White cells

The most striking difference between children and adults is the high lymphocyte count in infants and young children. This means that the normal differential WBC in those <4 years shows more lymphocytes than neu-trophils. Otherwise most of the changes in white cell counts seen in children are similar to those seen in adults and due to the same causes, with a few exceptions:

• Healthy term babies show a transiently raised neutrophil count in the first 24h after birth (7-14 x 109/L) which returns to the normal (adult) range by 48h.

• Immature neutrophils (band cells and myelocytes) may comprise 5-10% of the total WBC in healthy neonates.

• Sick neonates with bacterial infections commonly show a paradoxical neutropenia, with or without an increased band cell count.

• Black children have lower neutrophil counts that other ethnic groups.

• Lymphocytoses with very high counts occur in children with specific infections—notably pertussis.

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