An Overview of White Blood Cell Disorders

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White blood cells are manufactured in the bone marrow and are involved in fighting infections and inflammatory responses. Disorders of white blood cells (WBC) include leukocytosis, autoimmune neutropenia, and cyclic neutropenia. Most WBC disorders are benign, but some, like leukemia, can be malignant.

Symptoms

Symptoms of WBC disorders vary based on the type of illness, though some people do not have any symptoms. 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

Causes

WBC disorders can be due to over- or underproduction of cells, a problem with the function of the cells, or difficulty with a particular type of WBC. Too many of one type of WBC is indicated by the suffix -philia, while too few is called -penia.

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
  • basophils, which are involved in inflammatory reactions.

White blood cell disorders can be caused by viral infections, autoimmune disorders, cancer, certain medications, or severe infections, though some people can be born with congenital white blood cell disorders.

Common white blood cell disorders include:

  • Leukocytosis is an increased number of white blood cells. The most common causes are infection, medications like prednisone, or leukemia.
  • Autoimmune neutropenia occurs when the body produces antibodies that attack and destroy neutrophils.
  • Severe congenital neutropenia is secondary to a genetic mutation. People with severe congenital neutropenia have recurrent bacterial infections.
  • Cyclic 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.

    The normal number of WBC for adults ranges from 4 to 11 billion cells per liter, while counts for newborns to age 2 is higher range, from around 9 to 30 billion cells per liter.

    African-Americans have lower baseline WBC counts than Caucasians.

    Diagnosis

    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 the initial diagnosis, 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 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 workup, your primary care provider may refer you to a specialist.

    WBC disorders are usually treated by hematologists who specialize in blood disorders and immunologists, who specialize in disorders of the immune system.

    Since white blood cells are produced in the bone marrow, a bone marrow biopsy might be needed to complete the work-up.

    Treatment

    Treatment will depend on the type and cause of the WBC disorders.

    Antibiotics are used to treat and prevent infections, which is a frequent cause of a WBC disorder. There are also 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.

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    Article Sources

    1. Larosa DF, Orange JS. 1. Lymphocytes. J Allergy Clin Immunol. 2008;121(2 Suppl):S364-9. doi:10.1016/j.jaci.2007.06.016

    2. George TI. Malignant or benign leukocytosis. Hematology Am Soc Hematol Educ Program. 2012;2012:475-84. doi:10.1182/asheducation-2012.1.475

    3. Riley LK, Rupert J. Evaluation of Patients with Leukocytosis. Am Fam Physician. 2015;92(11):1004-11.

    Additional Reading

    • Medline Plus. Blood Count Tests. medlineplus.gov/bloodcounttests.html

    • University of Rochester Medical Library. What are white blood cells? www.urmc.rochester.edu/encyclopedia/content.aspx?ContentID=35&ContentTypeID=160

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