Because white cells have such a short time span in the peripheral circulation, alterations either in the quantity of or the quality of a particular cell can be quite dramatic. With the normal differential reference ranges for adults and children as a benchmark, any increase or decrease in a particular type of cell signals the body's unique response to "assaults" of any kind. Infection, inflammation, chronic disease, parasitic infestations, etc., each represents an unexpected occurrence, an opportunity for white cells to mobilize. As white cells respond to infection or other stimuli, changes are seen in the number of and types of a particular cell line. If a cell line is increased, the suffix used to designate an increase is "osis" or "philia," such as "eosinophilia" and "leukocytosis." If a cell line is decreased, the suffix used to designate a decrease is "penia," such as "neutropenia." Changes are observed in the complete blood count (CBC) as well as in the peripheral blood smear. An interesting situation is the role that granules from a particular cell line play in producing symptoms. For example, eosinophilic granules contain histamine. In allergy patients, eosinophils are usually seen in excess. Once histamine is released from eosinophils, this chemical stimulates allergy-related symptoms such as watery, itching eyes and rhinorrhea. Interestingly, most allergy medications contain antihistamines, formulated to block allergy symptoms.
In most cases, patients who have newly acquired infections will show an increase in white cells from the reference range. Care must be taken, however, when assessing a patient with an increased white count. Ethnic differences have been suggested in the normal white cell reference range, with blacks having a lower normal white count than whites. A symptomatology that reflects an infection combined with an elevated white count strongly suggests an infectious process.1
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