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White Blood Cells (WBC)

SI UNITS (recommended)

CONVENTIONAL UNITS

(Key Marker of Immune Status, Infection, Inflammation & Hematologic Diseases)

Synonyms

  • WBC count
  • Total leukocyte count (TLC)
  • Leukocytes
  • White cells
  • Total WBC
  • Peripheral white cell count

Units of Measurement

The following units represent absolute number of cells:

  • 10⁹/L
  • G/L (giga per liter)
  • Gpt/L
  • cells/L
  • 10³/µL
  • 1000/µL
  • 10³/mm³
  • 1000/mm³
  • K/µL
  • K/mm³
  • cells/µL
  • cells/mm³

All units express the same thing: total number of WBC per volume of blood.

Unit Conversions

Base equivalences

1 109/L=1 G/L=1 Gpt/L1\ \text{10}^9/\text{L} = 1\ \text{G/L} = 1\ \text{Gpt/L}1 109/L=1 G/L=1 Gpt/L 1 109/L=1000 cells/µL1\ \text{10}^9/\text{L} = 1000\ \text{cells/µL}1 109/L=1000 cells/µL 1 cells/µL=106 cells/L1\ \text{cells/µL} = 10^6\ \text{cells/L}1 cells/µL=106 cells/L 1 109/L=103/µL=1 K/µL1\ \text{10}^9/L = 10^3/\text{µL} = 1\ \text{K/µL}1 109/L=103/µL=1 K/µL

Quick conversion table

Common UnitEquivalent
1 × 10⁹/L1 × 10³/µL
1 × 10³/µL1 × 10⁹/L
1 K/µL1 × 10³/µL
1 × 10³/mm³1 × 10³/µL
1 G/L1 × 10⁹/L

Description

White Blood Cells (WBCs) are a group of immune cells produced primarily in the bone marrow, circulating in blood to defend the body against:

  • Infections (bacterial, viral, fungal, parasitic)
  • Inflammation
  • Allergic reactions
  • Tissue injury
  • Hematologic malignancies

WBC count reflects the total number of all leukocytes:

  • Neutrophils
  • Lymphocytes
  • Monocytes
  • Eosinophils
  • Basophils

A WBC count must always be interpreted with the Differential Count, clinical scenario, and other CBC parameters.

Physiological Role

White cells perform:

  • Pathogen killing (phagocytosis; neutrophils & monocytes)
  • Antibody production (lymphocytes)
  • Immune regulation
  • Allergic response (eosinophils, basophils)
  • Surveillance for malignant cells

Clinical Significance

HIGH WBC COUNT

Common causes:

1. Infections

  • Bacterial (most common: neutrophilia)
  • Viral (lymphocytosis)
  • Parasitic
  • Fungal

2. Inflammation

  • Rheumatoid arthritis
  • IBD
  • Autoimmune diseases

3. Physiological causes

  • Exercise
  • Pregnancy
  • Stress, surgery
  • Smoking

4. Medications

  • Steroids
  • Lithium

5. Hematologic Disorders

  • Leukemia
  • Myeloproliferative neoplasms
  • Polycythemia vera

LOW WBC COUNT

Causes:

1. Viral infections

(Early viral suppression of bone marrow)

2. Bone marrow suppression

  • Aplastic anemia
  • Myelodysplastic syndromes
  • Chemotherapy
  • Radiotherapy

3. Autoimmune destruction

  • Lupus
  • Graves’ disease

4. Drug-induced

  • Antithyroid drugs (carbimazole, methimazole)
  • Clozapine
  • Anticonvulsants
  • Antibiotics (chloramphenicol)

5. Nutritional deficiencies

  • Vitamin B12 deficiency
  • Folate deficiency

6. Severe bacterial sepsis

(Consumption/exhaustion of WBCs)

Low WBC significantly increases risk of infection.

Reference Intervals

(Tietz 8E + CLSI + Mayo + ARUP)

Total WBC Count

  • Adult: 4.0 – 11.0 × 10⁹/L
  • Children: wider range (5.0 – 15.0 × 10⁹/L depending on age)
  • Newborn: 9.0 – 30.0 × 10⁹/L

Leukopenia

  • < 4.0 × 10⁹/L

Leukocytosis

  • > 11.0 × 10⁹/L

All units measure the same parameter using different volume scales.

Diagnostic Uses

1. Infection Assessment

Most common use.

2. Hematologic Malignancy Screening

Leukemia/myeloproliferative disorders.

3. Immune Status Evaluation

Lymphopenia = immunodeficiency.

4. Monitoring of Chemotherapy

Predicts risk of neutropenic sepsis.

5. Autoimmune Disease Activity

E.g., SLE often causes leukopenia.

6. Inflammatory Disorders

High WBC reflects ongoing inflammation.

Analytical Notes

  • Automated analyzers provide total & differential.
  • Manual counts (hemocytometer) rarely used but confirm abnormal results.
  • Hemolysis has minimal effect.
  • Clotted samples give falsely low WBC (platelet clumping on analyzer flags).
  • Dilution or instrument error occurs in extremely high counts (>100 ×10⁹/L).

Clinical Pearls

  • Always interpret WBC with Differential (neutrophils, lymphocytes).
  • Stress response can cause transient WBC ↑.
  • Steroids consistently increase WBC via demargination.
  • In B12 deficiency, pancytopenia may occur with low WBC.
  • Leukemoid reaction (WBC >50 ×10⁹/L) must be differentiated from leukemia.
  • ANC (Absolute Neutrophil Count) is more clinically relevant in neutropenia.

Interesting Fact

During acute stress, ~50% of neutrophils shift from vessel walls (“marginated pool”) into circulation - causing a rapid increase in WBC count without any new cell production.

References

  1. Tietz Clinical Chemistry & Molecular Diagnostics, 8th Edition - Hematology
  2. CLSI Hematology Standards (H20, H26)
  3. British Society for Haematology (BSH) - Leukocyte Guidelines
  4. Mayo Clinic Laboratories - WBC Count
  5. ARUP Consult - CBC Interpretation
  6. NIH / MedlinePlus - WBC Test

Last updated: January 27, 2026

Reviewed by : Medical Review Board

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