White Blood Cell (WBC) Differential

About The Test

To help determine the cause of abnormal results on a white blood cell (WBC) count; to help diagnose and/or monitor an illness affecting your immune system, such as an infection or inflammatory condition, or cancers that affect your white blood cells, such as leukemia or lymphoma

White blood cells (WBCs), also called leukocytes, are cells that circulate in the blood and the lymphatic system that help protect the body against infections. They are an important part of the body’s immune system and also have a role in inflammation, allergies, and protection against cancer. A WBC differential categorizes the numbers of each of the different types of WBCs in sample of your blood.

There are five main types of white blood cells, each with different functions. The differential shows if:

• The different types of WBCs are present in normal proportion to one another
• The numbers of the different cell types are normal, increased or decreased
• Abnormal and/or immature WBCs are present

This information is helpful in diagnosing specific types of illnesses that affect the immune system and the bone marrow.

A differential may be performed along with or following a complete blood count (CBC), a test often used as a general health check, or it may be performed in follow-up to abnormal results on a CBC. Most often, a differential is performed on an automated blood analyzer. Occasionally, it is performed manually by a trained laboratory professional who examines a blood smear using a microscope.

Types of White Blood Cells

The bone marrow produces five main types of WBCs, neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

• Neutrophils (neu) normally make up the largest number of circulating WBCs. They move into an area of damaged or infected tissue, where they engulf and destroy bacteria or sometimes fungi.
• Lymphocytes (lymphs) exist in both the blood and the lymphatic system. They are broadly divided into three types, but the differential does not distinguish among them. The differential counts and reports all lymphocytes together. Separate specialized testing (like immunophenotyping) must be done to differentiate the three types:
  • B lymphocytes (B cells) are produce antibodies that help protect against infections. Plasma cells are fully differentiated B-cells that produce antibodies, immune proteins that target and destroy bacteria, viruses and other “non-self” foreign antigens.
  • T lymphocytes (T cells) finish maturing in the thymus and consist of a few different types. Some T cells help the body distinguish between “self” and “non-self” antigens. Others initiate and control the extent of an immune response, boosting it as needed and then slowing it as the condition resolves. Other types of T cells directly attack and neutralize virus-infected or cancerous cells.
  • Natural killer cells (NK cells) directly attack and kill abnormal cells such as cancer cells or those infected with a virus.
• Monocytes (mono), similar to neutrophils, move to an area of infection and engulf and destroy bacteria. They are associated more often with long-term (chronic) rather than acute infections. They are also involved in tissue repair and other functions involving the immune system.
• Eosinophils (eos) respond to infections caused by parasites, play a role in allergic reactions (hypersensitivities), and control the extent of immune responses and inflammation.
• Basophils (baso) usually make up the fewest number of circulating WBCs and are thought to be involved in allergic reactions.

What does a differential tell you?

A WBC differential can give clues about your condition or what is causing a low or high WBC count. When there is an infection or an inflammatory process somewhere in the body, the bone marrow produces more WBCs, releasing them into the blood. Depending on the cause of infection or inflammation, one particular type of WBC may be increased as opposed to other types. As the condition resolves, the bone marrow produces fewer of that type of WBC and the number drops back to normal levels.

In addition to infections and inflammation, there are a variety of conditions that can affect the production of WBCs by the bone marrow or their survival in the blood, resulting in either increased or decreased numbers. The differential, along with the other components of the CBC, alerts the healthcare provider to possible health issues. Results are often interpreted along with additional tests such as a blood smear exam, which can show the presence of abnormal and/or immature WBCs.

In a few serious diseases, some immature forms of the cells are released from the bone marrow into the circulation and may be detected by the WBC differential. This may occur with bacterial infection, leukemia, myelodysplastic syndrome, or myeloproliferative neoplasms, for example. Some immature cells that may be detected include metamyelocytes, myelocytes, promyelocytes, and/or blasts.

If results indicate a problem, a wide variety of other tests may be performed in order to help determine the cause. A health care provider will typically consider your signs and symptoms, medical history, and results of a physical examination to decide what other tests may be necessary. For example, as needed, a bone marrow biopsy might be performed because that is where WBCs normally are produced and where they mature.