Testing for white blood cell count and white cell differentials is an important part of leukemia diagnosis. But even after diagnosis, your white blood cell count helps monitor disease progression and the effectiveness of treatment.

Different types of leukemia can affect the blood in different ways. Your doctor can help you make sense of your blood work results and recommend the next steps.

You’ll probably have a complete blood count (CBC) and a white cell differential during leukemia diagnosis and treatment. Together, these tests can reveal a lot about your blood. Before looking at the numbers, it’s useful to know a little bit about what each type of blood cell does.

  • White blood cells (leukocytes). White blood cells help fight infection. If your white blood cell count is low, your risk of infections grows.
  • Red blood cells (erythrocytes). Red blood cells carry oxygen from the lungs to the rest of your body and return with carbon dioxide. If your red blood cell count is low, your tissues may lack oxygen, which can lead to fatigue, weakness, dizziness, and headaches.
  • Platelets. Platelets help your blood clot and control bleeding. If your platelet count is low, it can lead to excessive bleeding and easy bruising, even from minor cuts and bumps.

The CBC will also include measurements of:

  • Hemoglobin. This is a protein that red blood cells need to distribute oxygen.
  • Hematocrit. Hematocrit is the amount of blood taken up by red blood cells.

White blood cells make up only about 1 percent of your blood, according to the American Society of Hematology. But they’re an important part of your immune system. The white cell differential will measure the amount of each type of white cell, including granulocytes and agranulocytes.

Granulocytes include:

  • Basophils. These cells help fight bacteria and parasitic infection.
  • Eosinophils. These cells are useful against parasitic infection.
  • Neutrophils. These cells help fight off fungal and bacterial infection.

Agranulocytes include:

  • Lymphocytes. These are the B cells and T cells that make up the immune system.
  • Monocytes. Monocytes get rid of foreign organisms and dying cells.

Different labs use slightly different ranges and units, so you’ll want to look closely at the range provided on your report. These ranges are based on the cell counts of healthy people of similar age and sex.

According to the Leukemia & Lymphoma Society, the “normal” range of white blood cells per microliter of blood is:

  • 5,000 to 10,000 for men
  • 4,500 to 11,000 for women

Normal ranges for different types of white blood cells are:

  • Neutrophils: 55 to 70 percent
  • Lymphocytes: 20 to 40 percent
  • Monocytes: 2 to 8 percent
  • Eosinophils: 1 to 4 percent
  • Basophils: 0.5 to 1 percent
  • Band (young) neutrophils: 0 to 3 percent

Another important number to know in the differential is the absolute neutrophil count. This number is calculated by multiplying the percentage of neutrophils by the total white blood cell count. It’s an indicator of how well your body can fight off bacterial infections. Anything less than 1,000 puts you at an increased risk. Less than 500 is high risk and considered severe neutropenia.

In addition, your CBC will show:

Red cells (per microliter of blood)Platelets (per microliter of blood)Hematocrit (% of blood composed of red cells)Hemoglobin (grams per deciliter)
Men4.7–6.1 million150,000–400,00042–5214–18
Women4.2–5.4 million150,000–400,00037–4712–16

Ranges may differ during pregnancy. A study published in 2021 looked at white blood cell counts of 24,318 pregnant women measured over 5 years. The researchers found that total white blood cell count was elevated by 36 percent in pregnancy. This included:

  • 55 percent increase in neutrophils
  • 38 percent increase in monocytes
  • 36 percent reduction in lymphocytes
  • no change to eosinophils and basophils

Leukemia white blood cell count ranges in children

The Leukemia & Lymphoma Society says that children under 4 years old may have a higher percentage of lymphocytes in their blood than older children and adults. According to the University of Rochester Medical Center, the normal ranges of white blood cells per microliter of blood are:

  • 9,000 to 30,000 for newborns
  • 6,200 to 17,000 for children under 2
  • 5,000 to 10,000 for children over 2

Leukemia is the most common cancer in children and teens, according to the American Cancer Society. Most children with leukemia have a type called acute lymphocytic leukemia (ALL). A 2017 review indicates that about 80 percent of ALL occurs in children. Diagnosis includes the presence of 20 percent or more lymphoblasts, or immature lymphocytes, in the blood or bone marrow.

What white blood count is related to cancer?

Many conditions, such as infections and autoimmune disorders, can cause an elevated white blood count. The white blood cell count may also be elevated in leukemia. With acute leukemia, the best indicator is the presence of blasts in the blood. Blasts are immature, cancerous cells. If more than 20 percent of cells in the blood are blasts, this indicates a likely diagnosis of leukemia.

You may also have leukemia with a lower percentage of blasts. This can happen if the cancerous cells are trapped in the bone marrow. If your doctor suspects leukemia, they may perform specialized blood tests. Tests like flow cytometry, bone marrow biopsy, and genetic testing can confirm the diagnosis, determine the type, and monitor your response to treatment.

At diagnosis, people with leukemia can have extremely high white blood cell counts. According to the Roswell Park Comprehensive Cancer Center, they can reach into the 100,000 to 400,000 range. Leukemia can also present with very low white blood cell counts, because the immature cells get trapped in the bone marrow and are not detected in blood tests.

A decreasing number of blasts in the blood indicates that you’re responding to treatment. A rising number of blasts may be an early sign of relapse.

What count indicates remission?

Remission can look different depending on your exact situation. According to the Center for International Blood & Marrow Transplant Research, experts often divide remission into two common categories. These are complete remission and complete remission with incomplete hematologic recovery.

You can be in complete remission as long as you no longer need regular transfusions and fall within these ranges:

  • hemoglobin count lower than normal range but not lower than 7
  • no blasts present
  • platelet count over 100,000, but less than the normal range of 150,000
  • neutrophil count over 1,000

Your outlook depends on many factors, such as the specific type of leukemia. Acute and chronic leukemia don’t act the same and require different types of treatment. Other things that affect outlook are:

  • age
  • overall health
  • how early the cancer was detected

The American Cancer Society says that survival rates for children have increased over time. The overall 5-year survival rate for children is 90 percent for ALL and 65 to 70 percent for acute myeloid leukemia (AML). The 5-year survival rate for adults is 29 percent for AML and 69 percent for ALL, according to the National Cancer Institute.

It’s important to note that survival rates are based on people diagnosed 5 or more years ago. Newer treatments are being developed all the time and may provide a better outlook. Your doctor will review all your health information to offer a more personal prognosis.

Where to find support

Everyone’s different, so there’s no right or wrong way to feel about it. But life with leukemia may be overwhelming at times. If you need emotional support, practical support, or both, know that you’re not alone and help is available.

The Leukemia & Lymphoma Society provides a variety of educational and support services, such as:

Other resources include:

Your doctor or treatment center may be able to provide more information about local resources.

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