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^ Back to Top Differential blood count can be performed by the following 2 methods: Automated differential blood count: Automated hematology instruments using multiple parameters and methods (such as fluorescence flow cytometry and impedance) are used to count and identify the 5 major white blood cell types in blood (so-called 5-part

differential count): neutrophils, lymphocytes, monocytes, eosinophils and basophils. [4, 5] Manual differential blood count: This is performed by visual examination of peripheral blood smear (blood films) by trained personnel. [4] The automated differential blood count is less time-consuming and less expensive than routine examination of blood smear.

With the automated technique, thousands of white blood cells can be examined, whereas typically 100-200 white blood cells are examined by visual examination. [6] Differential blood count is primarily needed in the 2 following reasons. [2] To look for quantitative abnormalities in morphologically normal WBC population such as in the diagnosis of

infectious or allergic diseases and for therapeutic monitoring of cytotoxic or myelotoxic drugs (This requires a high level of precision and accuracy [ie, ability to provide consistent and correct results]). To look for morphologic abnormalities of white blood cells (eg, when circulating abnormal white blood cell population such as immature or atypical

cells are suspected for diagnostic or monitoring reasons; this requires a high level of clinical sensitivity, [ie, ability to identify all patients who have circulating abnormal WBCs]). Accuracy, precision, and clinical sensitivity The automated differential blood count provides a high level of accuracy and precision (correct and consistent results) for

quantification and identification of normal white blood cells; however, this method is not sensitive at identifying abnormal or immature cells and is not able to accurately identifying and classifying all types of white blood cells. To overcome this problem, most automated analyzers will flag samples with possible abnormal white blood cell populations,

indicating the need for peripheral smear examination to be examined by trained personnels to identify abnormal cells. [6, 2] Monocyte count and basophil count are the most difficult population to count and have a low level of precision and accuracy. Moreover, automated analyzers tend to underestimate the basophil count during true basophilia. [2]

False negative Both automated and manual methods may not detect small numbers of abnormal cells. The false negative rate for detection of abnormal cells varies from 1-20%, depending on the instrument and the detection limit desired (1-5% abnormal cells). The most difficult for both automated instruments and visual examination by human is

identification of lymphoma cells and reactive lymphocytes. [5] Band neutrophils and immature granulocytes (IGs) The value of reporting band neutrophils is questionable. The measurement of the immature cells of the myeloid lineages, specifically ¡°band,¡± has been considered clinically useful in the diagnosis of infections, especially neonatal sepsis. [7]

However, band neutrophils cannot be enumerated by automated analyzers and are reported together with segmented neutrophils as absolute neutrophil counts (ANC), which are used to defined neutropenia or neutrophilia. Identification of band neutrophils by visual examination (manual differential blood count) is neither precise nor consistent, as a

high variability of morphologic classification or quantification of band neutrophils exists due to interobserver variability. Some, therefore, advocated ceasing quantitative reporting of band neutrophils. [5, 2] The extended differential count includes reporting immature granulocytes (IG) can be used alternatively to help diagnosis neonatal sepsis. [2]

For further reading, see Interpretation. Neutropenia (noo-treh-PEE-nee-eh) is when the blood doesn't have enough of a type of white blood cell. These cells, called neutrophils, fight bacteria. Bacteria are germs that cause infections. Without enough neutrophils, serious infections can happen. Most children with neutropenia need medical care right

away if they have any signs of an infection. Common signs include fevers, spreading redness around a cut, and shivering or chills. With quick treatment, most infections in children with neutropenia get better. What Are the Signs & Symptoms of Neutropenia? Compared with other kids, a child with neutropenia may have infections: more often that are

more severe that get worse quickly The symptoms depend on what kind of infection the child has (for example, ear pain in a child with an ear infection). What Causes Neutropenia? Someone with neutropenia has a low number of neutrophils (NOO-treh-filz) in the bloodstream. Neutropenia can be due to: infections medicines (such as chemotherapy)

radiation therapy a genetic (inherited) problem the bone marrow (the spongy part inside bones that makes blood cells) not working well the germ-fighting immune system attacking the neutrophils (called autoimmune neutropenia) Neutropenia may: be present at birth (congenital neutropenia) come and go (cyclic neutropenia) Sometimes doctors

don't know what causes a person's neutropenia (called idiopathic neutropenia). How Is Neutropenia Diagnosed? Doctors diagnose neutropenia with a blood test called a complete blood count (CBC). To find out why a child has neutropenia, a hematologist (a doctor who specializes in blood diseases) will: look at the child's blood under a microscope

take a tiny amount of bone marrow to study under a microscope do tests for infections do genetic tests How Is Neutropenia Treated? Treatment for neutropenia depends on its cause and how severe it is. Not all cases need treatment. Doctors use the ANC (absolute neutrophil count) to help them make decisions about treatment. The ANC is a blood

test that measures the number of neutrophils. The lower the number is, the more likely the child is to get serious infections. Treatment, when needed, can include: correcting the neutropenia through: injections of granulocyte colony-stimulating growth factor (G-CSF) to push the bone marrow to make more neutrophils steroid medicines to stop the

body's immune system from attacking the neutrophils white blood cell transfusions to give the child more infection-fighting cells stem cell transplant to replace the blood-forming stem cells with healthy donated stem cells surgical removal of the spleen (splenectomy) since the spleen can sometimes destroy neutrophils preventing and treating

infections with antibiotics for children with very low neutrophil counts who are at very high risk for infection: avoiding public places, including schools avoiding sick people wearing a face mask if they must go out washing hands well and often brushing and flossing teeth every day not using a rectal thermometer cleaning cuts right after injury, then

covering with a bandage not using razors avoiding certain foods, including: unpasteurized dairy foods raw fruits, vegetables, and nuts raw honey How Can Parents Help? To help your child, follow the doctor's instructions on: getting scheduled blood tests taking any medicines preventing infections When Should I Call the Doctor? It's important to find

care right away if kids with neutropenia have any signs of infection. Quick treatment usually helps them get better. Call the doctor right away if you see any signs or symptoms of an infection, such as: a fever above 100.4¡ãF (38¡ãC) chills and/or sweats coughing shortness of breath mouth sores sore throat pain when peeing red area around a break in

the skin vomiting or diarrhea new pain What Else Should I Know? Having a child with a serious medical condition can feel overwhelming for any family. But you don't have to go it alone. Talk to anyone on the care team about ways to find support. You also can visit online sites for more information and support, such as: National Neutropenia Network

White blood cells fight infection. A normal white blood cell count is between 5,000 and 10,000 cells. A white blood cell count below 1,000 cells increases the risk of infection. In some cases, your child may be given a medicine, such as ¡°G-CSF (granulocyte-colony stimulating factor),¡± to help increase the number of white blood cells in the bone marrow.

Different types of white blood cells have different jobs. The ¡°differential¡± is part of the blood count report that shows the breakdown of the various types of white blood cells in your child¡¯s blood count. Neutrophils help to fight bacterial infections. Lymphocytes make antibodies to fight infections. Monocytes help to fight infection by killing and

removing bacteria. Basophils and eosinophils respond during an allergic reaction. The term ¡°ANC,¡± which stands for ¡°Absolute Neutrophil Count,¡± is the total number of neutrophils in your child¡¯s white blood cell count. We often refer to the ANC as the ¡°infection-fighting¡± count. The lower the ANC drops, the higher the risk of infection. When the

ANC drops below 500, the risk of infection is high. ANC Value Risk for Infection Lower than 500 Highest 500 to 1,000 Moderate More than 1,000 Lower On most blood count reports, you will see the ANC already calculated for you. You can also ask your health care provider to tell you the ANC. To calculate the ANC yourself, use this formula: ANC =

(% segs + % bands) x WBC Look at your child¡¯s differential. Add the percentage of segs (sometimes called polys or PMNs) and bands together (combined, these make up the neutrophil count). Multiply the neutrophil count by the white blood cell count (WBC). Example: WBC = 1,000 % segs = 20 % % bands = 1% ANC = (% segs + % bands) x WBC

ANC = (20% + 1%) x 1,000 ANC = (0.21 x 1,000) ANC = 210 (high risk for infection) Signs of Infection While there are no outward signs of a low white blood cell count, it's important to be aware of the timing of low blood counts following chemotherapy. Whenever your child receives chemotherapy, you¡¯ll want to speak with the nurse about the

timing of low counts.) Call your health care provider right away if you notice any signs of infection, including: Fever Chills Cough Trouble breathing Diarrhea Pain If your child has a central venous access device (central line or port), check for redness, swelling, pain or pus at the site. A child with a low ANC may not have redness or pus, but could still

have an infection. Medically reviewed by Stacy Sampson, D.O. ¡ª Written by Susan York Morris ¡ª Updated on September 28, 2018ANCHigh levelsLow levelsOutlookNext steps OverviewNeutrophils are a type of white blood cell. In fact, most of the white blood cells that lead the immune system¡¯s response are neutrophils. There are four other types of

white blood cells. Neutrophils are the most plentiful type, making up 55 to 70 percent of your white blood cells. White blood cells, also called leukocytes, are a key part of your immune system. Your immune system is made up of tissues, organs, and cells. As part of this complex system, white blood cells patrol your bloodstream and lymphatic system.

When you¡¯re sick or have a minor injury, substances that your body sees as foreign, known as antigens, call your immune system into action. Examples of antigens include: bacteriavirusesfungipoisonscancer cellsWhite blood cells produce chemicals that fight antigens by going to the source of the infection or inflammation.Neutrophils are important

because, unlike some of the other white blood cells, they aren¡¯t limited to a specific area of circulation. They can move freely through the walls of veins and into the tissues of your body to immediately attack all antigens.An absolute neutrophil count (ANC) can provide your doctor with important clues about your health. An ANC is typically ordered as

part of a complete blood count (CBC) with differential. A CBC measures the cells that are in your blood. Your doctor may order an ANC:to screen for a number of conditions to help diagnose a condition to monitor your status if you have an existing disease or if you¡¯re undergoing chemotherapyIf your ANC is abnormal, your doctor will likely want to

repeat the blood test multiple times over a period of weeks. This way, they can monitor for changes in your neutrophil count.What to expect For the ANC test, a small amount of blood will be drawn, usually from a vein in your arm. This will happen at your doctor¡¯s office or in a lab. The blood will be evaluated in a laboratory and the results will be sent

to your doctor.Certain conditions can affect the results of your blood test. Be sure to tell your doctor if you¡¯re pregnant, or if you¡¯ve had any of the following:Understanding the resultsIt¡¯s important to have your doctor explain your test results. Results can vary widely from lab to lab. They¡¯re also different depending on: your ageyour genderyour

heritagehow high above sea level you livewhat instruments were used during testingNote that the reference ranges listed here are measured in microliters (mcL), and are only approximate.Having a high percentage of neutrophils in your blood is called neutrophilia. This is a sign that your body has an infection. Neutrophilia can point to a number of

underlying conditions and factors, including:If your neutrophil counts are high, it can mean you have an infection or are under a lot of stress. It can also be a symptom of more serious conditions.Neutropenia, or a low neutrophil count, can last for a few weeks or it can be chronic. It also can be a symptom of other conditions and diseases, and it places

you at greater risk for acquiring more serious infections.If abnormal neutrophil counts are due to an underlying condition, your outlook and treatment will be determined by that condition.If your doctor orders a CBC with differential or an ANC screen, you may find it useful to ask the following questions.Why are you ordering this test?Are you trying

to confirm or eliminate a specific condition?Is there anything special I should do to prepare for the test?How soon will I get the results?Will you, or someone else, give me the results and explain them to me?If the test results are normal, what will the next steps be?If the test results are abnormal, what will the next steps be?What self-care steps should

I take while waiting for the results? Last medically reviewed on February 16, 2017 Doctors often do a blood test called a complete blood count. This test may be done for many different symptoms, including signs of infection (such as fever, cough, or abdominal pain), or signs of chronic illness (such as weight loss or fatigue). If doctors discover an

increased number of neutrophils and there is no clear reason, such as an obvious infection, a blood sample is viewed under a microscope to determine if immature neutrophils (myeloblasts) are leaving the bone marrow and entering the blood. Immature neutrophils in the blood may indicate the presence of a disorder in the bone marrow, such as

leukemia. When immature neutrophils are found in the blood, doctors usually take a sample of bone marrow (bone marrow examination).

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