ruler

Here’s an excellent question that comes up from time to time in class. It has to do with units of measurement, which sounds like a boring and unimportant topic – but it can be very confusing if you’re not aware of the different systems people use.

Q. I have a very odd question about cell counts. I’m looking over my notes and saw where my Professor listed a high white count as 60000 (6.0 x 109)/L. I don’t understand what she means by 6.0 x 109/L because if that were the case the white count would be 6,000,000,000. I tried looking it up but often times I see white counts listed as 109. Shouldn’t it be 106?

A. I know what you’re saying – it is confusing! There are three ways the white blood cell count can be listed:

  1. number of cells per μm
  2. number of cells per mm3
  3. number of cells per L

The first two units are more commonly used in the US. The third is part of the metric system, and is used more commonly in other countries. This system is also called the International System of Units, and is usually referred to by the abbreviation “SI.” Which didn’t bug me until I wrote this post, and then I was like, wait, SI?? Turns out the abbreviation comes from the original French name, Système international d’unités. In case you were wondering.

Here are typical reference ranges for the two systems:

  • Conventional: 4,000 – 11,000/μm or 4,000 – 11,000/mm3
  • SI: 4.0 – 11.0 x 109/L

The confusion arises when people are talking (or sometimes even writing) about the white count. Nobody says the patient’s white count is “8,200/mm3” – they just say “8,200.” So if you don’t have the context of their comment, you don’t know if that means that the patient’s white count is normal (8,200/mm3), or very high (8,200 x 109/L).

Usually, it’s fairly obvious in real life. A WBC count of 8,200 x 109/L , for example, would be incompatible with life. Sometimes, though (especially on exams, where trick questions are unfortunately pretty common), you really need to know the units. If it’s not abundantly obvious which units are implied, then you need to ask!

Back to your question. The confusion arose because the units were not listed correctly. It would be correct to say that 60,000/mm3 is a high white count. This number would be equivalent to 60.0 x 109/L in the SI system. The other number you listed – 6.0 x 109/L – is within the normal range. And you’re right: 60,000 x 109/L would be a ridiculously high white count (one that would not be seen in humans!).