low lymphocytes during an infection...

[serenity98]

I'm a nursing student and I've noticed that several patients who currently have infections have elevated WBC's except for the lymphocytes, which are low....Any feedback on this would be greatly appreciated.

[smk1, LPN]

If the infection is bacterial then the primary wbc's used to fight that infection are neutrophils. IF the bone marrow needs to mount a large response to bacteria then it will produce more neutrophils and less lymphocytes. (This is probably why many people will end up with a viral infection a few weeks later if they have had a bacterial infection because lymphocytes are the primary viral fighter.) If the infection has lasted several days to weeks you will probably also see monocytes going up because they are mobilized to help with phagocytosis.

[Virgo_RN, BSN, RN]

What SMK1 said.

[TiredMD]

In addition, it is possible that the OP is confusing the "low lymphocytes" on the differential with an overall low total lymphocyte count. The differential does not give you the total number of lymphoctes, just the percentage of all white cells that are lymphocytes.

In bacterial infections, the proportion of neurotrophils will be higher than normal, meaning that the lymphocyte proportion is low. However, if the overall total white count is elevated, this lower lymphocyte proportion may reflect a normal total lymphocyte count.

So if a normal lymphocyte differential is 30% and a normal white count is 7000, the normal number of total lymphocytes is about 2100.

But if the total white count is elevated to 15,000 and you still have the same number of lymphocytes (because most of the extra white cells are neutrophils), then your lymphocyte differential will be low at about 15%, even though the actual number of lymphocytes is unchanged.

[Virgo_RN, BSN, RN]

What TiredMD said.

[Medic2RN, BSN, RN, EMT-P]

Thank you TiredMD