Children's Medical Center · Clinical Laboratory
One Children's Plaza · Dayton, Ohio 45404

Appendix: Hematology Tables

Table HE-1 Normal Values: RBC, Hgb, Hct, and Indices

Male

Age RBC (106/mm3) HGB (g/dL) HCT (%) MCV (fL) MCH (pg) MCHC (%)
Birth 4.1 - 6.7 15.0 - 24.0 44 - 70 102 - 115 33 - 39 32 - 36
1 Month 3.8 - 5.4 10.5 - 14.0 44 - 56 72 - 88 24 - 30 32 - 36
3 Months 3.8 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
6 Months 3.8 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
9 Months 3.8 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
1 Year 3.8 - 5.4 10.0 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
2 Years 4.0 - 5.3 11.5 - 14.5 32 - 42 72 - 88 25 - 31 32 - 36
4 Years 4.0 - 5.3 11.5 - 14.5 32 - 42 76 - 90 25 - 31 32 - 36
8 years 4.0 – 5.1 11.5 - 14.5 33 - 43 76 - 90 25 - 31 32 - 36
14 Years 4.1– 5.3 12.5 - 16.1 35 - 45 78 - 95 26 - 32 32 - 36
Adult 4.3 – 5.9 13.5 - 18.0 42 - 52 78 - 100 27 - 31 32 - 36

 

Female

Age RBC (106/mm3) HGB (g/dL) HCT (%) MCV (fL) MCH (pg) MCHC (%)
Birth 4.1 - 6.7 15.0 - 24.0 44 - 70 102 - 115 33 - 39 32 - 36
1 Month 3.5 - 5.4 10.5 - 14.0 44 - 56 72 - 88 24 - 30 32 - 36
3 Months 3.5 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
6 Months 3.5 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
9 Months 3.5 - 5.4 10.5 - 14.0 32 - 42 72 - 88 24 - 30 32 - 36
1 Year 3.5 - 5.4 10.5 - 14.5 32 - 42 72 - 88 24 - 30 32 - 36
2 Years 4.0 – 5.3 11.5 - 14.5 32 - 42 72 - 88 25 - 31 32 - 36
4 Years 4.0 – 5.3 11.5 - 14.5 32 - 42 76 - 90 25 - 31 32 - 36
8 years 4.0 – 5.3 11.5 - 14.5 33 - 43 76 - 90 25 - 31 32 - 36
14 Years 4.1 – 5.3 12.0 - 15.0 35 - 45 78 - 95 26 - 32 32 - 36
Adult 4.2 – 5.4 12.5 - 16.0 37 - 47 78 - 100 27 - 31 32 - 36

 

Table HE-2. Normal Values: WBC and Differential Count 

Age

WBC Cells x 103 /mm3

Segmented Neutrophils (%)

Band Neutrophils (%)

 Eosinophils (%)

Basophils (%)

Lymphocytes (%)

Monocytes (%)
Birth

9.1 - 34.0

32 - 62

10 - 18

0 - 2

0 - 1

26 - 36

0 - 6
24 Hours

9.4 - 34.0

32 - 62

10 - 18

0 - 2

0 - 1

26 - 36

0 - 6
1 Week

5.0 - 21.0

19 - 49

8 - 16

0 - 4

0

36 - 46

0 - 9
2 Weeks

5.0 - 20.0

14 - 34

7 - 15

0 - 3

0 - 1

43 - 53

0 - 9
4 Weeks

6.0 – 14.0

15 - 35

7 - 13

0 - 3

0 - 1

41 - 71

0 - 7
2 Months

6.0 – 14.0

15 - 35

5 - 11

0 - 3

0 - 1

42 - 72

0 - 6
4 Months

6.0 – 14.0

14 - 34

6 - 12

0 - 3

0

44 - 74

0 - 5
6 Months

6.0 – 14.0

13 - 33

6 - 12

0 - 3

0

46 - 76

0 - 5
8 Months

6.0 – 14.0

12 - 32

5 - 11

0 - 3

0

47 - 77

0 - 5
1 Year

6.0 – 14.0

13 - 33

5 - 11

0 - 3

0

46 - 76

0 - 5
2 Years

4.0 - 12.0

15 - 35

5 - 11

0 - 3

0 - 1

44 - 74

0 - 5
4 Years

4.0 - 12.0

23 - 45

5 - 11

0 - 3

0 - 1

35 - 65

0 - 5
6 Years

4.0 - 12.0

32 - 54

5 - 11

0 - 3

0 - 1

27 - 57

0 - 5
8 Years

4.0 - 12.0

34 - 56

5 - 11

0 - 2

0 - 1

24 - 54

0 - 4
10 Years

4.0 - 12.0

31 - 61

5 - 11

0 - 2

0 - 1

28 - 48

0 - 4
12 Years

4.0 - 12.0

32 - 62

5 - 11

0 - 3

0 - 1

28 - 48

0 - 4
14 Years

4.0 - 10.5

33 - 63

5 - 11

0 - 3

0 - 1

27 - 47

0 - 5
16 Years

4.0 - 10.5

34 - 64

5 - 11

0 - 3

0 - 1

25 - 45

0 - 5
18 Years

4.0 - 10.5

34 - 64

5 - 11

0 - 3

0 - 1

25 - 45

0 - 5
20 Years

4.0 - 10.5

36 - 66

5 - 11

0 - 3

0 - 1

23 - 43

0 - 5
Adult

4.0 - 10.5

36 - 66

5 - 11

0 - 3

0 - 1

24 - 44

0 - 4

 Information taken from normal range study performed at The Children's Medical Center, Dayton, OH.

Table HE-3. Conditions Affecting Neutrophil Counts

Conditions Causing Neutrophilia (> 8,000 PMNs/mm3)
 

Infectious Disease:

  • Physiological response to stress:
  • Physical Exercise
  • Exposure to extreme heat or cold
  • Following acute hemorrhage or hemolysis
  • Acute emotional stress
  • Childbirth

Infectious Disease:

  • Systemic or severe local bacterial infections
  • Some viruses (smallpox, chickenpox, herpes zoster, polio)
  • Some rickettsial diseases (especially Rocky Mountain Spotted Fever)
  • Some fungi, especially if there is acute tissue necrosis

Inflammatory diseases:

  • Acute rheumatic fever
  • Rheumatoid arthritis
  • Acute gout
  • Vasculitis and myositis of many types
  • Hypersensitivity reactions to drugs

Tissue necrosis:

  • Ischemic damage to the heart abdominal viscera, extremities
  • Burns
  • Many carcinomas and sarcomas

Metabolic Disorders:

  • Uremia
  • Diabetic Ketoacidosis
  • Eclampsia
  • Thyroid Storm

Drugs:

  • Epinephrine
  • Lithium
  • Histamine
  • Heparin
  • Digitalis
  • Many toxins, venoms, and heavy metals
Conditions Causing Neutropenia (<1,500 PMNs/mm3)


Infectious diseases:

  • Some bacteria (typhoid, tularemia, brucellosis)
  • Some viruses (hepatitis, influenza, measles, mumps, rubella, infectious mononucleosis)
  • Protozoa (especially malaria)
  • Overwhelming infection of any kind

Chemical and physical agents:

  • Protozoa (especially malaria)
  • Dose-related, universal marrow depressants (radiation, cytotoxic drugs, benzene)
  • Idiosyncratic drug reactions (numerous)

Hypersplenism:

  • Liver disease
  • Storage diseases

Other disorders:

  • Some collagen-vascular diseases, especially lupus erythematosus
  • Severe folic acid or vitamin B12 deficiency

 

Table HE-4. Conditions Affecting Lymphocyte Counts

Conditions Causing Lymphocytosis
(>4,000 lymphocytes/mm3 in adults; >7,200/mm3 in children):

Infectious diseases

  • Bacterial (whooping cough, brucellosis, sometimes tuberculosis, secondary syphilis)
  • Viral (hepatitis, infectious mononucleosis, mumps, many exanthemas, cytomegalovirus)
  • Other (infectious lymphocytosis, toxoplasmosis)

Metabolic conditions

  • Hypoadrenalism
  • Hyperthyroidism (sometimes)

Chronic Inflammatory conditions

  • Ulcerative colitis
  • Immune diseases (serum sickness, idiopathic thrombocytopenic purpura)
Conditions Causing Lymphocytopenia
(<1,000 lymphocytes/mm3 in adults; <2,500/mm3 in children):

Immunodeficiency syndromes:

  • Congenital defects of cell-mediated immunity
  • Immunosuppressive medication

Adrenal corticosteroid exposure:

  • Adrenal gland hyperactivity
  • ACTH-producing pituitary gland tumors
  • Therapeutic administration of steroids

Severe debilitating illness of any kind:

  • Congestive heart failure
  • Renal failure
  • Far-advanced tuberculosis

Defects of lymphatic circulation:

  • Intestinal lyphangiectasia
  • Disorders of intestinal mucosa

 

Table HE-5 Conditions Affecting Other Circulating White Cells

Conditions Causing Monocytosis (>800 monocytes/mm3 in adults):
  • Infections (tuberculosis, subacute bacterial endocarditis, hepatitis, rickettsial diseases, syphilis)
  • Granulomatous diseases (sarcoid, ulcerative colitis, regional enteritis)
  • Collagen-vascular diseases (lupus, rheumatoid arthritis, polyarteritis)
  • Many cancers, lymphomas, and myeloproliferative disorders
 Conditions Causing Eosinophilia (>450 eosinophils/mm3):
  • Allergic diseases (asthma, hay fever, drug reactions, allergic vasculitis, serum sickness)
  • Parasitic infections (trichinosis, echinococcus, hookworm, schistosomiasis, amebiasis)
  • Skin disorders (some psoriasis, some eczema, pemphigus, dermatitis herpetiformis)
  • “Hypereosinophilic” syndromes (systemic eosinophilia associated with pulmonary infiltration and sometimes cardiovascular disturbances)
  • Neoplastic diseases (Hodgkin’s disease, extensive metastases or necrosis of solid tumors)
  • Miscellaneous (collagen-vascular diseases, adrenal cortical hypofunction, ulcerative colitis)
Conditions Causing Basophilia (>50 basophils/mm3):
  • Chronic hypersensitivity states in the absence of the specific allergen (exposure to the allergen triggers cell lysis and rapid drop in basophil count)
  • Systemic mast cell disease

  • Myeloproliferative disorders

 

Table HE-6 Peripheral Blood Red Cell Abnormalities

Abnormality Description Associated Diseases
Anisocytosis Abnormal variation in size (normal diameter = 6-8 mm) Any severe anemia, e.g., iron deficiency, megaloblastic
Macrocytosis Large cells, greater than 8 mm (MCV > 100 fl) Megaloblastic anemia, liver disease, hypothyroidism, hemolytic anemia (reticulocytes), multiple myeloma, physiologic macrocytosis of newborn, myelophthisis
Macroovalocytosis Large (> 8 mm) oval cells Megaloblastic anemia 
Hypochromia Pale cells with decreased concentration of hemoglobin (MCHC < 31 g/dL) Iron deficiency and iron-loading (sideroblastic) anemia, thalassemia, lead poisoning, transferrin deficiency, anemia of chronic disease (inflammatory diseases, e.g., rheumatoid arthritis, collagen diseases, malignancies)
Poikilocytosis Abnormal variation in shape Any severe anemia, e.g., megaloblastic, iron deficiency, myeloproliferative syndrome, hemolytic. Certain shapes are diagnostically helpful (see following, spherocytosis through teardrop cells)
Spherocytosis Spherical cells without pale centers; often small, i.e., microspherocytosis Hereditary spherocytosis, Coomb’s positive hemolytic anemia; small numbers are seen in any hemolytic anemia and after transfusion of stored blood.
Ovalocytosis Oval cells Hereditary eliptocytosis, iron deficiency
Stomatocytosis Red cells with slit-like, instead of circular, areas of central pallor Congenital hemolytic anemia, thalassemia, burns, lupus erythematosus, lead poisoning, liver disease, artifact
Sickle cells Crescent-shaped cells Sickle cell hemoglobinopathies
Target cells Cells with a dark center and periphery and a clear ring in between Liver disease, thalassemia, hemoglobinopathies (S, C, SC, S-thalassemia)
Schistocytes Irregularly contracted cells (severe poikilocytosis) Uremia, carcinoma, hemolytic-uremic syndrome, disseminated intravascular coagulation, microangiopathic hemolytic anemia, toxins (lead, phenylhydrazine), burns, thrombotic thrombocytopenic purpura
Echinocytes Cells with long, sharp, irregularly spaced, spinous processes Hemolytic anemias, liver disease (spur cell anemia) normal infants, uremia, microangiopathic hemolytic anemia, disseminated intravascular coagulation, thrombocytopenic purpura, pyruvate kinase deficiency, carcinoma
Acanthocytosis Small cells with thorny projections Abetalipoproteinemia (hereditary acanthocytosis or Bassen Kornzweig disease)
Teardrop cells Cells shaped like teardrops Myeloproliferative syndrome, myelophthisic anemia (neoplastic, granulomatous, or fibrotic marrow infiltration), anemia with extramedullary hematopoiesis or ineffective erythropoiesis
Nucleated red cells Erythrocytes with nuclei still present; may be normoblastic or megaloblastic Hemolytic anemias, leukemias, myeloproliferative syndrome, polycythemia vera, myelophthisic anemia (neoplastic, granulomatous or fibrotic marrow infiltration), multiple myeloma, extramedullary hematopoiesis, megaloblastic anemias, any severe anemia
Howell-Jolly bodies Spherical blue bodies (Wright stain) within or on erythrocytes; nuclear debris  Hyposplenism, pernicious anemia
Heinz inclusion bodies Small round inclusions seen under phase microscopy or with supravital staining Congenital hemolytic anemias (e.g., glucose-6-phosphate dehydrogenase deficiency), hemolytic anemia secondary to drugs (dapsone, phenacetin), thalassemia (Hb H), hemoglobinopathies (Hb Zurich, Koln, Ube, I, etc.)
Pappemheimer bodies (siderocytes) Siderotic granules, staining blue with Wright or Prussian blue stains  Iron-loading anemias, hyposplenism, hemolytic anemias
Cabot rings Purple, fine, ring-like intraerythrocytic structures Pernicious anemia, lead poisoning
Basophilic stippling Punctate stippling when Wright-stained Hemolytic anemia, punctate stippling seen in lead poisoning (mitochondrial RNA and iron), thalassemia
Rouleaux Aggregated erythrocytes regularly stacked on one another Multiple myeloma, Waldenstrom’s macroglobulinemia, cord blood, pregnancy, hypergammaglobinemia, hyperfibrinogenemia 
Polychromasia RBCs containing RNA, staining a pinkish blue color; stains supravitally as reticular network with new methylene blue Hemolytic anemia, blood loss, uremia, following treatment of iron deficiency or megaloblastic anemias

 

Table HE-7 Leukocyte Abnormalities and Diseases

Abnormality Description Associated Diseases
Leukocytosis White blood cell count > 11.0 x 106/L Any physiological or pathological stress, corticosteroids
Neutrophilic leukocytosis (granulocytosis) Neutrophilic leukocyte count >8,000/mm3 Infection, intoxication, tissue necrosis, myeloproliferative syndromes, leukemia (e.g., chronic myelocytic), leukemoid reaction, hemorrhage, hemolysis 
Neutropenia or granulocytopenia Neutrophilic count <1,500/mm3 Drugs, infection, congenital megaloblastic anemia, aplastic anemia, leukemia, lupus erythematosus, postirradiation hypersplenism, myelophthisis anemia
Toxic granulation Coarse black or purple cytoplasmic granules Infections of inflammatory diseases
Dohle bodies Small (1-2 mm) blue cytoplasmic inclusions in neutrophils Infections or inflammatory diseases, burns, myelocytic leukemia, myeloproliferative syndromes, cyclophosphamide therapy
Pelger-Huet anomaly Neutrophil with bilobed nucleus or no segmentation of nucleus. Chromatin is coarse and cytoplasm is pink with normal granulation. Hereditary, myelocytic leukemias, myeloproliferative syndromes
May-Hegglin anomaly Basophilic, cytoplasmic inclusions of leukocytes. Similar to Dohle bodies. May-Hegglin syndrome (hereditary), includes thrombocytopenia and giant platelets.
Alder’s anomaly Prominent azurophilic granulation in leukocytes. Similar to toxic granulation. Granulation is seen better with Giemsa stain. Hereditary, gargoylism
Chediak-Higashi anomaly Gray-green, large cytoplasmic inclusions resembling Dohle bodies.  Chediak-Higashi syndrome
Tart cell Neutrophilic leukocyte with a phagocytized nucleus of a granulocyte that retains some nuclear structure  Drug reactions (e.g., penicillin, procainamide)
Myeloid “shift to left” Presence of bands, myelocytes, metamyelocytes or promyelocytes Infections, intoxications, tissue necrosis, myeloproliferative syndrome, leukemia (chronic myelocytic), leukemoid reaction, pernicious anemia, hyposplenism
Hypersegmented neutrophil Mature neutrophil with more than 5 distinct lobes Magaloblastic anemia, hereditary constitutional hypersegmentation of neutrophils; rarely, iron deficiency anemia, malignancy, or infection
Atypical lymphocytes
Reactive lymphocytes
“Downey cells”		 Lymphocytes, some with vacuolated cytoplasm, irregularly shaped nucleus, increased numbers of cytoplasmic azurophilic granules, peripheral basophilia, or some with more abundant basophilic cytoplasm Infectious mononucleosis, viral hepatitis and other viral infections, tuberculosis, drug (e.g., penicillin) sensitivity, posttransfusion syndrome
Leukemic cells (lymphoblasts, myeloblasts, etc.) Presence of lymphoblasts, myeloblasts, monoblasts, myelomonoblasts, promyelocytes (none normally present in peripheral blood) Leukemia (acute or chronic), leukemoid reaction, severe infectious or inflammatory diseases, myeloproliferative syndrome, intoxications, malignancies, recovery from bone marrow suppression, infectious mononucleosis, myelophthisis
Auer bodies Round or rod-like, 1-6 mm long, red-purple, refractile inclusions in neutrophils  Acute myelocytic leukemia
Smudge cell Disintegrating nucleus of a rupture white cell Increased numbers in leukemic blood, particularly in CML or CLL when WBC count is greater than 100,000/mm3