" if a laboratory test shows a high number of bands in circulation. This is an indication of bacterial infection, with its degree of severity measured by the rate of increase of its bands in numbers.
A-2 - Eosinophils: Up to 3% of the total WBCs, these are mainly active in response to histamine. These are released during allergic reactions (asthma) and parasitic infections.
A-3 - Basophils: Up to 1% of the total WBCs - they are released by the bone marrow in response to many inflammatory reactions, especially parasitic infection. These typically leave the bloodstream, enter the tissue affected, and then transfrom into mast cells capable of releasing histamine and heparin.
B. Lymphocytes: About 30% to 40% of the total WBCs, these are the primary cells of immune response to include T cells and B cells. Their main objective is to fight chronic bacterial infection and acute infections. Lymphocytosis is an increase in lymphocytes within the bloodstream.
C. Monocytes: About 3% to 7% of the total circulating WBCs, their mission is to leave the circulation and enter tissue from the bloodstream. Found in large quantities in the spleen and other organs, they mature into macrophages. In the phagocytosis stage, these macrophages are the first responders of our innate immune system to defend against an antigen. In using its many lysosomal enzymes to digest the antigen, the monocyte a) moves out of the capillary pore to attack the bacteria, and b) engulfs and captures the antigen, by c) releasing lysosomal enzymes (lysosomes which contain enzymes) to digest the antigen.
Blood Test: At time of your blood test, the complete blood cell (CBC) count is ordered and drawn, in order to measure the volume of leukocytes present in 1 mm3 of venous blood. Other indexes related to red cells and platelets are also measured and reported.
Bone Marrow Biopsy & Aspiration: Human bone marrow is normally the site for the genesis of most of our blood cells - a white- walled nursery of fresh (young) blood. The doctor drives the steel needle (the length of an index finger) through the rim, and into the outer furl of the patient's pelvic bone. Previously numbed with a pulse of anesthetic, the doctor pulls the marrow - a few milliliters of red spongy tissue
When a CBC with differential count is ordered, the differential count to the panel provides the clinician with more specific diagnostic data like the number, variety, and concentration of each type of leukocyte. The differential measures the % of each type of leukocyte present in the same specimen - for a total of 100%. The normal WBC count in absolute number is up to 10,000 for a differential of 100%.
By collecting and examining bone marrow (the spongy tissue inside some of our larger bones), these two procedures can show whether our bone marrow is healthy and making normal amounts of blood cells. Doctors use these procedures to diagnose and monitor blood and marrow diseases, including some cancers, as well as fevers of unknown origin. The total number of total leukocytes varies - different illnesses at different tally. In cancers, the main problem is that cells refuse to stop growing. In others, the problem is compounded by cells refusing to grow (Mukherjee, 201).
For example, the Myelodysplastic Syndrome or MDS is a preleukemic syndrome, affecting the bone marrow and blood. A term used to describe disorders of the stem cells in the bone marrow, it is a mysterious disease with few known treatments. Here, the bone-marrow cells acquire genetic mutations, resulting in uncontrollable growth. As a result, all or part of the bone marrow hematopoiesis is disorderly and ineffective. Differentiation of all or one category of precursor stem cells into committed cell lines is impaired. The cells fail to mature into blood. Dying in droves, the patient suffers deficient numbers of all blood cells or one type of blood cell: WBCs, RBCs or Platelets.
For Differential Count Reactions -
Leukocytosis - A WBC count above 11,000/uL usually indicates infection, inflammation, leukemia, or tissue necrosis. A leukemoid reaction is leukocytosis in excess of 50,000/uL caused by serious conditions other than leukemia such as sepsis, the WBC count will reach extremely high levels.
Leukopenia - A WBC count of less than 4,000/uL usually indicates leukopenia. This is a general term to describe a decrease in all types of WBCs. Leukopenia increases the risk of infection, decreases signs of infection, and diminishes healing ability. This would indicate bone marrow failure such as in chemotherapy and radiation therapy, during an overpowering infection. Even when WBC count drop below normal, the person is more at risk for infection.
Filgrastim (Neupogen) is a stimulant of the bone marrow that can increase leukocyte synthesis, specifically neutrophils. For a WBC count of less than 2,000, precautions for immunosuppression may be needed.
Laboratory Tests for Hematologic Cancer: Complete blood count (CBC) with differential is an important initial diagnostic test to identify which specific type of WBC is causing the neoplastic disorder. A bone marrow aspiration (also known as bone marrow biopsy), the Fluorescence in-situ hybridization (FISH) is used to analyze cells for chromosome defects.
Abnormal Differential tests: Abnormal test results may offer clinical significance to include the following:
Neutrophils Differential: Neutrophilia is the term used for neutrophil predominance in the WBCs - defined as neutrophil count above 7,700/uL in patients with a total WBC count of fewer than 11,000/uL. This is evidence of bacterial infection, inflammation, malignancy, physical or emotional stress, or metabolic disorders. Leukemia significance is prevalent at extremely high counts. Neutropenia is the term used for the lack of sufficient number of neutrophils. Considered the most frequent kind of leukopenia, it is diagnosed in patients with fewer than 1,500 neutrophils/uL. Decreased count is evidence of response to radiation therapy, chemotherapy, viral infection, or prolonged infection. Due to medications such as nonsteroidal anti-inflammatory drugs, vancomycin, phenytoin and furosemide, patients require protective isolation at count less than 1,000. Bandemia is the term used for the increase in the count of immature neutrophils in the bloodstream. Evidence of severe bacterial infections, it is a measure of how responsive the body must be to quickly replace the mature ones with immature forms.
Lymphocytes Differential: Lymphocytosis is the term used for the increase in the count of lymphocytes. This is evidence of chronic bacterial infections, like viral infections (such as mumps and mononucleosis), leukemia, rheumatoid arthritis, multiple myeloma, and hepatitis. Lymphocytopenia is the term used for the decrease in the count of lymphocytes. This is evidence of leukemia, sepsis, lupus erythematosus, radiation therepy, & immuno- deficiency diseases such as HIV.
Monocytes Differential: Monocytosis is the term used for the increase in the count of monocytes. This is evidence of chronic inflammatory disorders (such as ulcerative colitis), infectious mononucleosis and tuberculosis. Monocytopenia is the term used for the decrease in the count of monocytes, in response to prednisone therapy, or caused by aplastic anemia or leukemia.
Eosinophil Differential: Eosinophilia is the term used for the decrease in the total count of eosinophil. This is evidence of parasitic infections, allergic reactions, asthma, eczema, autoimmune diseases or leukemia. Eosinopenia is the term used for the decrease in the total count of eosinophil, as evidence of increased adreno-steroid production
Basophils Differential: Basophilia is the term used for the increase in the total count of basophils, as related to myeloproliferative disorders such as polycythemia or leukemia. Basophinia is the term used for the decrease in the total count of basophils, in reaction to acute allergic reactions of hyperthyroidism or stress
Bone Marrow Transplant: As treatments for hematologic cancers, doctors secured bone marrow stem cell transplants.
In so called Allogeneic Hematologic Stem Cell transplants, healthy bone marrow cells are harvested from the donor of matching tissue type to the recipient. Successful donor's healthy bone marrow cells replace the recipient's cancerous bone marrow. Main rejections abound.
In so called Autologous Hematologic Stem Cell transplants, this involves the extraction of healthy hematopoietic stem cells from the patient, followed by the storage of these harvested cells in a freezer. The patient is then treated with high-dose chemotherapy w/ or w/o radiation so to destroy the patients' malignant cells. After a complete or partial bone marrow transplant, these harvested healthy stem cells are returned, as to replace the destroyed tissue. The end-result is to resume the patients' normal blood cell production.
Side Note: A Muscular Response to Diabetes: More than half of Americans to be diagnosed with diabetes this year are between age 45 and 64. So it is essential to act quickly after diagnosis, in order to better manage one's long-term health.
No Need for Specialist: According to Medha N. Munshi, M.D., it is critical to consult first with your primary care doctor. At this early-onset stage, what's really important is to adopt lifestyle changes, mainly one's diet and exercise. In this phase of the primary care setting, diabetics ought to consult with a dietitian and exercise physiologist. Otherwise, patients of 10, 15, or 20 years diagnosis are left with no relevant knowledge and no understanding of such lifestyle changes (Hurlock, 2018).
Protection from diabetes complications: Contrary to high blood pressure or cholesterol, one cannot treat diabetes with a pill. Rather, a change in lifestyle is more pertinent. There are enough evidence that a protocol of healthy diet and exercise will lessen the odds (chances) of developing diabetes (prediabetes range) or complications (diabetes range). The key is a combination of diet modification with exercise. Losing weight simply through dieting is not sufficient, as you are losing not just fat but also muscle. Hence, exercise is critical. Even a 5 to 7% weight loss would lessen the risk of developing diabetes from prediabetes (Hurlock, 2018).
Muscle Loss is contra-indication for diabetes: Sarcopenia is the process of muscle loss while aging - a natural element of such process. As one gets older, it becomes not only hard to build but also to maintain muscle. Henceforth, managing diabetes with diet restrictions only does lead to further decline in muscle mass. In turn, low muscle mass results in a spike in insulin resistance, hence, increased glucose levels. This is in addition to the ill-effects of lower muscle mass like lower energy as well as increased balance problems. All combined would increase the risk of falls (Hurlock, 2018).
Best Protocol to Treat Diabetes: There is no one approach to treat diabetic patients. Patients must work closely with their physicians to find the right approach. In situations like being in for surgery, whether hip replacement or heart bypass, the diabetic patient is getting treated for blood sugar (four insulin injections a day) as well as for post-op care. As a result, the patient is discharged while maintaining such high level of medication, albeit unnecessary. Such level of treatment might place the patient at a high risk of hypoglycemia (low blood sugar), leading to bad outcomes. Such condition is further compounded by other comorbidities. Simply stated, diabetes is a serious health condition, whereas the treatment plan may not be the best regimen for diabetes, though the best one for the patient (Hurlock, 2018).
References:
Hurlock, Healther. (2018, August/September). HealthyYou: Q&A - A Muscular Response to Diabetes. AARP Real Possibilities. www.aarp.org/magazine, Vol. 61, No. 5A, p. 26
Mukherjee, Siddhartha. (2016, May 15). The Health Issue: The New Anatomy of Cancer. NY Times Magazine.
Pathophysiology for the Health Professions
Pathophysiology: The Biologic Basis for Disease in Adults and Children
MedlinePlus: Blood Differential
MedlinePlus; WBC Count
National Library of Medicine, WBC Count
Mosby's Manual of Diagnostic and Laboratory Tests