LEUCOCYTES 



135 



LEUCOCYTE COUNTS 



demonstration of degenerative leucocytic 

 changes associated with ageing is de- 

 scribed by Lowell (A. L., J. Lab. & Clin. 

 Med . , 1937-38, 23, 791-796 ) , of varial)ili ty 

 in relation to alterations in raeteorologic 

 conditions by Berg (M., J. Lab. &Clin. 

 Med., 1937-38, 23, 797-803) and of lipoid 

 components by Bacsich (P., J. Anat., 

 1935-36, 70, 267-272). Chemotactic re- 

 sponse and motility can be measured 

 both in tissue cultures (Coman, D. R., 

 Arch. Path., 1940, 30, 896-901) and 

 directly by observing the behavior of 

 leucocytes with relation to bacteria and 

 in temporary mounts (Mallery, O. T. 

 and McCutcheon, M., Am. J. Med. Sci., 

 1940,200,394-399). By the latter method 

 differences in behavior of neutrophiles 

 from seriously ill and normal persons 

 have been reported. Motion pictures are 

 of great assistance in making a thorough 

 analj'^sis of the movements and behavior 

 of leucocytes. Some excellent ones, 

 taken by Dr. W. H. Lewis, are available 

 for distribution by the Wistar Institute 

 of Anatomy in Philadelphia. To in- 

 vestigate their behavior after they have 

 left the blood vessels and entered the 

 surrounding tissues is immensely more 

 difficult. The only method that gives 

 promise of important results is to employ 

 for this purpose special chambers in- 

 serted in the ears of rabbits (Clark, E.R. 

 and E. L., Am. J. Anat., 1936, 59, 123- 

 173) . See Neutrophile, Eosinophile and 

 Basophile Leucocytes. 

 Leucocyte Counts. 1. Total number white 

 blood cells per c. mm. Over 12,000 a 

 leucocytosis, less than 5000, a leucopenia. 

 Average about 7,500. 



2. Differential. Smears colored by 

 Giemsa's or Wright's stains are more 

 satisfactoiy than supravitall.y stained 

 preparations because the latter are more 

 difficult to handle and the cells are 

 slowly dying and showing more and more 

 deviations from normal. Relative num- 

 ber of different white cells is expressed 

 in percentages, i.e. neutrophiles 55-75, 

 eosinophiles, 2-4, basophiles, 0-1, lym- 

 phocytes 21-31, and monocytes 4-5. 

 Both total and differential counts should 

 be correlated to avoid misconceptions. 

 60% neutrophiles in total count of 8,000 

 amounts to 4,800 neutrophiles per c. mm. 

 80% neutrophiles in total count of 4,800 

 is the same, namely 4,800 neutrophiles 

 per c. mm. although a relative neutro- 

 philic leucocytosis exists. 60% neutro- 

 philes in a total count of 16,000 makes 

 on the other hand 9,600 neutrophiles 

 per c. mm. which is an actual neutro- 

 philic leucocytosis. 20% lymphocytes 

 of 9,000 is the same number per c. mm. 

 as 60% of 3,000; while 30%, of 11,000 is an 

 actual IjTnphocytosis. 



3. Age. Since young neutrophiles 

 have fewer nuclear lobes than older ones 

 counts of the number with from 1-5 

 lobes were made by Arneth. Today 

 simpler methods are used. 



The Schilling is the usual one. It is 

 both a total, a differential and an age 

 count combined. The normal is given 



above. B = basophile. E = eosino- 

 phile. M = myelocyte (Nucleus large, 

 occupying about half cytoplasmic area, 

 spherical to oval or kidney-shaped, pale 

 staining, chromatin reticulated, nu- 

 cleoli present. Cytoplasm faintly 

 basophilic with few specific granules 

 which are small, often difficult to stain 

 and irregularly distributed). J = 

 juvenile (A little larger than mature 

 neutrophiles. Nucleus saucer to bean 

 shaped. Stains poorly. Circum- 



scribed basophilic nucleoli). St = 

 stab nuclear (Slightly smaller than 

 juveniles. Nucleus T V or U shaped 

 but not divided into segments by fila- 

 ments and without nucleoli). S = seg- 

 ment nuclear (Fully differentiated neu- 

 trophiles having 2-5 or more segments 

 often joined only by filaments. Nuclei 

 stain intensely.) L = lymphocyte. 

 Mon = monocyte. 



When the numbers of M. J. St. are 

 increased relative to S., it is called a 

 "shift to the left", meaning that im- 

 mature leucocytes are called into the 

 circulation , which is an unfavorable sign. 

 When the relative number of S is in- 

 creased over the others, it is termed a 

 "shift to the right", meaning that only 

 mature leucocytes are called out, which 

 is a favorable sign if it follows a previous 

 shift to the left. Details are given by 

 Wintrobe, M. M., Clinical Hematology, 

 Philadelphia, Lea & Febiger, 1942, 792 

 pp. For blood containing gum acacia, 

 see Monke, J. V., J. Lab. & Clin. Med., 

 1940-41, 26, 1664-1G67 and for inter- 

 ference by decreased fragility of eryth- 

 rocytes see Bohrod, M. G., J. Lab. & 

 Clin. Med., 1940-11, 2G, 1953-1955. 



A better method, unfortunately not 

 widely employed, is the filament-non- 

 filament count. Filaments arc neutro- 

 philes in which th(! nuclear segments 

 are connected by delicate strands 



