Leukocytes increased or too low – what is behind it?

In addition to the  red blood cells  (erythrocytes), which owe their color to the red blood pigment  hemoglobin  , there are also white blood cells (leukocytes) in our blood system, which contain no red blood pigment and therefore appear white. The leukocytes are involved in the  immune  system. With the help of a  small blood count  , you can determine their number in the blood and draw conclusions about existing diseases based on changes in this laboratory value. In this article you can read which diseases are manifested by a too low or increased number of white blood cells and which symptoms can result.

What are leukocytes?

Leukocytes are also referred to as  white blood cells  or white blood cells, and the abbreviations leukos or WBC (white blood cell) are also often used. Leukocytes are mainly found in the blood, in the lymphatic system, in tissue, in the mucous membranes and in the bone marrow. Their most important function is the immune system, because they “patrol” our body and render harmless pathogens, foreign bodies and other incompatible substances. To this end, if necessary, they can multiply very quickly. They have a lifespan of a few days to several months.

The white blood cells can be divided into different forms: These include the  granulocytes  and  lymphocytes  as well as the  monocytes  and other cells of the immune system. Granulocytes can be further subdivided into neutrophilic, eosinophilic and basophilic granulocytes. The different forms have different roles in our body’s immune response. For example, the lymphocytes can produce antibodies, while the monocytes, which are also known as macrophages or scavenger cells, absorb the pathogens and thus render them harmless.

With the help of a complete blood count (differential blood count), you can not only determine the number of all leukocytes, but also determine how many leukocytes of the different subtypes are in the blood. Not only their determination in the blood, but also the determination of the leukocytes in the urine can provide information about the presence of various diseases. Values ​​that are too high or too low can indicate a disease.

When and how is the laboratory value determined?

The leukocytes are determined by standard with a small blood count. But the value can also be collected if an inflammation is suspected or if the immune system is to be checked. The leukocyte value is also important if certain diseases are suspected, such as infectious diseases or leukemia, and for monitoring the progress of certain therapies.

blood sample  is required to determine the leukocytes in the blood. A drop of whole blood is enough to determine the distribution, number and condition of the different leukocytes, either using automatic counting devices or manually under a microscope.

The leukocytes in the urine are determined above all if a urinary tract infection is suspected or if there are abnormalities in the urine. This usually requires a midstream urine sample.

In addition to the microscopic examination, test strips can also be used as quick tests in both cases.

What is the normal leukocyte count in the blood?

The normal  laboratory value  for leukocytes in the blood depends on age and can be determined after a blood test in the laboratory. It is usually given in cells/µl, i.e. the number of cells per microliter of blood.

The following table provides an overview of the normal values, although there may be slight deviations in the normal values ​​from laboratory to laboratory.

The information is often given in cells/nl, i.e. cells per nanoliter of blood. Then the value must be divided by 1,000.

When are the leukocytes too high?

An increased number of leukocytes (leukocytosis) in the blood is present when the normal values ​​listed in the table are exceeded. Leukocytosis  can arise  due to various causes and diseases, of which important examples are given below:

  • A common reason for increased leukocytes in the blood is infection. Whether it’s  the flu , a urinary tract infection or  myocarditis , each of these infections can be accompanied by leukocytosis in the blood count.
  • In smokers, the leukocytes are often slightly elevated.
  • Autoimmune diseases, for example from the group of rheumatic diseases, can be a cause. One example is rheumatoid  arthritis , an inflammatory disease that primarily affects the joints.
  • Drugs can also be the trigger. These include steroids, such as the drug budesonide, which is used in the context of the chronic inflammatory bowel  disease Crohn’s  disease
  • An existing pregnancy can lead to increased leukocyte levels.
  • A cell death in the context of a heart attack or stroke can be the reason.
  • Tumor diseases, including  blood cancer  (leukaemia), can be associated with leukocytosis.

Elevated leukocytes caused by smoking are common, another common reason is infections of all kinds. The complete blood count also provides information about which types of white blood cells are particularly high. If, for example, there is monocytosis, i.e. an increased occurrence of monocytes, this can speak for the presence of glandular fever. An increased number of eosinophilic granulocytes can occur, for example, in the context of  allergies  .

Leukocytosis does not necessarily mean leukemia

Many associate elevated leukocytes with the presence of leukemia. However, this is not always accompanied by an increased number of leukocytes, but also in some cases with a normal or reduced number. Only 60 percent of those affected by acute leukemia show classic leukocytosis.

Leukemia can manifest itself through symptoms such as unwanted weight loss, heavy night sweats that require you to change your clothes at night, and  fever . In addition, those affected often feel weak, are very pale and have a tendency to bleed. The tendency to bleed can show itself, for example, as pinpoint bleeding under the skin or frequent bruising and  nosebleeds  .

There may also be other changes in the blood count, such as a reduced number of red blood cells (erythrocytes) and blood platelets ( thrombocytes ), which are responsible for the tiredness and paleness and the tendency to bleed.

Leukocytes too high – what helps?

If the laboratory value of the leukocytes is increased, the cause of this should be clarified. This can be determined, among other things, with the help of other blood values ​​or through the symptoms. Necessary treatment ultimately depends on the identified trigger.

Slightly elevated values ​​in smokers, without symptoms and with an otherwise normal blood count, usually have no medical significance. Of course, it is still recommended to stop smoking.

If an infection is present, it must either be treated with medication or simply cured. It depends on which germs are the cause:

  • If bacteria are the trigger, antibiotics can be taken depending on the severity of the disease   .
  • If viruses are the trigger, the disease can often only be treated symptomatically. This means that the therapy depends on the symptoms of those affected, so that, for example, pain-relieving or antipyretic drugs are administered.

Once the infection has subsided, the blood value of the leukocytes should also return to normal.

The other disease groups listed, such as autoimmune diseases or tumor diseases, also have their individual therapies that should be discussed with a doctor.

What if you have too few leukocytes?

A low level of leukocytes in the blood is called  leukopenia  or  leukocytopenia.  There are a number of potential causes for this, and the following are a few examples:

  • Infectious diseases can also be the cause here. This is due to the fact that many leukocytes are used up for the immune system as part of infections, which can ultimately lead to a deficiency of these.
  • In addition, drugs can also be the cause in this case. Clozapine and the pain medication  metamizol  (Novalgin®) are examples of medications that can, in very rare cases, trigger what is known as agranulocytosis. This refers to an almost complete lack of granulocytes, a subtype of white blood cells.
  • A lack of  vitamin B12  can also be the cause. In addition, a lack of the vitamin can lead to states of exhaustion and sensory disturbances in the legs, among other things.
  • Radiation in the context of a tumor disease can damage the bone marrow. Since the leukocytes are formed there, leukopenia can occur.

Since the white blood cells play a central role in the immune response, leukopenia can be dangerous. A lack of leukocytes can therefore lead to a higher susceptibility to infections.

What to do if the leukocyte count is low?

As in the case of leukocytosis, the treatment of leukopenia depends on the underlying disease. For example, if there is a vitamin B12 deficiency, this can be administered in the form of tablets or injections.

If, on the other hand, a drug is the cause, then this should be discontinued after medical consultation and replaced by another.

What is the normal leukocyte count in urine?

The normal value in urine is 0-5 cells/µl (cells per microliter). The value can be determined by a urine sample from a doctor. Increased urinary excretion is known as  leukocyturia  .

When are the leukocytes in the urine elevated?

An increased number of leukocytes in the urine is usually caused by an infection of the kidneys and/or urinary tract. These infections include, for example,  cystitis , which can manifest itself primarily through burning when urinating and the frequent need to go to the toilet. If such an infection spreads to the renal pelvis, those affected often complain of pain in the flanks and fever. One speaks then of an  inflammation of the renal pelvis .

In men, an infection of the prostate or epididymis can also be behind it.

What to do against increased leukocytes in the urine?

A bladder infection, which is often the cause of the increased number of leukocytes, can be treated purely symptomatically or with antibiotics.

If the leukocytes in the urine are increased during pregnancy or if the renal pelvis is also affected, then treatment with an antibiotic should be carried out. Outside of pregnancy, symptomatic therapy is recommended in mild cases, in which the amount of fluids can be increased and pain medication can be taken if necessary. If the symptoms are more severe, antibiotics can also be used here.


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