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flowchart TD
Start[WBC Analysis] --> InitialWBC{Check Total WBC Count}
%% Severe Leukocytosis Branch
InitialWBC -->|"> 50,000/µL"| SevereLeuko[Severe Leukocytosis]
SevereLeuko --> BlastCheck{Check Blasts}
BlastCheck -->|"Blasts ≥ 20%"| AML["AML Suspect:
- Check bone marrow
- Flow cytometry
- Genetic testing"]
BlastCheck -->|"Blasts < 20%"| DiffCount1{Differential Count}
DiffCount1 --> |"NE# > 30,000/µL"| CML["CML Suspect:
1. BCR-ABL testing
2. JAK2 mutation
3. Bone marrow biopsy"]
DiffCount1 --> |"LY# > 30,000/µL"| CLL["CLL Suspect:
1. Flow cytometry
2. FISH analysis
3. Check CD markers"]
%% Moderate Leukocytosis Branch
InitialWBC -->|"11,000-50,000/µL"| ModerateLeuko[Moderate Leukocytosis]
ModerateLeuko --> DiffCount2{Differential Count}
DiffCount2 -->|"NE# > 7,500/µL"| Neutrophilia["Neutrophilia:
- Infection
- Inflammation
- Early CML"]
DiffCount2 -->|"LY# > 4,000/µL"| Lymphocytosis["Lymphocytosis:
- Viral infection
- Early CLL
- Lymphoma"]
DiffCount2 -->|"MO# > 1,000/µL"| Monocytosis["Monocytosis:
- CMML
- Infection
- Autoimmune"]
DiffCount2 -->|"EO# > 1,500/µL"| Eosinophilia["Eosinophilia:
- Allergy
- Parasitic
- HES"]
DiffCount2 -->|"BA# > 200/µL"| Basophilia["Basophilia:
- CML
- Allergy
- Inflammation"]
%% Leukopenia Branch
InitialWBC -->|"< 4,000/µL"| Leukopenia[Leukopenia]
Leukopenia --> DiffCount3{Differential Count}
DiffCount3 -->|"NE# < 1,500/µL"| Neutropenia["Neutropenia:
- Aplastic anemia
- Drug-induced
- Early AML"]
DiffCount3 -->|"LY# < 1,000/µL"| Lymphopenia["Lymphopenia:
- HIV
- Chemotherapy
- ALL"]
%% Combined Abnormalities
InitialWBC --> CombinedCheck{Check Combined Parameters}
CombinedCheck --> |"WBC > 25k + PLT < 100k"| AcuteLeuk["Acute Leukemia Likely:
1. Urgent bone marrow
2. Cytogenetics"]
CombinedCheck --> |"WBC > 25k + PLT > 450k"| ChronicLeuk["Chronic MPNs:
1. JAK2 testing
2. BCR-ABL"]
%% Blast Patterns
InitialWBC --> BlastPattern{Blast Patterns}
BlastPattern --> |"Blasts ≥ 20%
Any WBC count"| AcuteLeukemia["Acute Leukemia:
- AML if myeloid
- ALL if lymphoid"]
BlastPattern --> |"Blasts 5-19%"| MDS["MDS/Early Leukemia:
1. Bone marrow
2. Cytogenetics"]
%% Special Considerations
InitialWBC --> SpecialCases{Special Cases}
SpecialCases --> |"Pancytopenia"| PanCases["Check For:
1. Aplastic anemia
2. PNH
3. Early leukemia"]
SpecialCases --> |"Bicytopenia"| BiCases["Check For:
1. MDS
2. Early leukemia
3. Bone marrow failure"]
%% PLT Integration
InitialWBC --> PLTCheck{Check PLT Count}
PLTCheck -->|"PLT < 50,000/µL"| SevereThromb["Severe Thrombocytopenia:
1. Check bone marrow
2. Rule out DIC"]
PLTCheck -->|"PLT > 1,000,000/µL"| ExtremeThromb["Extreme Thrombocytosis:
1. JAK2 testing
2. Check for MPN"]
%% MPV Considerations
PLTCheck --> MPVCheck{Check MPV}
MPVCheck -->|"MPV > 12.0 fL"| HighMPV["High MPV:
- ITP
- Bernard-Soulier
- Pre-AML"]
MPVCheck -->|"MPV < 7.0 fL"| LowMPV["Low MPV:
- Aplastic anemia
- WAS
- Pre-ALL"]
Understanding the WBC Analysis Chart
Initial Assessment
Begins with total WBC count evaluation to identify leukocytosis or leukopenia.
Severe Leukocytosis
When WBC > 50,000/µL, focuses on identifying potential malignancies like AML, CML, or CLL.
Moderate Changes
For WBC between 11,000-50,000/µL, evaluates various causes including infections and inflammation.
Special Testing
Indicates when to perform specialized tests like flow cytometry or genetic testing.