White Blood Cells and Transplantation

Dr. Ramesh Prasad

One of the most important tests monitored in the post-transplant patient is the complete blood count, or CBC. Within the CBC, one of the important tests is the white blood cell, or WBC count. Although the normal range varies somewhat depending on the laboratory, the normal total WBC count is considered as between 4000 and 11,000/mm3. Within the WBC are five distinct classes of cells, called neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Neutrophils and lymphocytes are the most common and the ones most closely monitored, although the others can also be important in certain situations.

Neutrophils increase in response to infection, typically bacterial, as well as in response to stress and steroids. A rise in neutrophils usually means the total WBC count is elevated as well. It is quite common to see a rise in neutrophils early after the transplant from stress and steroids alone. However, if there are symptoms like fever or burning in the urine, then infection is definitely possible. A low neutrophil count (neutropenia) can occur in viral infection, and because of certain medications. This is not dangerous unless the count is very low, in which case other medications can be used to stimulate neutrophil production.

Increased lymphocytes (lymphocytosis) results from viral infections, and rarely cancer. Neutrophil and lymphocyte counts often move in opposite directions, so if one is high, the other may appear low. A low lymphocyte count may be due to certain medications, autoimmune disorders, malnutrition, and more recently with COVID-19 infection.

As for the remaining three types of WBC, monocytosis occurs in autoimmune disease, certain cancers, infections like tuberculosis, and inflammatory bowel disease. Monocytopenia can occur from cancer and cancer drugs, and aplastic anemia. Eosinophilia typically results from allergic reactions, but can be seen in parasitic diseases and autoimmune disorders. Basophilia also relates to infections, allergies, and chronic inflammation, but is rare.

Please do not hesitate to ask us in the Transplant Clinic if you have any question regarding your WBC count.