Blood differential test
The blood differential test measures the percentage of each type of white blood cell (WBC) that you have in your blood. It also reveals if there are any abnormal or immature cells.
Differential; Diff; White blood cell differential count
How the Test is Performed
A blood sample is needed.
A laboratory specialist takes a drop of blood from your sample and smears it onto a glass slide. The smear is stained with a special dye, which helps tell the difference between various types of white blood cells.
Five types of white blood cells, also called leukocytes, normally appear in the blood:
- Lymphocytes (B cells and T cells)
A special machine or a health care provider counts the number of each type of cell. The test shows if the number of cells are in proper proportion with one another, and if there is more or less of one cell type.
How to Prepare for the Test
No special preparation is necessary.
How the Test will Feel
When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging. Afterward, there may be some throbbing or slight bruising. This soon goes away.
Why the Test is Performed
This test is done to diagnose an infection, anemia, or leukemia. It may also be used to monitor one of these conditions, or to see if treatment is working.
The different types of white blood cells are given as a percentage:
- Neutrophils: 40% to 60%
- Lymphocytes: 20% to 40%
- Monocytes: 2% to 8%
- Eosinophils: 1% to 4%
- Basophils: 0.5% to 1%
- Band (young neutrophil): 0% to 3%
What Abnormal Results Mean
Any infection or acute stress increases your number of white blood cells. High white blood cell counts may be due to inflammation, an immune response, or blood diseases such as leukemia.
It is important to realize that an abnormal increase in one type of white blood cell can cause a decrease in the percentage of other types of white blood cells.
An increased percentage of neutrophils may be due to:
- Acute infection
- Acute stress
- Eclampsia (seizures or coma in a pregnant woman)
- Gout (type of arthritis due to uric acid buildup in the blood)
- Myelocytic leukemia (a bone marrow cancer)
- Rheumatoid arthritis
- Rheumatic fever (disease due to an infection with group A streptococcus bacteria)
- Thyroiditis (a thyroid disease)
A decreased percentage of neutrophils may be due to:
- Aplastic anemia
- Influenza (flu)
- Radiation therapy or exposure
- Viral infection
- Widespread severe bacterial infection
An increased percentage of lymphocytes may be due to:
- Chronic bacterial infection
- Infectious hepatitis (liver swelling and inflammation from bacteria or viruses)
- Infectious mononucleosis, or mono (viral infection that causes fever, sore throat, and swollen lymph glands)
- Lymphocytic leukemia (a type of blood cancer)
- Multiple myeloma (a type of blood cancer)
- Viral infection (such as mumps or measles)
A decreased percentage of lymphocytes may be due to:
- HIV/AIDS infection
- Radiation therapy or exposure
- Sepsis (severe, inflammatory response to bacteria or other germs)
- Steroid use
An increased percentage of monocytes may be due to:
- Chronic inflammatory disease
- Parasitic infection
- Tuberculosis, or TB (bacterial infection that involves the lungs)
- Viral infection (for example, infectious mononucleosis, mumps, measles)
An increased percentage of eosinophils may be due to:
An increased percentage of basophils may be due to:
- After splenectomy
- Allergic reaction
- Chronic myelogenous leukemia (a type of bone marrow cancer)
- Collagen vascular disease
- Myeloproliferative diseases (group of bone marrow diseases)
A decreased percentage of basophils may be due to:
- Acute infection
- Severe injury
There is very little risk involved with having your blood taken. Veins and arteries vary in size from one patient to another, and from one side of the body to the other. Taking blood from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight, but may include:
- Excessive bleeding
- Fainting or feeling lightheaded
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
Chernecky CC, Berger BJ. Differential leukocyte count (diff) - peripheral blood. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures. 6th ed. Philadelphia, PA: Elsevier Saunders; 2013:440-446.
Hutchison RE, Schexneider KI. Leukocytic disorders. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods. 23rd ed. St Louis, MO: Elsevier; 2017:chap 33.
Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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