What are the implications of white blood cells (leukocytes)?

From the Guidelines

Elevated white blood cell counts are a significant indicator of underlying bacterial infection, inflammation, or immune system disorders, and prompt medical attention is crucial to prevent severe complications, as highlighted in the most recent study from 2024 1. When considering the implications of white blood cells, it's essential to understand the different types of white blood cells and their functions. Neutrophils, lymphocytes, monocytes, eosinophils, and basophils each play a unique role in protecting the body against infections and diseases.

• Normal white blood cell counts typically range from 4,500 to 11,000 cells per microliter of blood.
• Abnormal counts, such as leukopenia (low white blood cell count) or leukocytosis (high white blood cell count), can have significant implications for health, including increased risk of infections, inflammation, or immune system disorders.
• The study from 2009 1 found that leukocytosis with a leukocyte count of 14,000 cells/mm3 had a likelihood ratio of 3.7 for underlying bacterial infection, emphasizing the importance of monitoring white blood cell counts.
• Another study from 2010 1 discussed the management of hyperleukocytosis, which is associated with increased induction mortality due to hemorrhagic events, tumor lysis syndrome, and infections, and recommended hydroxyurea as a therapy to lower WBC counts.
• The most recent study from 2024 1 highlights the importance of managing high WBC counts to prevent leukostasis and resultant tissue damage, which can cause organ compromise.
• Regular blood tests can monitor white blood cell counts, helping to detect health issues early, and maintaining a healthy lifestyle with proper nutrition, regular exercise, adequate sleep, and stress management supports optimal white blood cell function and overall immune health.

From the FDA Drug Label

Hematologic Eosinophilia (6%), thrombocytosis (5.1%) and leukopenia (2.1%). Less frequently reported (<1%) were anemia, hemolytic anemia, neutropenia, lymphopenia, thrombocytopenia and prolongation of the prothrombin time. Blood and lymphatic disorders Granulocytopenia (0.9%), coagulopathy (0.4%). Hematological changes Isolated cases of agranulocytosis (< 500/mm3) have been reported, most of them after 10 days of treatment and following total doses of 20 grams or more. Hematologic – Eosinophilia (0.6%), leukopenia (0.4%), decreased blood platelets (0.1%), elevated blood platelets (0. 1%), pancytopenia (0.1%).

White blood cell implications:

• Leukopenia was reported in 2.1% of patients.
• Neutropenia was reported in less than 1% of patients.
• Lymphopenia was reported in less than 1% of patients.
• Eosinophilia was reported in 6% of patients.
• Agranulocytosis was reported in isolated cases, most of them after 10 days of treatment and following total doses of 20 grams or more 2, 2.
• Granulocytopenia was reported in 0.9% of patients 2, 2.
• Pancytopenia was reported in 0.1% of patients 3.

From the Research

White Blood Cell Implications

• White blood cells play a crucial role in the body's immune response, and their count can be affected by various factors, including infections, inflammatory processes, and medications 4.
• A high white blood cell count, also known as leukocytosis, can be caused by relatively benign conditions, such as infections or inflammatory processes, but can also be a sign of more serious underlying conditions, such as primary bone marrow disorders 4.
• Certain medications, including corticosteroids, lithium, and beta agonists, can also elevate white blood cell counts, while others, such as antibiotics, can have varying effects on white blood cell counts depending on the specific medication and individual patient response 4, 5.

Effects of Antibiotics on White Blood Cells

• The use of antibiotics can have a significant impact on white blood cell counts, with some antibiotics causing a decrease in white blood cell counts, particularly when used in combination with other medications, such as clozapine 5.
• Other antibiotics, such as ciprofloxacin and moxifloxacin, may have less of an impact on white blood cell counts, and may be preferred in certain situations 5.
• However, the combination of certain antibiotics, such as ciprofloxacin and ceftriaxone, may also have unintended consequences, such as thrombocytosis, which is an increase in platelet count 6.

Diagnostic Value of White Blood Cell Count

• White blood cell count can be a valuable tool in the diagnosis of infections, particularly in the emergency department, where it can help to identify patients with bacterial infections 7.
• Eosinopenia, or a decrease in eosinophil count, can be a particularly useful parameter in the diagnosis of urinary and biliary tract infections, with a high specificity for infection 7.
• The combination of white blood cell count with other laboratory parameters, such as C-reactive protein levels, can also provide valuable information in the diagnosis and management of infections 7, 8.

Perioperative Use of Antibiotics

• The use of antibiotics in the perioperative period can help to prevent infection and reduce the risk of complications, such as wound infections and sepsis 8.
• The timing and duration of antibiotic use can also have an impact on outcomes, with single prophylactic use of antibiotics 30 minutes before surgery being effective in preventing infection and shortening hospital-stay length 8.