Immature Granulocytes and Lupus: What’s the Normal Range? | MyLupusTeam

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Immature Granulocytes and Lupus: What’s the Normal Range?

Medically reviewed by Florentina Negoi, M.D.
Written by Bora Lee, Ph.D.
Posted on June 15, 2023

Have you been diagnosed with lupus? Have you received blood test results showing a high count of immature granulocytes? If so, you might be wondering what that means and whether it was caused by lupus.

Levels of white blood cells can be affected in many people with lupus, and this can signal a related health condition or infection that needs to be addressed. Learn how lupus can affect the levels of white blood cells in your body and what that means for your lupus symptoms.

What Are Granulocytes?

White blood cells are an important part of the immune system responsible for defending the body against infections and diseases. The three types of white blood cells are called granulocytes, lymphocytes, and monocytes. They protect our body from microorganisms, such as viruses, bacteria, and allergens.

Granulocytes are the most abundant type of white blood cells found in our body. They are called granulocytes because they contain small sacs called granules filled with special enzymes. These enzymes are released by granulocytes to protect our immune system against foreign organisms. Granulocytes play an important role in defending our body and keeping our immune response strong.

There are three types of granulocytes:

  • Neutrophils — Fight against bacterial infections
  • Eosinophils — Most commonly act in allergic reactions and fight off parasites
  • Basophils — Release histamine during allergic reactions

Granulocytes are produced and matured in the bone marrow, a spongy tissue found at the center of bones. Immature granulocytes live in the bone marrow, and once matured, they are released into the bloodstream. From there, they travel until they are called to sites of immune response.

Blood Cell Counts

The number of white blood cells in the body goes up or down depending on the state of your immune system. In many health conditions, the number of white blood cells rises as they prepare to attack the pathogens (harmful microorganisms that can cause disease).

In some cases, however, underlying conditions cause white blood cell counts to decrease. A complete blood count (CBC) test measures the number of different types of blood cells in your blood, which can help detect health problems.

Blood Cell Counts in Lupus

As a chronic (long-term) inflammatory disease that affects multiple organs, lupus causes changes in the composition of different types of blood cells. Changes in blood cell counts are often linked with worsening of the disease and may indicate additional health problems.

In about 50 percent to 60 percent of people with systemic lupus erythematosus (SLE), the level of all white blood cells combined is lower (leukopenia) than in people without SLE. Normal levels of white blood cells in adults range from 4,000 to 11,000 cells per microliter. Leukopenia is defined as a white blood cell count of less than 4,000 cells per microliter.

Mature Granulocyte Counts

While leukopenia is common in people with lupus and is one of the hematologic clinical classification criteria for SLE, neutropenia only occurs in about 5 percent of people with SLE. Neutropenia refers to a low number of neutrophil granulocytes (also called neutrophils) and is defined as a neutrophil count of less than 1,500 cells per microliter.

One member from MyLupusTeam shared, “My blood test results show lower than average lymphocytes and neutrophils” and wanted to find out if lupus alone can cause the decrease in these levels.

Neutropenia in people with lupus is commonly associated with the following:

  • High exposure to immunosuppressive drugs that can be used as treatment in SLE
  • Decreased bone marrow function
  • Central nervous system lupus
  • History of low platelet levels

Neutropenia in people with SLE is usually mild and often doesn’t need treatment. However, it can make you more likely to get infections — either more often or for a longer time.

If neutropenia occurs with a fever, seek immediate medical attention. Severe neutropenia can be treated with granulocyte colony-stimulating factor, a drug that stimulates the bone marrow to produce more white blood cells. In some cases, a bone marrow transplant may be needed.

Immature Granulocyte Counts

Granulocytes are produced from stem cells in the bone marrow and go through a maturation process before being released. The normal range of each type of granulocyte per microliter of blood is:

  • Neutrophils — 1,800 to 7,800
  • Eosinophils — Zero to 450
  • Basophils — Zero to 200

During an infection, the number of granulocytes rises to fight off pathogens. In some cases, immature granulocytes (IGs) may be recruited to be released into the bloodstream, leading to high levels of IGs.

The level of IGs is usually given as a percentage of total white blood cells. It’s normally less than 1 percent. However, there are some instances when the number of IGs is higher in the bloodstream.

One MyLupusTeam member shared that their “immature granulocyte percentage is almost double the reference range,” and wanted to know what that means.

A high IG count often signals an early-stage infection in the body. In addition to infection, high IG counts can be caused by:

  • Bone marrow disorders — Myelofibrosis
  • Autoimmune diseases — SLE, rheumatoid arthritis
  • Cancer — For example, chronic myeloid leukemia

  • Tissue injury and inflammation — Sepsis
  • Steroid use — Commonly used as treatment in SLE

Changes in the number of granulocytes can reflect changes in disease activity. In lupus, a rise in the number of immature granulocytes often happens with active disease or flares.

Treatment for elevated IG counts in people with SLE involves treating the autoimmune effects of lupus. Immunosuppression drugs may be used to lower the activity of the immune system.

Other Abnormal Blood Cell Counts in Lupus

Other abnormal blood counts found in people with lupus include:

  • Low lymphocyte count (lymphopenia) — Found in about 20 percent to 93 percent of people with SLE
  • Low red blood cell count (anemia) — Found in about 50 percent of people with SLE
  • Low platelet count (thrombocytopenia) — Found in about 20 percent to 40 percent of people with SLE and thrombocytopenia and is also one of the hematologic clinical criteria for diagnosis in SLE

Blood cell counts are affected in many people with chronic inflammatory diseases such as SLE and can often signal that the disease is getting worse. Make sure to see your doctor for regular checkups that include blood cell counts to monitor your lupus.

You’ll want to have a hematologist (blood disease specialist) explain how lupus may affect your blood cells. A member echoed this, saying, “You definitely need blood tests to keep an eye on what’s going on with lupus symptoms to make sure it’s not affecting other organs.” A hematologist can help you understand any changes or abnormalities in your CBC results that may be connected to lupus. They will also provide guidance, monitoring, and treatment options that are appropriate for your condition.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Have you had blood test results showing abnormal white blood cell counts? Share your experience in the comments below, or start a conversation by posting on MyLupusTeam.

References
  1. Granulocytes — Cleveland Clinic
  2. Haematological Manifestations of Lupus — Lupus Science & Medicine
  3. Function of White Blood Cells — Cleveland Clinic
  4. Components of Blood — Merck Manual
  5. Neutrophils — From Bone Marrow to First-Line Defense of the Innate Immune System — Frontiers in Immunology
  6. Granulocytosis — Cleveland Clinic
  7. EULAR/ACR Classification Criteria for SLE — Seminars in Arthritis and Rheumatism
  8. Agranulocytosis — Cleveland Clinic
  9. Lupus Blood Test Results Explained — Hospital for Special Surgery
  10. How Lupus Affects the Blood — Lupus Foundation of America
  11. Neutrophils in the Pathogenesis and Manifestations of SLE — Nature Reviews Rheumatology
  12. Histology, White Blood Cell — StatPearls
  13. Drug-Induced Neutropenia — Pharmacy and Therapeutics
  14. Moderate and Severe Neutropenia in Patients With Systemic Lupus Erythematosus — Rheumatology
  15. Agranulocytosis in Systemic Lupus Erythematosus: A Case Report — Clinical Case Reports
  16. G-CSF (Granulocyte-Colony Stimulating Factor) — Cleveland Clinic
  17. Myelofibrosis — Cleveland Clinic
  18. Treatment of Systemic Lupus Erythematosus — Australian Prescriber
  19. Delta Neutrophil Index as a Marker for Differential Diagnosis Between Flare and Infection in Febrile Systemic Lupus Erythematosus Patients — Lupus
  20. Is Immature Granulocyte Count a Potential Prognostic Marker for Upper Gastrointestinal Tract Bleeding? A New Road to Explore — Indian Journal of Critical Care Medicine
  21. Age-Dependent Reference Ranges for Automated Assessment of Immature Granulocytes and Clinical Significance in an Outpatient Setting — Archives of Pathology & Laboratory Medicine
  22. Anaemia in Systemic Lupus Erythematosus: From Pathophysiology to Clinical Assessment — Annals of the Rheumatic Diseases
  23. Lupus Thrombocytopenia: Pathogenesis and Therapeutic Implications — Mediterranean Journal of Rheumatology
  24. 2019 EULAR/ACR Classification Criteria for Systemic Lupus Erythematosus — Arthritis & Rheumatology

Posted on June 15, 2023
All updates must be accompanied by text or a picture.

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Florentina Negoi, M.D. attended the Carol Davila University of Medicine and Pharmacy in Bucharest, Romania, and is currently enrolled in a rheumatology training program at St. Mary Clinical Hospital. Learn more about her here
Bora Lee, Ph.D. has more than 10 years of translational research experience in reproductive medicine and women’s health, with a focus on fertility and placental health. Learn more about her here

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