The White Blood Cell (WBC) differential is typically ordered in conjunction with the Complete Blood Count (CBC).

By looking at and differentiating the different types of WBC’s, it can show the body’s ability to fight infection. Also based on which WBC is increased or decreased, it can indicate which type of infection (bacterial, viral or parasitic) you may be fighting.

The WBC differential is also useful for determining or identifying the various types of leukemias.

The WBC differential can be determined by various types of hematology analyzers or performed manually by examining a stained blood smear microscopically.

The results are reported as absolute numbers (expressed as # of cells x 109/L) or relative numbers (expressed as a %).

The different types of white blood cells are as follows:

? Segmented neutrophils

These usually increase in bacterial infections or other inflammatory response. It can also be very elevated in certain leukemias.

? Band neutrophils

This is younger form of the neutrophil. An increase in band neutrophils or more immature neutrophils indicate possible blood disorders.

? Lymphocyte

Increases can be seen in viral infections and certain types of leukemia. Decreases can be seen in certain autoimmune conditions or HIV.

? Monocytes

Increases can be seen in leukemias, malignant disorders and tuberculosis.

? Eosinophils

Increases can be seen in parasitic infections and allergies.

? Basophils

Increases can be seen in leukemias and Hodgkins disease.

Examination of the WBC differential smear can also show alterations is the WBCs such as toxic granulation and other abnormal inclusion bodies.

In addition to examination and differentiation of WBC’s, examination of the blood smear can show abnormalities in red blood cell morphology. This is useful in the diagnosis of the various types of anemias and other disorders.

Platelets can also be looked at for estimation of quantity and appearance.

What is a “normal” or reference range? It is a set of values of some measurement that a physician or other health professional can use to interpret a set of results for a particular patient. You will see the reference ranges on the lab report next to your lab result. Your lab result will be low, normal or high based on this range.

Introduction

The treatment of Multiple Sclerosis is not always successful. The aim of the treatment is therefore firstly to halt the destruction of nerve fibres and secondly to repair existing defects. Researchers in the UK have found that Alemtuzumab, a drug initially developed to treat leukaemia, stopped the advance of multiple sclerosis (MS) in patients with early stage active relapsing-remitting multiple sclerosis (RRMS) and may even have reversed some of the damage caused by this debilitating neurological disease. It is a monoclonal antibody that has been used since the 1980s to treat chronic lymphocytic leukaemia.

What is Alemtuzumab/”Campath-1H”?

Alemtuzumab is the generic name for an experimental MS drug branded as Campath-1H by Millennium Pharmaceuticals and ILEX Oncology. It is a humanized monoclonal antibody directed against the CD52 antigen, which is abundantly expressed on all normal and most malignant T-lymphocytes. The drug appears to stop progression of the disease in patients with early stage active relapsing-remitting MS. It also reduced the risk of sustained accumulation of disability by 71% compared to beta-interferon.

Administration

Alemtuzumab is given by a drip into a vein (intravenous infusion), but can also be given as an injection under the skin, and trials are in progress to confirm that the drug is as effective and safe when given in this way. Available data suggest that there are fewer side effects when given under the skin although it takes a little longer to work. However, it has been associated with infusion-related events including hypotension, rigors, fever, shortness of breath, bronchospasm, chills, and/or rash. It may also be inadvisable if you have had a hypersensitivity (allergic) reaction to another monoclonal antibody and it cannot be taken if an infection is present.

How does it work?

Campath-1H works by destroying one population of white blood cell (lymphocytes) and, by shutting down the immune system, inhibits the damage to brain tissue that occurs in MS. It works well, killing off nearly all the T and B cells, and thus wiping out a huge portion of a person’s immune system. Unfortunately it may make you feel generally unwell and may increase your tendency to bruise or bleed. Amazingly this drug completely outperformed the rival drug, reducing the number of relapses by 78% over and above that achieved with interferon. It also reduced the risk of sustained accumulation of disability by 71% compared to beta-interferon.

When people with early-stage MS were treated with Alemtuzumab, their condition improved significantly more than those on beta interferon. The different disease-modifying drugs available on the market for treatment of relapsing-remitting multiple sclerosis (MS) result in similar rates of disease relapse when examined over the long term, according to a retrospective chart review.

Conclusion

Patients on Alemtuzumab also showed recovery of brain function, so that they were less disabled at the end of the three-year study than at the beginning, while those on beta interferon continued to decline. Almost every patient taking Campath-1H improved, whereas about half of MS patients show no response to beta interferon.

Scientists cautioned that this drug will not be available outside clinical trials for about five years, and that it is suitable only for patients with early-phase MS.