High Red Blood Cell Count And Low Lymphocytes – In Part 1 we focused on interpreting blood tests related to red blood cells and clotting. We now turn our attention to blood tests that focus on white blood cells and tumor markers.

Or WBCs, are immune system response centers that help the body fight infection, destroy abnormal cells and prevent disease. WBCs usually live only a few days, so your bone marrow keeps making new ones. There are five basic types, but 60-70% are there

High Red Blood Cell Count And Low Lymphocytes

When the number of neutrophils is low (neutropenia), you have a higher risk of infection, because your immune system is weaker. Some degree of neutropenia is common during cancer treatment.

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The results will include the number of white blood cells – as a number and / or percentage – and the type of WBCs and how many of each type are in the blood.

The level of WBCs in your blood remains stable, but your number can go up or down, depending on what’s going on in your body. For example, bacterial infections tend to cause an increase in neutrophils, allergies cause an increase in eosinophils, and viral infections cause an increase in lymphocytes. The normal range for a WBC count is usually 4,500-11,000, which can be written as 4.5-11 x 10³.

Your blood can also show the presence of tumor markers (biomarkers), which the National Cancer Institute describes as “anything present in or produced by cancer cells or other body cells in response to cancer or certain benign (noncancerous) conditions.”

In the past, the only tumor markers that had been identified were proteins produced in higher amounts by cancer cells. However, with the advancement of science, we have learned that genetic markers can also be used as tumor markers. These include gene mutations, changes in tumor DNA and the specific way tumor genes are expressed (how genes change the way a cell looks/behaves).

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Currently, various tumor markers are used clinically. It is important to know that there are no signs of a tumor that can indicate that someone has cancer. Some tumor markers are associated with only one type of cancer; others, with different types of cancer – but there is no “universal” tumor marker that can reveal the presence of any type of cancer.

Another limitation is that tumor marker levels can rise and fall constantly, so it can be difficult to use the information provided by blood samples. Also, some tumors don’t have markers, and even for tumors that do, not everyone with that type of cancer will have a marker.

For more information about white blood cells, see the Roswell Park publication “Understanding Your Blood Tests.” You will find it online in the Patient Education Library in the MyRoswell patient portal, or you can pick up a copy of the brochure from the Resource Center for Patients and Families or ask a nurse at your center. Leukemia is a type of blood cancer in the bone marrow that makes too many abnormal white blood cells, also known as leukocytes. As more cells are made, they start crowding out the body’s healthy blood cells, leading to symptoms of leukemia. Monocytes are one type of white blood cell that is produced excessively in leukemia.

High levels of monocytes or other white blood cells can clue your doctor into the specific type of leukemia you have. Your monocyte count, along with other blood test results, can help your doctor determine the recommended treatment regimen for your leukemia.

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Blood contains many types of cells, including red blood cells, platelets, and several types of white blood cells, including monocytes. Symptoms of leukemia occur when monocytes are produced in excess and outcompete other healthy cells. (Adobe Stock).

Monocytes are produced in the bone marrow but circulate in the blood. During an infection, the immune system activates monocytes to destroy the invading germs. Other types of white blood cells include lymphocytes (T cells and B cells) and granulocytes (neutrophils, eosinophils, and basophils).

Monocytes are normally distributed throughout the bloodstream, spleen, and bone marrow. To be activated, it must come into contact with inflammatory signaling molecules. When monocytes encounter signaling molecules that indicate the presence of infection, they mature into one of two types of innate effector immune cells (first responders) – dendritic cells or macrophages. These are specialized cells known as antigen presenting cells. Antigens are substances, usually foreign proteins such as viral or bacterial particles, that attract the attention of the immune system.

Dendritic cells travel to different areas of the body and take up antigens. Dendritic cells then “show” these proteins to other immune cells, spreading the message of infection or cancer and mounting an immune attack. Macrophages also present antigens to other immune cells but have other functions as well. For example, they surround and kill bacteria and infected cells and remove dead cells from the body.

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Immature blood cells called myeloblasts develop into white blood cells, including monocytes. If monocytes detect an infection, they mature into dendritic cells and macrophages that help fight disease. (Adobe Stock)

Blood cell counts are measured using a test known as a complete blood count (CBC). This blood test measures the levels of white blood cells, red blood cells, and platelets to help your doctor see your overall health. The number is measured in cells per microliter of blood. An absolute monocyte count, which is the CBC’s percentage of monocytes multiplied by the total white blood cell count, may also be performed.

Normally, monocytes comprise 2 percent to 8 percent of the cells circulating in the blood, or 200 to 800 cells per microliter of blood. Levels that are lower or higher than normal can indicate an underlying health condition. Abnormal levels of monocytes are called monocytosis and can be a sign of cancer, autoimmune disease, or mononucleosis infection. A low-normal number of monocytes, or monocytopenia, can be caused by aplastic anemia (a low number of red blood cells), a bacterial infection in the blood, or chemotherapy.

A differential blood test counts the number of each type of white blood cell in a blood sample. In most healthy people, monocytes make up 2 percent to 8 percent of the white blood cells circulating in the blood.

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Monocyte counts vary from person to person but should generally be within the normal range. However, high numbers occur in certain types of cancer, especially chronic and acute myelomonocytic leukemia and acute monocytic leukemia. In these conditions, monocytes are abnormal and cannot function effectively in their usual roles. Treatment focuses mainly on reducing the number of immature white blood cells and monocytes, known as myeloblasts or simply blasts.

Chronic myelomonocytic leukemia (CMML) is characterized by a high level of blasts that do not function properly. Eventually, these immature cells destroy healthy, mature cells and cause the symptoms of CMML.

Although the condition has “leukemia” in its name, CMML is classified as a myelodysplastic syndrome/myeloproliferative neoplasm because of abnormalities in monocyte count and red blood cell production. Sometimes, CMML progresses and becomes acute myeloid leukemia (AML).

The monocyte level for those with CMML is at least 1,000 per microliter of blood. Excess monocytes also build up in the bone marrow and interfere with the normal production of other types of blood cells, such as red blood cells and platelets. A low number of red blood cells prevents oxygen from reaching body tissues, leading to anemia and symptoms of fatigue, pale skin, and chest pain. Thrombocytopenia (low platelet count) can cause you to bleed and bruise easily. Monocytes can also grow in the body’s organs, causing symptoms such as an enlarged spleen.

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Possible treatments for CMML include chemotherapy followed by a bone marrow transplant. For cases where a transplant is not possible, CMML can be managed with chemotherapy to lower the white blood cell count.

High levels of monocytes in AML can be diagnosed as a specific subtype. These guidelines, which follow the French-American-British classification of AML, are based on the way leukemic cells appear under the microscope and on the high level of different immune cells.

Acute myelomonocytic leukemia (AMML, or AML-M4) is diagnosed based on elevated levels of monocytes and neutrophils. In AMML, blasts make up more than 20 percent of the blood and bone marrow. In addition, mature monocytes and neutrophils make up at least 20 percent of bone marrow cells. Between 5 percent and 10 percent of AML cases are AMML, according to Leukemia Care. Like CMML, the condition can also cause anemia and thrombocytopenia.

Treatment for AMML aims to reduce the blast rate to below 5 percent and bring blood counts back into the normal range. Ideally, treatment includes induction chemotherapy to kill many of the blasts in the bone marrow and blood to achieve remission (signs and symptoms of cancer diminish). This can be followed by an allogeneic bone marrow transplant, which uses cells from a healthy donor.

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Acute monocytic leukemia (AML-M5) – also known as acute monoblastic leukemia – is a common subtype of AML diagnosed when 80 percent of the leukemia cells come from monocytes or promonocytes (precursor cells for monocytes). It can be divided into two groups – AML-M5a and AML-M5b

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