White Blood Cell (WBC) Count (Nursing)

00:01 Hi. Welcome to our video series on interpreting lab values.

00:05 Now, in this one, we're going to dig way down in looking at white blood cells; one of the components of the CBC, or the Complete Blood Count.

00:14 Okay. Now, you've got 5 different types of white blood cells: monocytes, lymphocytes, neutrophils, eosinophil, and basophils.

00:24 So when you hear us talk about white blood cells, know that there's 5 different types of these cells.

00:29 You've got some pictures up there to let you see the differences of them, but we're going to break it down even more.

00:34 Now, you're either going to have a low white blood cell count or a high white blood cell count if we're talking about an abnormal white blood cell count.

00:43 So get that in mind. We've got a low white blood cell count or a high white blood cell count.

00:48 Now the low white blood cell count is called "leuko," meaning white cell, "penia," that means low.

00:55 So the causes of that could be some type of medical condition.

00:58 Maybe the patient has an autoimmune disorder because in autoimmune disorders, your body destroys the white blood cells.

01:05 They might have a bone marrow problem because that's where our blood cells come from, or something as serious as cancer.

01:12 So low white blood cell count, you start thinking, "What could possibly be the cause of it?" They might have an autoimmune disorder, they might have bone marrow problems, or they might have a case of cancer.

01:26 Now, there's also medications that can drop the white blood cell count, so keep that in mind too.

01:30 See, that's why it's always important -- A lab test is just a lab test, just numbers.

01:36 What's really important is you take this lab work and you compare it to what you see and what you've assessed in your patient.

01:42 So we've talked about low white blood cell count.

01:45 Before we go on, look away from your notes and see if you can remember the 3 reasons a patient might have white blood cells.

01:54 Okay, good. See, that's the best way to study.

01:57 If you just let me pour all this information onto you without you stopping to pause, it's like wrapping your lips around a fire hydrant to get a drink.

02:06 Your brain needs time and space to process what we're talking about.

02:10 So as we're moving through the video series, I'll give you time to stop and think and write some notes of your own.

02:17 That's really important because that will help your brain remember things, encode them, and store it in a way that you can retrieve it when you need it, like a test or when you're actually taking care of your patients.

02:30 So we're back to white blood cells. We already looked at leukopenia, which is low white blood cells. Now let's talk about high white blood cell count.

02:38 That's leukocytosis.

02:40 Look at those 2 words. Both start with "leuko," that tells us we're talking about white blood cells. So underline "leuko" and write "white" above it.

02:49 "Penia" means low, and "cytosis" means elevated.

02:53 Now when you're looking at the results of your patient's white blood cell count from their CBC, you say, "What are the possible reasons they could have a high white cell count?" Well, it might be caused by an infection or inflammation.

03:06 See, these white cells are the responders when the body's under attack.

03:10 So that's why you'll see leukocytosis, or a high white cell count, because of a possible infection or inflammation.

03:17 Now, it could also mean you have some type of immune system disorder or a bone marrow disease.

03:22 Hey, wait a minute. Look back over to the low white cell count.

03:27 Remember, we talked there might be an immune system problem or some type of bone marrow problem.

03:32 So, a low white cell count or a high white cell count could be an indication of both of those.

03:37 Now, lastly, it also might be a reaction to medication.

03:40 Hey, there's another pattern.

03:43 So keep in mind, look at the similarities between a low white cell count and a high white cell count.

03:49 Some similarities that you see are the immune disorder or bone marrow problems.

03:54 And also, a low white cell count could be caused by certain medications, and a high white cell count could be a reaction to a medication.

04:01 So when you see all these bullet points, try and look for patterns and relationships and things that link them together.

04:08 It'll help it make more sense to you and stick in your brain better.

04:12 Okay, so we've talked about 5 types of white blood cells.

04:15 We talked about the reasons for low white blood cells, and the reasons for high white blood cells.

04:21 Whoa, okay, that is a lot of numbers.

04:25 But don't worry about it. This is just here as a reference for you.

04:29 Now, this is an example of some adult values.

04:32 But keep in mind, every lab is going to have a little bit different type of values, but they'll post them with your lab work.

04:38 So this is just an example of one that it could be.

04:41 Could be pretty similar, but not exactly the same.

04:45 So don't take this slide as the only reason or the only references that we can use for white blood cells.

04:51 This is just an example of one.

04:54 Okay, look at the top one. It says "WBC." That stands for white blood cell, right? We get the same from the blood, good to know.

05:03 The value is 5.6.

05:06 Okay, so, a normal reference range is 5-10.

05:10 So this patient's value is 5.6.

05:12 A little bit on the low side, but still within normal range.

05:16 So when you're looking at these values, look at what you're looking at, WBCs. The patient's value is 5.6., and the normal range for this lab is 5-10.

05:26 So, our white blood cells are about right where we'd want them to be.

05:31 Now look beneath white blood cells.

05:33 You see the other 5 different types.

05:36 Now these are reported as percentages. So see the units? It's in percentages.

05:41 So it tells you that the neutrophils are 52.1%, the lymphocytes are 31.8%.

05:47 And I know you don't need me to read those last 3 to you.

05:50 But if we added up that column, 52.1, 31.8, 13.5, 2.2, and 0.4, that would add up to a total of 100%.

06:03 So when you're looking at the white blood cell breakdown, we see what the total is, 5.6.

06:08 Now that's in units, per microliter, then the 5 different types of white cells will tell you the percentage that makes up that total. So, why this matters is because when these percentages are off, it's going to give us even more specific information about what's going on with your patient.

06:26 Okay, so pull back and look at this one more time.

06:30 White blood cell at the top is within the normal range.

06:33 Look at the neutrophils. Is that within normal range? Yes, because this patient's value is 52.1.

06:40 The normal reference range is 55.75 -- Oh, wait a minute.

06:46 Looks like the neutrophils are a little low.

06:48 And those are the things that you're looking for.

06:51 Don't glance so quickly through the lab values that you miss small differences like that.

06:56 Now, this may be nothing or it might be something.

06:58 It depends on the other information we have about the patient.

07:02 So make sure you're very careful as you're walking through this.

07:06 52.1 means we're a little low on neutrophils.

07:09 31.8 for lymphocytes is definitely within the normal range of 15-41.

07:16 Monocytes, 13.5 -- hey, those are a little elevated.

07:21 Eosinophils, we're within normal range.

07:24 Basophils, they're a little low, but we're really okay, right, because it's 0-2.

07:30 And that's a little bit of a weird one because 0 is actually normal.

07:34 So what I want you to take away from this slide is, while we can learn a lot about the patient, you need to slow down and carefully walk through those lab values to make sure you're very clear which ones are out of line or outside of normal.