Is a CBC differential with neutrophils 63%, lymphocytes 27%, monocytes 8% and eosinophils 2% in an otherwise healthy adult normal or does it require further evaluation?

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Normal CBC Differential - No Further Evaluation Needed

These differential values (neutrophils 63%, lymphocytes 27%, monocytes 8%, eosinophils 2%) fall within normal reference ranges for a healthy adult and do not require further evaluation. 1, 2

Reference Ranges for Peripheral Blood Differential

Your values align with established normal ranges:

  • Neutrophils 63%: Normal range is 45-75% 3
  • Lymphocytes 27%: Normal range is 16-46% 3
  • Monocytes 8%: Normal range is 4-11% 3
  • Eosinophils 2%: Normal range is 0-5% (typically <3%) 3

All four cell populations are well within their respective normal limits. 3, 1

Clinical Interpretation

No pathologic findings are present. The differential shows:

  • A physiologic neutrophil predominance, which is expected in healthy adults 1
  • Normal lymphocyte percentage without lymphocytosis or lymphopenia 3, 1
  • Normal monocyte percentage 3
  • Normal eosinophil percentage, ruling out eosinophilia (which would require >5% or absolute count considerations) 3

When to Investigate Further

Further evaluation would only be warranted if:

  • Total WBC count is elevated (>11,000 cells/mm³) with absolute neutrophil count >6,700 cells/mm³, suggesting possible bacterial infection even without fever 1
  • Clinical symptoms are present such as fever, signs of infection, unexplained fatigue, or lymphadenopathy 3, 1
  • Band forms (immature neutrophils) are elevated (>5% or absolute band count >1,500/mm³), which would indicate a "left shift" suggestive of acute bacterial infection 1, 2
  • Absolute cell counts are abnormal despite normal percentages (requires knowing total WBC count) 1

Common Pitfall to Avoid

Do not confuse these peripheral blood differential ranges with bronchoalveolar lavage (BAL) differential ranges, which have entirely different normal values (BAL: 85-95% macrophages, 4-15% lymphocytes, <3% neutrophils, <1% eosinophils). 3, 2, 4 The question refers to peripheral blood, where your values are completely normal.

References

Guideline

Interpretation of Slightly Elevated WBC Count and Elevated Absolute Neutrophil Count

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Normal Differential Count Values by Age

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Guideline

Guidelines for Interpretation of Bronchoalveolar Lavage (BAL) Cellular Differentials

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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