Here are the six main types of WBCs and the average percentage of each type in the blood:
Neutrophils - 58 percent
Eosinophils - 2 percent
Basophils - 1 percent
Bands - 3 percent
Monocytes - 4 percent
Lymphocytes - 30 percent
The only one that matters for tracking CLL progression are the lymphocytes. These contain B cells, T cells and NK cells, Natural Killer cells.
Tracking white blood cell count (WBC) you have a large number of cell types in that count, which also fluctuate like neutrophils ...so this fact makes the white blood cell count (WBC) very general and rather inaccurate for monitoring CLL progression.
Track your absolute lymphocyte count (ALC) NOT the percentage of lymphocytes, forget white blood cell count (WBC).
When the absolute lymphocyte count (ALC) doubles within 6 months called ...LTD, lymphocyte doubling time...pretreatment talks should be started...
Which does explain a lot, also how to calculate your ALC if your results only show Percent Lymphs. Perhaps an important observation, the article points out that roughly only about 5-10% of the total number of WBC are seen in the peripheral blood. Therefor Full Blood Count ,” FBC numbers are useful, but they do not give the whole picture.”
WBC (White Blood Cell count)
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-cell lymphocytes.
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.
Percent Lymphs (WHAT PERCENT OF WHITE BLOOD CELLS ARE LYMPHOCYTES)
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 (ALC) Absolute Lymphocyte Count
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.
Your sample is correct..it is the decimal not the percent... but the last formula is wrong...
It should be
ALC = white blood cell count (WBC) times (percent of lymphocytes divided by 100)
Or use the decimal or fraction of lymphocytes NOT the percentage...
.............
From Chaya's site...
WBC is reported at 27.3K and the percentage of these white blood cells that are lymphocytes (“%lymphs”) is reported at 75%. How many lymphocytes are present in this case? What is the ALC?
ALC = WBC x % lymphocytes.
(Remember, 75% expressed as a fraction/decimal is 0.75)
thanks for your lesson Percent Lymphs is given as a percentage.I automatically convert that to a fraction in all implementation. . For example 65% =65/100 or 0.65.
I know WE both convert to a fraction but many people miss the decimal conversion part and panic when the absolute lymphocyte count (ALC) is out 2 decimal places...
They miss this note... from Chaya
(Remember, 75% expressed as a fraction/decimal is 0.75)
Its been going on for years...
The correct expression is...
absolute lymphocyte count (ALC) = white blood cell count (WBC) X ( percent of lymphocytes divided by 100)
OK that makes sense. I have an idea why it may be so hard to see clearly for Brits. ( :
"In the mid 1960s, Britain was different to most other countries by having Roman-style non-decimal currency and measurement units still in use. In Britain, and other Commonwealth countries, it was realised that there were major advantages to be gained by adopting decimal currency and a modern system of decimal measurement units.
While Australia successfully linked both transitions, Britain is remarkable because its highly successful transition to decimal currency was combined with its failure to pull off a similar success in adopting metric units. Indeed when adopting metric, Britain has acted in completely the opposite direction to those policies that made introducing decimal currency such a success.
This divergence is strange when both Britain and Australia saw that the benefits of adopting decimal currency were linked to those of adopting decimal measurement units."
Interesting the UK D-Day (decimilisation day) was February 15th 1971 (I was 8). No sooner had I got to grips with one system, I had to learn and prepare for another. . We kept the penny and had a new unit of 100p not the mille of Europe, the decimal pound, One hundred old pennies before would have been eight shillings and fourpence. We have ended up living with two measurement systems. That don't all follow the 100 rule, maybe that's why I automatically think of percentage as a fraction and a decimal all together and don't automatically remember to portion it in to bits of 100 or identify the calculation?
For Britain there are clear lessons to be learned. Many people have said that Britons are incapable of accepting changes like the conversion to metric units. History shows that this is not the case. Britain has coped well with change when it is well planned and rapid.
It is not too late to learn from the D-day experience. remember 100
Remember, 75% expressed as a fraction/decimal is 0.75
I rarely see posts mentioning ALC, but plenty mentioning WBC. Chris's post is as true now as it was 7 years ago. We've had posts from members concerned at their rising WBC, only to find that it's not their CLL stirring at all, just their neutrophils.
Always monitor your absolute lymphocyte count and totally ignore the percentage of lymphocytes. Percentages just unnecessarily confuse matters and can mislead, as I often see happening, per this example: healthunlocked.com/cllsuppo...
Remember, your WBC change could be due to any one of 5 different white cell types. This reply includes an analogy to help explain the different white blood cell types. healthunlocked.com/cllsuppo...
Look at your ALC and you only have to worry about lymphocyte changes, which, once your lymphocyte count exceeds 30 (thousand), is mainly due to changes in the quantity of CLL cells in your blood.
What we see in our CBE/FBC white blood cell differential report is a vast simplification of the complexity.
I note that many of us are posting questions about our White Blood Cell (WBC) count. As Chris said 8 years ago, way back when this community first started on HealthUnlocked, "The only one that matters for tracking CLL progression are the lymphocytes. These contain B cells, T cells and NK cells, Natural Killer cells." CLL cells are B cells.
Chris lists the 6 categories and normal percentages of white blood cell types, all of which can change and confuse the picture of what's happening with your CLL, particularly in early stages or when under treatment. Generally Bands are not separately listed, but are included in the neutrophil count, which can also be called Segs.
Finally, as Chris also said "Track your absolute lymphocyte count (ALC) NOT the percentage of lymphocytes, forget white blood cell count (WBC)."
When you have CLL, the lymphocyte count is generally so dominant, percentages become meaningless. More importantly, ANY change in the absolute count of any white blood cell type has to impact the percentages of ALL the white blood cell types, simply because the percentages must total to 100%. In my experience, most GP/PCP doctors don't get this important fact about checking blood test results of patients with leukaemia/lymphoma. They might see under 10 cases of blood cancer in their entire career, so looking at percentages nearly always works for them.
Remember, there is no defined lymphocyte level that indicates cancer. There is a normal range for lymphocyte counts, and if your count falls outside this range, you should talk to your doctor to investigate the cause further.
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Absolute Lymohpcyte Count (ALC) and other metrics
Still not sure
At what point in CLL am I supposed to have reduced immune function?
FBC results.....something missing?
Interpretation of blood test
