Original Article

White Blood Counts of Hospitalized Patients Without Infection, Malignancy, or Immune Dysfunction

Authors: Yazan Abu Omar, MD, Erin Sullivan, BS, Rebecca Schulte, MPH, Rayli Pichardo, MD, Michael B. Rothberg, MD, MPH

Abstract

Objectives: An elevated white blood cell (WBC) count may indicate malignancy, infection, and immune dysfunction. In diagnosing these conditions, physicians generally evaluate laboratory results compared with reference ranges based on healthy populations. Reference ranges for hospitalized patients are lacking. This study aims to define a normal reference range for WBC count in hospitalized patients without malignancy, infection, or immune dysfunction.

Methods: This was a retrospective cross-sectional study of nonsurgical patients hospitalized from 2017 to 2018 in the Cleveland Clinic Health System without malignancy, infection, or immunological dysfunction. WBC count, absolute neutrophil count, and absolute lymphocyte count were collected. We calculated means, standard deviations, and the reference range for each variable.

Results: A total of 46,419 patients had WBC counts. Mean WBC count was 8.0 (standard deviation 3.31, reference range 1.6–14.5). In a multivariable linear regression, mean WBC count decreased with age, Black race relative to White race, and congestive heart failure. Body mass index, diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease, and steroid use were associated with higher WBC count. In total, 13.5% of patients in this cohort had WBC counts above the “normal” threshold of 11.

Conclusions: Among hospitalized patients without infection, malignancy, or immune dysfunction, the normal range for WBC count was 1.6 to 14.5 × 109 WBCs/L. Age, race, body mass index, steroid use, and several comorbidities were associated with WBC count variation from the reference levels established based on healthy populations. Physicians should be cautious when interpreting WBC counts between 11 and 14.5 × 109 WBCs/L, which appear to represent normal values in the hospital.
Posted in: Allergy and Immunology10

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Cerny J, Rosmarin AG. Why does my patient have leukocytosis? Hematol Clin 2012;26: 303–319.
 
2. Chabot-Richards DS, George TI. Leukocytosis. Int J Lab Hematol 2014;36:279–288.
 
3. Lim EM, Cembrowski G, Cembrowski M, et al. Race-specific WBC and neutrophil count reference intervals. Int J Lab Hematol 2010;32(6 Part 2):590–597.
 
4. The International Expert Committee. International expert committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327–1334.
 
5. Friedberg RC, Souers R, Wagar EA, et al. The origin of reference intervals: a College of American Pathologists Q-probes study of “normal ranges” used in 163 clinical laboratories. Arch Pathol Lab Med 2007;131:348–357.
 
6. Osgood EE, Brownlee IE, Osgood MW, et al. Total differential and absolute leukocyte counts and sedimentation rates: determined for healthy persons nineteen years of age and over. Arch Intern Med 1939;64:105–120.
 
7. Blackburn CRB. The normal leucocyte count. Med J Aust 1947;1:525–528.
 
8. Bain BJ, England JM. Normal haematological values: sex difference in neutrophil count. Br Med J 1975;1:306–309.
 
9. Carel RS, Eviatar J. Factors affecting leukocyte count in healthy adults. Prev Med 1985;14: 607–619.
 
10. McGrath CR, Hitchcock DC, van Assendelft OW. Total white blood cell counts for persons ages 1–74 years with differential leukocyte counts for adults ages 25–74 years: United States, 1971-75. Vital Health Stat 1982;11(220):1–36.
 
11. Freedman DS, Gates L, Flanders WD, et al. Black/white differences in leukocyte subpopulations in men. Int J Epidemiol 1997;26:757–764.
 
12. Bain B, Seed M, Godsland I. Normal values for peripheral blood white cell counts in women of four different ethnic origins. J Clin Pathol 1984;37:188–193.
 
13. Brain M. Haematological differences in three population groups. S Afr Med J 1979;55: 635–636.
 
14. Friedman GD, Siegelaub AB, Seltzer CC, et al. Smoking habits and the leukocyte count. Arch Environ Health 1973;26:137–143.
 
15. MacNee W. Oxidants/antioxidants and COPD. Chest 2000;117(5 Suppl 1):303S–317S.
 
16. Thomsen M, Dahl M, Lange P, et al. Inflammatory biomarkers and comorbidities in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2012;186:982–988.
 
17. Mahdiani A, Kheirandish M, Bonakdaran S. Correlation between white blood cell count and insulin resistance in type 2 diabetes. Curr Diabetes Rev 2019;15:62–66.
 
18. Nanji AA, Freeman JB. Relationship between body weight and total leukocyte count in morbid obesity. Am J Clin Pathol 1985;84:346–347.
 
19. Nakagawa M, Terashima T, D’yachkova Y, et al. Glucocorticoid-induced granulocytosis: contribution of marrow release and demargination of intravascular granulocytes. Circulation 1998;98:2307–2313.
 
20. Shoenfeld Y, Gurewich Y, Gallant LA, et al. Prednisone-induced leukocytosis. Influence of dosage, method and duration of administration on the degree of leukocytosis. Am J Med 1981; 71:773–778.