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	WBCCells 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/mm³in 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/mm³in 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/mm³in 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

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