White Blood Cell (WBC) Lab Values

Overview

1. White Blood Cells
   1. Normal Value Range
   2. Pathophysiology
   3. Special considerations
   4. Abnormal values (high)
   5. Abnormal values (low)

Nursing Points

General

1. Normal value range
   1. WBC
      1. 4500-10000/mcL
   2. Differential
      1. Neutrophils
         1. 40-60%
      2. Bands
         1. 3-5%
            1. >8% indicates signal to WBC for more production
            2. Infection or inflammation is severe
      3. Eosinophils
         1. 1-4%
      4. Basophils
         1. 0.5-1%
      5. Lymphocytes
         1. 20-40%
      6. Monocytes
         1. 2-8%
2. Pathophysiology
   1. WBC
      1. Formed in the bone marrow
      2. Responsible for responding to foreign invaders
         1. Creating antibodies (immunity)
         2. Phagocytosis (eating bacteria or fungi)
      3. Multiple types with different purposes
         1. Neutrophils –
            1. inflammation and first response to invader
         2. Eosinophils –
            1. Inflammation
            2. Allergic response
            3. Parasites
         3. Basophils
            1. Inflammation
            2. Allergic response
         4. Lymphocytes
            1. Create antibodies
            2. Recognize antigens
            3. Destroy cells
               1. T Cells
               2. B Cells
               3. Natural Killer cells
         5. Monocytes
            1. Macrophages
               1. Engulf and destroy invaders
            2. Indicative of infection
3. Special considerations
   1. Lavender top tube
   2. Will commonly be submitted for Complete Blood Count with differential
4. Abnormal lab values
   1. Increased White Blood Cell count (leukocytosis)
      1. Infection
      2. Inflammation
      3. Trauma/Stress
      4. Pregnancy
      5. Asthma
      6. Allergic Reaction
   2. Decreased lab values (leukopenia)
      1. Systemic Lupus Erythematosus (SLE)/Rheumatoid arthritis
      2. Cancers
      3. Chemotherapy/Radiation
      4. Medications
         1. Neutropenic precautions
            1. Masks
            2. Gloves
            3. Wash hands
            4. Consider yourself infectious
               1. Prevent spread of infection to the patient

Assessment

1. Consider the overall WBC count plus abnormalities in differential
   1. Evaluate patient
      1. Signs or symptoms of:
         1. Trauma
         2. Inflammation
         3. Infection

Therapeutic Management

1. Antibiotic therapies where indicated by infection (followed by cultures to determine efficacy of antibiotics)
2. Anti-inflammatories for inflammation
3. Provide neutropenic precautions when necessary

Nursing Concepts

1. Lab Values
2. Infection Control

Patient Education

1. Educate patient on the finishing any antibiotics completely. Do not stop prior, even if the patient says they are feeling better.