White Blood Cell Differential Count

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White Blood Cell Differential Count DR. Yasir M. Khaleel M.B.Ch.B , M.Sc.

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DefinitionThe relative percentage of each type of white blood cells in peripheral blood. White Blood Cells (leucocytes) Total 4.0 – 11.0 × 10 9 /L Absolute Relative Percentage Average Neutrophils 2.5 – 7.5 × 10 9 /L 50-70% 65% Lymphocytes 1.5 – 3.5 × 10 9 /L 25-35% 30% Monocytes 0.2 – 0.8 × 10 9 /L 2-10% 6% Eosinophils 0.04 – 0.44 × 10 9 /L 1-5% 3% Basophils 0.01 – 0.1 × 10 9 /L 0.4-1% 0.5%

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Microscopic exam 10× (low fold): overall smear quality, rouleaux, agglutination or parasites 100× (oil Len): WBC Diff, RBC morphology

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tail body head

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Counting Area:Observe one field and record the number of WBC according to the different type then turn to another field in the snake-liked direction *avoid repeat or miss some cells

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Normal peripheral blood smear

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White blood cellsThere are three types of granulocyte named according to their staining characteristics in blood films. They are neutrophils,eosinophils and basophils. Mononuclear cells are divided into lymphocytes and monocytes.

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Stab (band) neutrophilDiameter:12-16 Cytoplasm : pink Granules : primary & secondary Nucleus : dark purple blue dense chromatin

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Band form Neutrophils There are smaller numbers of cells of neutrophil lineage with non-segmented nuclei. They are referred to as neutrophil band cells or band forms. They are less mature than segmented neutrophils. An increased number of band cells is referred to as a left shift'.

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Segmented neutrophilDiameter: 12-16 Cytoplasm: very pale blue Granules: primary secondary lilac-staining (purple) Nucleus: dark purple blue dense heterogeneous chromatin 2-5 lobes

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Neutrophils The neutrophils in the circulating blood are mainly mature segmented neutrophils. neutrophilic because they owe their color to uptake of both the acidic and the basic components of the stain

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EosinophilDiameter: 14-16 Cytoplasm : full of granules Granules: large refractile orange-red Nucleus: blue dense chromatin 2 lobes like a pair of glass

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BasophilDiameter: 14-16 Cytoplasm: pink Granules: dark blue –black obscure nucleus Nucleus: blue

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LymphocyteDiameter: small 7-9 large 12-16 Cytoplasm : rim, clear, pale blue Granules: small (a granular) large (a variable number of pinkish-purple granules) Nucleus: dark blue / round dense homogeneous chromatin

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Normal lymphocytesLymphocytes are the smallest WBC. They have large condensed nucleus, with a scanty pale blue cytoplasm.

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MonocyteDiameter: 14-20(are the largest normal blood cells) Cytoplasm: grey blue Granules: dust-like lilac color granules(purple) Nucleus: blue large irregularly shaped and folded

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The red blood cells here are normal, happy RBC's. They have a zone of central pallor about 1/3 the size of the RBC. The RBC's demonstrate minimal variation in size (anisocytosis) and shape (poikilocytosis). A few small fuzzy blue platelets are seen. In the center of the field are a band neutrophil on the left and a segmented neutrophil on the right.Samples of Blood films: 1

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Last Updated: 8th March 2018

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