Pharmacotherapy Newsletter

Volume 1, Issue 35, 09/14/2009

Question

What are the average increases in white blood cell (WBC) counts sometimes seen when starting glucocorticoids (e.g., dexamethasone, methylprednisolone, and prednisone)?

Answer

The white blood cell (WBC) count normally drawn from a patient is made up of a number of different leukocytes which include neutrophils at 60-70%, lymphocytes at 28%, monocytes at 5%, eosinophils at 2-4%, and basophils at 0.5% of the total.(1)  When a WBC count is done on a patient, the lab value reflects the leukocytes distributed within the blood and not those in the bone marrow, tissue or attached to the endovascular lining of blood vessels.  It is evident that the neutrophils make up the greatest amount of leukocytes in the total WBC count and thus can have the greatest impact on changes in the WBC count.  Neutrophils are also called polymorphonuclear leukocytes (PMN) because of the number of stages they go through in their appearance.  They are initially released from the bone marrow as immature neutrophils that are characterized as having a nonsegmented, band like appearing nucleus.  As such these immature neutrophils are called "bands".  An increase in the number of these immature neutrophils in circulation can be indicative of.... 

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