An Overview of White Blood Cell Disorders

White blood cell disorders include a large number of disorders that affect the white blood cells (WBC), one of the three types of blood cells.  

  • White blood cells are predominantly involved in fighting infections and participating in inflammatory reactions.
  • Red blood cells carry oxygen to the body.
  • Platelets help stop bleeding. 

The normal number of WBC ranges from around 4 to 11 billion cells per liter.

This range is different based on which lab you have your blood work drawn. Newborn babies have a higher range from around 9 to 30 billion cells per liter. This range goes down over the first two years of life and is similar to adult normal ranges for the rest of childhood. Opposed to red blood cells (RBC), the normal range is not affected by gender (male or female). It is, however, affected by race; in national studies, African-Americans have lower baseline WBC counts than Caucasians.  

Categories of White Blood Cell Disorders

There are several different ways to categorize WBC disorders. First, they can be categorized by cause: those that affect WBC production (too many or too few) and others that affect the function of the WBC. Second, WBC disorders might be categorized by which type of WBC is affected. In some disorders all the WBC are affected but others only affect one type. There are five major types of WBC: neutrophils, which predominantly fight bacterial infections; lymphocytes, which predominantly fight viral infections; monocytes, which predominantly fight fungal infections; eosinophils, which predominantly fight parasitic infections and are involved in allergic reactions; and basophils, which are involved in inflammatory reactions.

 Thirdly, WBC disorders can be classified as benign or malignant. The majority of WBC disorders are benign.  

Basic Terms Associated With White Blood Cell Disorders

In general, too many of one type of WBC is indicated by -philia on the end of the word, and too few of one type of WBC is called -penia. These can be applied to all WBC; leukocytosis is a WBC count above the normal range, and leukopenia is a WBC count below the normal range.

These can also be used to describe specific WBCs like neutropenia (too few neutrophils) or basophilia (too many basophils).  

Common Types of White Blood Cell Disorders

  • Leukocytosis: Leukocytosis is an increased number of white blood cells. The most common causes are infection, medications like prednisone, or leukemia.  
  • Autoimmune neutropenia: Autoimmune neutropenia occurs when the body produces antibodies that attack and destroy neutrophils.    
  • Severe congenital neutropenia​: People with this condition are born with severe neutropenia secondary to a genetic mutation. People with severe congenital neutropenia have recurrent bacterial infections.
  • Cyclic neutropenia: This neutropenia is also due to a genetic mutation, similar to severe congenital neutropenia. However, the neutropenia does not occur every day but in cycles of about 21 days.  
  • Leukemia is a cancer of the cells that produce white blood cells in the bone marrow. 
  • Chronic granulomatous disease is a disorder where multiple types of WBCs (neutrophils, monocytes, macrophages) are unable to function properly. It is an inherited condition and results in multiple infections, particularly pneumonia and abscesses.  
  • Leukocyte adhesion deficiency is a disorder where the white blood cells are unable move to areas of infection.  

Symptoms of White Blood Cell Disorders

Symptoms of WBC disorders vary greatly based on the cause. Some people with WBC disorders may not have any symptoms. Other symptoms are predominantly related to infection and include:

  • frequent or recurrent infections
  • infections with unusual bacteria, viruses, or fungus
  • fever
  • mouth ulcers
  • skin abscesses (commonly called boils)
  • pneumonia

Diagnosing White Blood Cell Disorders

Similar to other blood disorders, the first test commonly performed is the complete blood count (CBC), Sometimes this test is run because you are having recurrent or unusual infections or other times it is identified incidentally when a CBC is drawn for routine annual labs. Your healthcare provider will be looking for a change in either the total WBC count or in the number of a particular type of WBC.  

After diagnosing you with a WBC disorder, your physician will work on determining the cause of it. Sometimes the cause is temporary, like an elevation in the WBC count during an active infection. In these circumstances, the CBC is often repeated to ensure that things have returned to normal. Your physician may also request a blood smear. A blood smear is a test where a small amount of blood is placed on a glass slide, so a physician can review your blood cells under the microscope looking for abnormalities that might point to the cause of your disorder.

If you require further work-up, your primary care provider may refer you to a specialist. WBC disorders are usually shared between hematologists, physicians that specialize in blood disorders, and immunologists, physicians that specialize in disorders of the immune system. Because WBCs are produced in the bone marrow, a bone marrow biopsy might be needed to complete the work-up. 

Treatment of White Blood Cell Disorders

Just like the causes of WBC disorders, there are numerous treatments for it. Antibiotics are used to treat the frequent infections. Sometimes antibiotics might be used prevent infections. Unlike disorders affecting red blood cells or platelets, white blood cell transfusions are rarely used. There are medications that can be used to stimulate white blood cell production in the bone marrow called growth factors. Additionally, stem cell transplantation can be used for curative therapy for some of these disorders.  

A Word From Verywell

After learning you have a white blood cell disorder, you may be scared, uncertain about the future. This a natural feeling. Make sure you discuss your fears with your physician. Together you can come up with a plan to address these concerns.  

Source:

Kaushansky K, Lichtman MA, Prchal J,  Levi MM,  Press O, Burns L, Caligiuri M.  (2016). Williams Hematology (9th ed.) USA. McGraw-Hill Education.

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