Also Known As
Leukocyte Differential Count
Peripheral Differential
WBC Count Differential
Diff
Blood Differential
Differential Blood Count
Formal Name
White Blood Cell Differential
This article was last reviewed on
This article waslast modified on
April 26, 2018.
At a Glance
Why Get Tested?

To help determine the cause of abnormal results on a white blood cell (WBC) count; to help diagnose and/or monitor an illness affecting your immune system, such as an infection or inflammatory condition, or cancers that affect your white blood cells, such as leukemia

When To Get Tested?

As part of a complete blood count (CBC), when you have a routine health examination; when results of a CBC fall outside the reference range; when you have any number of signs and symptoms that may be related to a condition affecting white blood cells, such as infection, inflammation, or cancer; when you are receiving treatment that is known to affect WBCs, such as chemotherapy

Sample Required?

A blood sample drawn from a vein in your arm or by a fingerstick (children and adults) or heelstick (infants)

Test Preparation Needed?

None

You may be able to find your test results on your laboratory's website or patient portal. However, you are currently at Lab Tests Online. You may have been directed here by your lab's website in order to provide you with background information about the test(s) you had performed. You will need to return to your lab's website or portal, or contact your healthcare practitioner in order to obtain your test results.

Lab Tests Online is an award-winning patient education website offering information on laboratory tests. The content on the site, which has been reviewed by laboratory scientists and other medical professionals, provides general explanations of what results might mean for each test listed on the site, such as what a high or low value might suggest to your healthcare practitioner about your health or medical condition.

The reference ranges for your tests can be found on your laboratory report. They are typically found to the right of your results.

If you do not have your lab report, consult your healthcare provider or the laboratory that performed the test(s) to obtain the reference range.

Laboratory test results are not meaningful by themselves. Their meaning comes from comparison to reference ranges. Reference ranges are the values expected for a healthy person. They are sometimes called "normal" values. By comparing your test results with reference values, you and your healthcare provider can see if any of your test results fall outside the range of expected values. Values that are outside expected ranges can provide clues to help identify possible conditions or diseases.

While accuracy of laboratory testing has significantly evolved over the past few decades, some lab-to-lab variability can occur due to differences in testing equipment, chemical reagents, and techniques. This is a reason why so few reference ranges are provided on this site. It is important to know that you must use the range supplied by the laboratory that performed your test to evaluate whether your results are "within normal limits."

For more information, please read the article Reference Ranges and What They Mean.

WBC Differential Reference Range

The reference ranges1 provided here represent a theoretical guideline that should not be used to interpret your test results. Some variation is likely between these numbers and the reference range reported by the lab that ran your test. Please consult your healthcare provider.

WBC diff Conventional Units2 SI Units3
Component Percentage
(mean)		 Absolute counts 
(per microliter)		 Mean number
fraction		 Absolute counts X 109
per liter
Segs  56  1800-7800  0.56  1.8-7.8
Eos  2.7  0-450  0.027  0-0.45 
Baso  0.3  0-200  0.003  0-0.20 
Lymphs  34  1000-4800  0.34  1.0-4.8 
Monos  4  0-800  0.04  0-0.80 

1 from Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Elsevier Saunders; 2011.

2 Conventional Units are typically used for reporting results in U.S. labs

3 SI Units are used to report lab results outside of the U.S.

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What is being tested?

White blood cells (WBCs), also called leukocytes, are cells that circulate in the blood and the lymphatic system that help protect the body against infections. They are an important part of the body's immune system and also have a role in inflammation, allergic responses, and protection against cancer. A WBC differential totals the number of each of the different types of WBCs in a person's sample of blood.

There are five types of white blood cells, each with different functions. The differential reveals if the cells are present in normal proportion to one another, if the number of one cell type is increased or decreased, or if abnormal and/or immature cells are present. This information is helpful in diagnosing specific types of illnesses that affect the immune system and the bone marrow.

A differential may be performed in conjunction with a complete blood count (CBC), a test often used as a general health check, or it may be performed in follow-up to abnormal results on a CBC. Most often, a differential is performed on an automated blood analyzer but also may be performed manually by a trained laboratorian who examines a blood smear under a microscope. The values are typically reported as absolute numbers of cells but may be expressed as the relative percentages of the total number of WBCs.

White blood cells develop from precursor cells produced in the bone marrow. The five different types of WBCs include:

  • Granulocytes—these white blood cells have granules in their cytoplasm. The granules contain chemicals and other substances that are released as part of an immune response. The three types of granulocytes include:
    • Neutrophils (neu) normally make up the largest number of circulating WBCs. They move into an area of damaged or infected tissue, where they engulf and destroy bacteria or sometimes fungi.
    • Eosinophils (eos) respond to infections caused by parasites, play a role in allergic reactions (hypersensitivities), and control the extent of immune responses and inflammation.
    • Basophils (baso) usually make up the fewest number of circulating WBCs and are thought to be involved in allergic reactions.
  • Lymphocytes (lymphs) exist in both the blood and the lymphatic system. They are divided into three types, but the differential does not distinguish among them. All lymphocytes differentiate from common lymphoid progenitor cells in the bone marrow. The differential counts and reports all lymphocytes together. Separate specialized testing (like immunophenotyping) must be done to differentiate the three types:
    • B lymphocytes (B cells) are antibody-producing cells that are essential for acquired, antigen-specific immune responses. Plasma cells are fully differentiated B-cells that produce antibodies, immune proteins that target and destroy bacteria, viruses and other "non-self" foreign antigens.
    • T lymphocytes (T cells) finish maturing in the thymus and consist of a few different types. Some T cells help the body distinguish between "self" and "non-self" antigens. Others initiate and control the extent of an immune response, boosting it as needed and then slowing it as the condition resolves. Other types of T cells directly attack and neutralize virus-infected or cancerous cells.
    • Natural killer cells (NK cells) directly attack and kill abnormal cells such as cancer cells or those infected with a virus.
  • Monocytes (mono), similar to neutrophils, move to an area of infection and engulf and destroy bacteria. They are associated more often with chronic rather than acute infections. They are also involved in tissue repair and other functions involving the immune system.

When there is an infection or an inflammatory process somewhere in the body, the bone marrow produces more WBCs, releasing them into the blood. Depending on the cause of infection or inflammation, one particular type of WBC may be increased as opposed to other types. As the condition resolves, the production of that type of WBC subsides and the number drops to normal levels again.

In addition to infections and inflammation, there are a variety of conditions that can affect the production of WBCs by the bone marrow or their survival in the blood, resulting in either increased or decreased numbers. The differential, along with the other components of the CBC, alerts the healthcare provider to possible health issues. Results are often interpreted in conjunction with additional tests such as a blood smear review, which can reveal the presence of abnormal and/or immature populations of WBCs.

In a few serious diseases, some immature forms of the cells are released from the bone marrow into the circulation and may be detected by the WBC differential. This may occur with bacterial infection, leukemia, bone marrow involvement by solid tumor, myelodysplastic syndrome, or myeloproliferative neoplasms, for example. Some immature cells that may be detected include metamyelocytes, myelocytes, promyelocytes, and/or blasts.

If results indicate a problem, a wide variety of other tests may be performed in order to help determine the cause. A healthcare provider will typically consider an individual's signs and symptoms, medical history, and results of a physical examination to decide what other tests may be necessary. For example, as needed, a bone marrow biopsy will be performed to evaluate the bone marrow status.

How is the sample collected for testing?

A blood sample is drawn from a vein in the arm or from a fingerstick (for children and adults) or heelstick (for infants).

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

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Common Questions
  • How is it used?

    The white blood cell differential is often used as part of a complete blood count (CBC) as a general health check. It may be used to help diagnose the cause of a high or low white blood cell (WBC) count, as determined with a CBC. It may also be used to help diagnose and/or monitor other diseases and conditions that affect one or more different types of WBCs.

    The five types include: neutrophils, lymphocytes, monocytes, eosinophils and basophils. (For more details on these, see the "What is being tested?" section.)

    The differential totals the number of each type and determines if the cells are present in normal proportion to one another, if one cell type is increased or decreased, or if immature cells are present. This information is useful in helping to diagnose the specific cause of an illness, such as:

    Some diseases trigger a response by the immune system that causes an increase in certain types of WBCs. A differential may give clues to the specific cause of that immune response. For example, it may help determine whether an infection is caused by bacteria or by viruses.

    Other conditions affect the production of certain WBCs by the bone marrow or their survival in the circulation, resulting in either an increase or decrease in their number. A differential informs the healthcare provider as to which type of WBC is low or high.

    An abnormal differential result may be followed by other tests such as a blood smear, bone marrow biopsy, chromosome analysis, or immunophenotyping (e.g., flow cytometry). These tests can reveal the presence of abnormal and/or immature populations of WBCs.

  • When is it ordered?

    The differential is often performed as part of the complete blood count (CBC), which may be ordered at the time of a routine health exam.

    A differential may be included as part of the CBC when someone has general signs and symptoms of an infection and/or inflammation, such as:

    • Fever, chills
    • Body aches, pain
    • Headache
    • A variety of other signs and symptoms, depending on the site of suspected infection or inflammation

    Testing may be performed when there are signs and symptoms that the healthcare provider thinks may be related to a blood and/or bone marrow disorder, autoimmune disease or other immune disorder.

    If a differential is not done at the same time as a CBC, it may be ordered when results from the CBC are not within the reference ranges.

  • What does the test result mean?

    The results indicate the number and/or the percentage of each type of white blood cell that is present in a person's sample of blood.

    Results of a differential are usually reported as absolute values of the five types of WBCs and/or may be reported as a percent of the total number of WBCs. Absolute values are calculated by multiplying the total number of WBCs by the percentage of each type of white cell. This information can aid in diagnosing illness and monitoring therapy. Neutrophils typically make up the highest number of WBC, followed by lymphocytes, then monocytes, eosinophils and basophils.

    Care must be taken when interpreting the results of a differential. A healthcare provider will consider an individual's signs and symptoms and medical history as well as the degree to which the cells are increased or decreased. A number of factors can cause a transient rise or drop in the number of any one type of cell. A persistent increase or decrease will usually prompt further testing to determine the cause.

    The following table gives some examples as to what the results of a differential may indicate:

    Possible Causes of High and Low WBC Differential Results

    Type of WBC Abbreviations Examples of causes of a high count Examples of causes of a low count
    Neutrophils (Absolute neutrophil count, percent neutrophils)

    Neu, Polys, PMNs, ANC, % Neu

    		 Known as neutrophilia Known as neutropenia
    • Myelodysplastic syndrome
    • Severe, overwhelming infection (e.g., sepsis--neutrophils are used up)
    • Reaction to drugs (e.g., penicillin, ibuprofen, phenytoin, etc.)
    • Autoimmune disorder
    • Chemotherapy
    • Cancer that spreads to the bone marrow
    • Aplastic anemia
    Lymphocytes (Absolute lymphocyte count, percent lymphocytes

    Lymphs, lym, ly, ALC, % lymphs

    		 Known as lymphocytosis Known as lymphopenia or lymphocytopenia
    • Autoimmune disorders (e.g., lupus, rheumatoid arthritis)
    • Infections (e.g., HIV, TB, hepatitis, influenza)
    • Bone marrow damage (e.g., chemotherapy, radiation therapy)
    • Immune deficiency
    Monocytes (Absolute monocyte count, percent monocytes)

    Monos, AMC, % monos

    		 Known as monocytosis
    • Chronic infections (e.g., tuberculosis, fungal infection)
    • Infection within the heart (bacterial endocarditis)
    • Collagen vascular diseases (e.g., lupus, scleroderma, rheumatoid arthritis, vasculitis)
    • Inflammatory bowel disease
    • Monocytic leukemia
    • Chronic myelomonocytic leukemia
    • Juvenile myelomonocytic leukemia
    		 Known as monocytopenia

    Usually, one low count is not medically significant.

    Repeated low counts can indicate:

    • Bone marrow damage or failure
    • Hairy-cell leukemia
    Eosinophils (Absolute eosinophil count, percent eosinophils)

    Eos, AEC, % eos

    		 Known as eosinophilia
    • Asthma, allergies such as hay fever
    • Drug reactions
    • Inflammation of the skin (e.g., eczema, dermatitis)
    • Parasitic infections
    • Inflammatory disorders (e.g., celiac disease, inflammatory bowel disease)
    • Certain malignancies/cancers
    • Hypereosinophilic myeloid neoplasms
    		 Known as eosinopenia

    This is often difficult to determine because numbers are normally low in the blood. One or an occasional low number is usually not medically significant.
    Basophils (Absolute basophil count, percent basophils)

    Baso, ABC, % baso

    		 Known as basophilia
    • Rare allergic reactions (e.g., hives, food allergy)
    • Inflammation (rheumatoid arthritis, ulcerative colitis)
    • Some leukemias (e.g., chronic myeloid leukemia)
    		 Known as basopenia

    As with eosinophils, numbers are normally low in the blood; usually not medically significant.

    In certain cases, immature and/or abnormal forms of the cells may be present in the blood and may be detected with a differential. Immature forms include metamyelocytes, myelocytes, promyelocytes, and/or blasts. Further work-up (e.g., bone marrow biopsy) may be necessary.

  • Is there anything else I should know?

    Long-term use of steroids or long-term exposure to toxic chemicals (such as lye or insecticides) can increase the risk of an abnormal differential.

  • Can a white blood cell (WBC) differential be performed on samples other than blood?

    Yes. WBC differentials, along with WBC counts, may be performed on many different types of body fluids. A common reason that this is done is to more directly assess one area of the body that may be infected or inflamed. For example, if meningitis is suspected, then a WBC count plus differential may be performed on a sample of cerebrospinal fluid (CSF). Many other examples are listed in the article on Body Fluid Analysis.

  • If I have an abnormal result on my WBC differential, what other tests might my healthcare provider order?

    Other general tests to check your health may include a comprehensive metabolic panel (CMP). Depending on your signs, symptoms, medical history, physical exam and suspected condition, your healthcare provider may choose to order a variety of other tests. A few general examples include:

    • Bacterial infection: a culture of the affected area (e.g., urine culture, sputum culture, blood culture), strep test

    • Viral infection: tests for mononucleosis, EBV

    • Inflammation: CRP, ESR

    • Autoimmune diseases: ANA

    • Allergies: Allergy tests

    • Leukemia or other bone marrow disorders: Bone marrow biopsy, immunophenotyping, chromosome analysis

  • My report mentions a "left shift." What does this mean?

    A "left shift" is a phrase used to note that there are a high number of young, immature white blood cells present. Most commonly, this means that there is an infection or inflammation present and the bone marrow is producing more WBCs and releasing them into the blood before they are fully mature. This is a natural immune response to infection and inflammation.

  • My complete blood count (CBC) report includes a result for immature granulocytes (IG). What are they?

    Some automated hematology analyzers report the total number of immature granulocytes (IG) present in a person's blood sample. Immature granulocytes are white blood cells that have not fully developed before being released from the bone marrow into the blood. They may include metamyelocytes, myelocytes, and promyelocytes. These cells are normally only present in the bone marrow because they are precursors of neutrophils, the predominant type of white cells in blood. The presence of immature granulocytes in the blood may occur in various diseases, such as infection or a blood cancer, and thus will often prompt further investigation, which may include additional laboratory testing.

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View Sources

Sources Used in Current Review

2015 review performed by Nicole Ziegler, MT (ASCP) and the Lab Tests Online Editorial Review Board.

Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F. A. Davis Company, Philadelphia, 2009, Pp 305-328.

Holland, K. (Updated 2013 June 14). White Blood Cell Count and Differential. Healthline Reference [On-line information]. Available online at http://www.healthline.com/health/white-blood-cell-count-and-differential#Overview1. Accessed September 2015.

Curry, C. (Updated 2015 January 14). Differential Blood Count. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/2085133-overview. Accessed September 2015.

Muniz V., Weller P., et al. Eosinophil crystalloid granules: structure, function, and beyond. Journal of Leukocyte Biology. 2012 August 92(2). Pp 281-288. Available online at http://jleukobio.org/content/92/2/281.long. Accessed September 2015.

Legrand F., Driss V., et al. Human Eosinophils Exert TNF-α and Granzyme A-Mediated Tumoricidal Activity Toward Colon Carcinoma Cells. Journal of Immunology. 2010 December 15 185(12). Pp 7443-7451. Available online at http://jimmunol.org/content/185/12/7443. Accessed September 2015.

Sources Used in Previous Reviews

Thomas, Clayton L., Editor (1997). Taber's Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition].

Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby's Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO.

Susan J. Leclair, PhD, CLS(NCA). Professor of Medical Laboratory Science, Department of Medical Laboratory Science, University of Massachusetts, Dartmouth, MA.

Pagana, Kathleen D. & Pagana, Timothy J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 1003-1008.

Harmening D. Clinical Hematology and Fundamentals of Hemostasis, Fifth Edition, F.A. Davis Company, Philadelphia, 2009, Pp 305-328.

Henry's Clinical Diagnosis and Management by Laboratory Methods. 21st ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2007, Pp 547-559.

Wintrobe's Clinical Hematology. 12th ed. Greer J, Foerster J, Rodgers G, Paraskevas F, Glader B, Arber D, Means R, eds. Philadelphia, PA: Lippincott Williams & Wilkins: 2009, Pp 170-402, 1528-1533.

(Feb 1 2011) National Heart Lung Blood Institute. What is lymphocytopenia? Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/lym/. Accessed April 2012.

(Jan 23 2012) American Cancer Society. Acute Lymphocytic Leukemia. Available onlne at http://www.cancer.org/Cancer/Leukemia-AcuteLymphocyticALLinAdults/DetailedGuide/leukemia-acute-lymphocytic-what-is-all. Accessed April 2012.

(Dec 7 2010) American Cancer Society. Acute Myeloid Leukemia. Available online at http://www.cancer.org/Cancer/Leukemia-AcuteMyeloidAML/DetailedGuide/leukemia-acute-myeloid-myelogenous-what-is-aml. Accessed April 2012.

(Oct 25 2010) American Cancer Society. Non-Hodgkin Lymphoma. Available online at http://www.cancer.org/Cancer/Non-HodgkinLymphoma/DetailedGuide/non-hodgkin-lymphoma-what-is-non-hodgkin-lymphoma. Accessed April 2012.

(January 8 2010) Kempert P. White Blood Cell Function, Overview of the Immune System. Medscape Reference article. Available online at http://emedicine.medscape.com/article/960027-overview. Accessed April 2012.

(January 26, 2010) Naushad H. Leukocyte Count (WBC). Medscape Reference article. Available online at http://emedicine.medscape.com/article/2054452-overview#aw2aab6b2. Accessed April 2012.

(Updated December 5, 2011) Nader N. Neutrophilia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/208576-overview. Accessed April 2012.

(May 24, 2011) Godwin J. Neutropenia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/204821-overview. Accessed April 2012.

(August 25, 2011) Liss M. Eosinophilia. Medscape Reference article. Available online at http://emedicine.medscape.com/article/199879-overview. Accessed April 2012.

(January 14, 2015) Curry C. White Blood Cell Differential. Medscape Reference. Available online at http://emedicine.medscape.com/article/2085133-overview#a2. Accessed July 10, 2015.

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