Review of Critical WBC Values (Nursing)

by Rhonda Lawes

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    00:01 Okay, now, let's review the critical values.

    00:04 There's a couple things I want to point out first.

    00:06 Now you see at the top, it says, "Examples of a normal white blood cell count." Now, in the hospitals, you hear us talk about, you know, 13-38, or 5.8-13.2.

    00:16 I want you to keep in mind, that's 1,000.

    00:20 So it's 13,000-38,000.

    00:23 You saw back on the other sides how we talked about times 103? That means you add three 0s. So just write yourself a note.

    00:31 When you hear a health care professional say 13-38, or 5-20, they really mean 5,000-20,000, or 5,000-10,000.

    00:42 So when we look at what a low value is, we'll talk about that they may just say the number 4, or they may say 4,000.

    00:50 But leukopenia, that means white for "leuko" and "penia" means low, is a white blood cell count that's <4,000.

    00:59 Now, compare that to the adult.

    01:01 A normal adult is 5-10 or 5,000-10,000.

    01:06 So leukopenia, <4,000, really starts to be a problem for your patient.

    01:12 Okay, so you're going to start thinking if you see a lab value that says, "White blood cell count <4," you know that is too low, because we're <4,000.

    01:22 That's 1,000 lower than normal for an adult.

    01:25 Now, the causes could be a viral infection, or it could be an overwhelming bacterial infection, or bone marrow disorder.

    01:33 Okay, now, I don't just want to give you a list. Let's break those down a little bit.

    01:37 So, why would a patient have a white blood cell count that's <4,000 when I know that 5,000 is normal? A viral infection. That can be one of the causes.

    01:49 An overwhelming bacterial infection. Well, does that make sense? Because if I have a really big infection, don't I want a whole lot of white cells to respond? Yes, you do, but this is an indication that your patient's body can't fight back like we need it to, because it's just overwhelmed by the intensity of this bacterial infection.

    02:10 So if I have someone who has a really big infection, and their white cell count is low, this is a big problem.

    02:17 The last thing was bone marrow disorders.

    02:19 So your bone marrow is where the blood cells come from.

    02:22 If your bone marrow isn't functioning well, you may not have enough white blood cells.

    02:26 Okay, so we talked about leukopenia, meaning low white cells.

    02:30 Make sure you underline that "leuko," it will remind you that it's white, and then "penia" means low.

    02:36 It's 4,000, which is less than normal, because normal is 5,000-10,000 for an adult.

    02:43 We know the 3 causes are viral infection, overwhelming bacterial infection, and/or bone marrow disorder.

    02:49 Now, we have to treat these patients with extra care.

    02:52 So someone with a white cell count that this low, we want to make sure we use special precautions with them because their immune system isn't effective. So I would be careful about who they're exposed to, and what we expose them to, because they're going to be under precautions to protect that immune system that's kind of limping along.

    03:11 So, on this slide, we've organized it so you have the normal white blood cell values in the thousands at the top.

    03:18 And we're talking here about what happens when a patient has low white cell count that's <4. The 3 causes? Viral infection, overwhelming bacterial infection, or a bone marrow disorder.

    03:32 And we want to take extra care with them to not expose them to any bugs, that includes visitors who might have a cold or the flu.

    03:40 Now, you thought 4,000 was bad, it gets worse.

    03:43 This is a white cell count <500.

    03:47 Now that's not 500,000. That's literally <500.

    03:51 Normal is 5,000, right? That's the bottom line for an adult.

    03:56 But this is somebody who has a white cell count that's <500.

    04:00 This is the most severe leukopenia, and this patient is at risk to die from infection.

    04:07 That means the kind of bug that most of us could fight off without any problem might cause this patient to die.

    04:13 So white blood cell count <500 when the normal is 5,000, this is the most severe leukopenia.

    04:22 At the opposite end of that spectrum, you've got a white blood cell count that's >30,000.

    04:27 Remember, normal for an adult is 10,000.

    04:31 So white blood cell count >30,000 is leukocytosis, that's extra white cells.

    04:38 This indicates a massive infection and an immune system that is definitely responding.

    04:44 So, it can either be a massive infection, or something more serious like leukemia.

    04:49 Massive infection, we hope we can address and fix rather quickly.

    04:53 A serious disease like leukemia is a lot more complex.

    04:57 So anytime your numbers are outside of normal, you need to stop and think, "Hey, what are all the possible reasons that this could be happening?" Look at the rest of your patient assessment and see what lines up to help you identify what's going on with these lab values.

    About the Lecture

    The lecture Review of Critical WBC Values (Nursing) by Rhonda Lawes is from the course Complete Blood Count (CBC) (Nursing).

    Included Quiz Questions

    1. Viral infection
    2. Overwhelming bacterial infection
    3. Bone marrow disorders
    4. Internal bleeding
    5. Anemia
    1. < 500 and > 30,000
    2. > 500 and < 30,000
    3. < 4000 and > 10,000
    4. > 4000 and < 10,000

    Author of lecture Review of Critical WBC Values (Nursing)

     Rhonda Lawes

    Rhonda Lawes

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