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Normal Range


White blood cells are produced by the immune system to help defend the body against infection. They and their precursors are formed in the bone marrow and then travel through the blood to various parts of the body. There are several different types of white blood cells, the major ones being neutrophils (also called granulocytes), T-cells and B-cells.

Your FBC report gives the number of white blood cells in the peripheral blood, but it fails to capture the vast majority of them hiding out in the lymph nodes, spleen, bone marrow etc.  Only roughly about 5-10% of the total number of WBC are seen in the peripheral blood.  FBC numbers are useful, but they do not give the whole picture.



RBC: Red Blood Cells, sometimes referred to as erythrocytes, are responsible for delivering oxygen throughout the body. There are several million of them in a single drop of blood. A low red blood cell count indicates anaemia, which can lead to fatigue, one of the B-symptoms of progressing CLL.

In CLL, low numbers of red blood cells can be due to a variety of causes, one of them being that the bone marrow is so heavily infiltrated with CLL cells that it is no longer able to make the other necessary cell lines, such as red blood cells, platelets.  The bone marrow is the only location where red blood cells are made.

Another cause is AIHA, an auto-immune disease where the red blood cells are attacked and destroyed before their time by the body's own immune system gone awry.



Hb: Haemoglobin is another way of testing for anaemia. Haemoglobin is a protein used by red blood cells to distribute oxygen to other tissues and cells in the body. Low haemoglobin levels means the red cells cannot carry out the vital oxygen transport efficiently.

Low haemoglobin levels cause anaemia, and therefore fatigue.  These days there are options other than blood transfusions to handle chronic anaemia.  One of them is called erythropoeitin.



HCT: Haematocrit (sometimes called packed cell volume, PCV)  measures the amount of volume red blood cells occupy in the blood. The value is given as a percentage of red blood cells in a volume of blood. For example, a haematocrit of 38 means that 38% of the blood's volume is composed of red cells.



Platelets are tiny cells produced by the bone marrow to help your blood clot in the event of a cut or scrape.  A decreased platelet count is called thrombocytopenia. There are a number of possible causes of thrombocytopenia.  These include a disorder of the immune system in which antibodies kill platelets (known as idiopathic thrombocytopenia purpura, or ITP), hypersplenism, in which an enlarged spleen destroys more platelets than normal, and suppression of the bone marrow (the only site where platelet precursors are made), because it is heavily infiltrated with CLL.

Platelets tend to be the first to start dropping precipitously when CLL progresses.  Haematologists see platelets below 100 as the criteria for upgrading the CLL to Binet stage C (or Rai Stage-4) and a cause for starting treatment.


Percent Lymphs

Remember, WBC or white blood cells are many different kinds of cells, the major groups being neutrophils (also called granulocytes) and lymphocytes (which are both B-cells and T-cells).

In CLL, we are interested in following the numbers of lymphocytes.  The FBC report typically gives the percentage of the WBC that are lymphocytes.  In healthy individuals, there are many more neutrophils than there are lymphocytes (B-cells plus T-cells).  As CLL progresses, the absolute numbers of neutrophils may stay the same or even decrease, but the absolute numbers of lymphocytes (B-cells) increase alarmingly.  The percentage of the WBC that is lymphocytes therefore also increases as CLL progresses. CLL patients with advanced disease can have WBC and absolute lymphocyte counts as high as 500K or even higher, and their percent lymphocytes can be almost 100%, suggesting that almost all of the WBC are lymphocytes.  The absolute number is much more important than the percentage.


Absolute Lymphs

To get the Absolute lymphocytes number, multiply the WBC by the percent lymphocytes.  For example, if the WBC is 30.0, and the lymphocyte percent is 65%, the absolute lymphocyte number is 30.0 X 0.65 = 19.5. 


Percent Neuts

In normal individuals, there are many more neutrophils than there are lymphocytes in the white blood cells: roughly, there are 3 neutrophils for every one lymphocyte.  This ratio changes sharply in CLL patients, where an ever increasing percentage of the WBC are lymphocytes, because of the proliferating CLL B-cells. Several of the chemotherapy drugs used in CLL also are known to cause decrease in neutrophil counts.

Neutrophils are important for preventing and fighting infections.  When their numbers drop below healthy levels, the individual is at more risk for developing infections.  When their numbers decrease too much, the patient is declared to be "neutropenic" and carefully managed to avoid infections.

More recently, drugs such as Lenograstim, Filgrastim and Pegfilgrastim have made it easier to control neutropenia.


Absolute Neuts

To get the Absolute Neutrophils number, multiply the WBC by the percent neutrophils.  For example, if the WBC is 30.0K, and the percent neutrophils is 15%, the absolute neutrophil number is 30.0 X 0.15 = 4.5. The absolute number is much more important. Neutrophil levels of less than 0.5 are dangerous and are a reason for special precautions.



B2M: Beta-2-microglobulin is a protein that is sometimes shed from cell surfaces into blood serum.  It has been observed that CLL patients have a higher level of this protein in the blood, and higher amounts suggest poorer prognosis.  Patients with B2M levels of 2 or lower are expected to have a slower progression of the disease.  Many labs now test for B2M routinely, when screening blood samples from CLL patients, though this test is much more popular in America than in the UK.



Other Frequently Used Terms

Statistic Description Normal Range


(MCV): "Mean Corpuscular Volume" measures the average volume (size) of individual red blood cells. A low MCV means that the cells are smaller than normal. This is usually caused by an iron deficiency or chronic disease or thalassaemia.



(MCH): "Mean Corpuscular Haemoglobin" measures the amount of Haemoglobin in the average cell. It is calculated by dividing total Haemoglobin by the total number of red blood cells.



(MCHC): "Mean Corpuscular Haemoglobin Concentration" measures the amount of Haemoglobin in red blood cells. Low levels indicate anaemia.  It is calculated by dividing Haemoglobin by haematocrit.   



(RDW): Red blood cell Distribution Width.  Red blood cells can come in different sizes. RDW looks at the range of these sizes in a blood sample. If anaemia is suspected, based on other blood counts, RDW test results are often used together with MCV results to figure out what the cause of the anaemia might be.



(MPV): Mean Platelet Volume measures the average size of your platelets. A higher-than-normal MPV has been shown to be associated with a greater risk of heart attacks and stroke.



Blood Electrolytes



Normal Range


Sodium level indicates your balance of salt and water. It is also a sign of the functioning of your kidneys and adrenal glands. Abnormal blood sodium level often indicates that blood volume is too low and dehydration is the major cause of such abnormality. It can also occur when the heart is not pumping blood normally, or when the kidneys are not working properly.



Potassium affects several major organs including the heart. Potassium levels rise in kidney failure, and may be abnormal due to vomiting or diarrhea.



Chloride levels often go up and down along with sodium levels. This is because sodium chloride, or common salt, is a major component of blood.



Bicarbonate or CO2 measures a buffer system in the blood. A normal CO2 level keeps the blood acidity at the correct level.

Contrary to popular urban myth, cancer does not make blood more acidic, and cancer cannot be eradicated by making blood less acidic.



Calcium: Increased levels of plasma calcium may indicate the presence of malignant disease or hyperparathyroidism. Less commonly, it could reflect thyrotoxicosis, excessive vitamin D intake, the use of thiazide diuretics, and other disorders. Reduced levels of calcium may reflect vitamin D deficiency, renal disease, hypoparathyroidism, magnesium deficiency and other disorders.



Serum Glutamic Pyruvic Transaminase or ALT is an enzyme found primarily in the liver but also to a lesser degree, the heart and other tissues. It is useful in diagnosing liver function more so than SGOT levels. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction.



LDH, Lactic Acid Dehydrogenase, is an intracellular enzyme from particularly the kidneys, heart, skeletal muscle, brain, liver and lungs. Increases are usually found when large number of cells die, or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levels of the enzyme may be seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity.



Alkaline phosphatase (ALP): Alkaline phosphatases are a family of enzymes that are present throughout the body. Elevated levels of ALP are associated with liver and bile duct disorders, and bone diseases.



Bilirubin is the breakdown product of haemoglobin. Raised levels mean either excessive breakdown as in haemolytic anaemia, liver cell damage, or obstruction to excretion of bile.



Creatinine is a waste product of protein digestion and a measure of kidney function. High levels are usually due to kidney problems. Doctors use the creatinine level as most direct sign of how well the kidneys are removing waste products from the body. 



Blood Urea. This is a waste product that is normally removed by the kidneys in the urine. High Blood Urea levels can be due to dehydration, or kidney or heart failure.



Albumin: Albumin is the most abundant protein found in blood plasma, representing 40 to 60% of the total protein. Reduced levels of albumin may reflect a variety of conditions, including primary liver disease, increased breakdown of macromolecules resulting from tissue damage or inflammation, malabsorption syndromes, malnutrition, and renal diseases.



Globulin: Globulins are a diverse group of proteins in the blood, and together represent the second most common proteins (after albumin) in the bloodstream. An elevation in the level of serum globulin can indicate the presence of cirrhosis of the liver.


Total Protein

Total protein: Measurement of the total protein concentration in plasma. Elevated concentrations reflect dehydration, which might be attributable to vomiting, diarrhea, Addison's disease, diabetic acidosis, and other conditions. 






Normal Range


IgM: Usually, IgM combines into star-shaped clusters, that tend to remain in the bloodstream, where it is highly effective in killing bacteria. IgM functions in much the same way as IgG, but is formed earlier in the immune response.



IgA: IgA is found in blood, tears, saliva, and on the mucous membranes of the respiratory and intestinal tracts where it helps prevent the entrance of bacteria and viruses into body.



IgG: IgG is able to enter tissue space; it coats microorganisms, speeding their uptake by other cells in the immune system. IgG functions mainly against bacteria and some viruses.



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