Monocytes macrophages role and function of the norm in the analysis of the causes of changes in

The situation when monocytes are elevated in the blood is quite common. They are an important echelon of protecting the body from foreign agents. Their increase may indicate the occurrence of a pathological process of a very different nature.

To treat an increase in monocytes in the blood should be through the treatment of the underlying disease, which caused the development of such a deviation.

These cells are the largest shaped elements in the vessels; they belong to the leukocyte fraction, a subgroup of agranulocytes. The main activity of monocytes is carried out not in the vascular bed, but in the tissues. Where they migrate a few days after leaving their place of bone marrow formation.

In tissues, monocytes degenerate into macrophages. But up to this point, they are able to perform part of their functions. The main one is phagocytosis. It is characterized by the ability to capture antigens, dying cells, as well as their decay products. Knowledge of the importance of monocytes is the key to understanding what their increase in blood in adults is.

Additional functions of monocytes and macrophages include:

  • the presentation of a foreign agent to lymphocytes, which in the future will be able to recognize and more effectively destroy the “intruder”;
  • participation in the life and reproduction of surrounding cellular structures, healing processes;
  • fight against tumor cells;
  • activity in allergic and inflammatory reactions;
  • pyrogenic effect – acting on the center of thermoregulation, they take part in the mechanism of increasing body temperature.

This type of white blood cell is involved in complex immune responses. Exceeding the normal level of monocytes in an adult blood is called monocytosis in the medical literature.

In absolute values, under normal conditions, the level of monocytes in the blood remains in the range of 240-700 cells per microliter (cells / μl). When using a standard general blood test, a different indicator is calculated – their percentage in the leukocyte formula.

If the concentration of monocytes per 100 leukocytes does not fit into the range of 3-11 cells, their decreased or increased level in the blood is observed.

A similar deviation is often observed due to a decrease in the concentration of other formed elements in the blood. At the same time, the percentage of monocytes in the leukocyte formula is increased, but when calculating the absolute numbers, it remains within the normal range.

An increase in the level of agranulocytes in an adult is a fairly common occurrence – in order to understand what this is talking about, you need to know which diseases such a blood test is observed in.

Monocytosis is an indicator of one of the following conditions:

  • inflammatory process in the body;
  • penetration of infection (viruses, bacteria, fungi) or parasites;
  • development of pathology of the blood system.
  • rheumatic diseases – periarteritis nodosa, rheumatism, rheumatoid arthritis;
  • pathologies with a specific course: syphilis, sarcoidosis, tuberculosis;
  • increased function of the adrenal cortex – Cushing’s syndrome;
  • digestive system diseases – ulcerative colitis, Crohn’s disease;
  • sickle cell anemia, acute leukemia, polycythemia, myeloma.

An elevated level of monocytes in the blood is found in both women and men – the doctor will tell you exactly what this means in a particular case after conducting the necessary amount of examinations.

A similar deviation in the analyzes can be observed during the recovery period after surgery or a serious illness.

Poisoning with phosphorus or tetrachloroethane also causes monocyte levels to rise above normal.

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In women, a blood test has its own characteristics, due to periodic fluctuations in the hormonal background – this means that an elevated level of monocytes may depend on the endocrine system. Studies have been conducted in which there was a connection between the menstrual cycle and the concentration of these cells. But such fluctuations do not go beyond normal values.

Under certain conditions, when monocytes are above normal, a decrease in reproductive function may be observed – this means that excessive activity of agranulocytes is associated with the ability to conceive.

This fact continues to be actively studied. Monocytosis is observed after an artificial termination of pregnancy.

The reasons for the increase in blood monocytes in women are still subject to comprehensive study.

In pregnancy

During pregnancy, a woman’s body is particularly sensitive. The penetration of even the most harmless infection can provoke an increased content of monocytes in the blood.

In the early stages, monocytosis in a pregnant woman is a normal option. It arises from the adaptation of immunity to a new physiological state.

If the monocytes are slightly elevated, but the woman does not feel signs of malaise, do not worry. In case of any complaints, it is necessary to inform the doctor.

The reasons why monocytes can be elevated in a child should be said separately. In children, the causes of this deviation are the same as in adults, but there are a number of pathologies that are inherent mainly in childhood. Among them, monocytosis is more often present in the following diseases:

An increased number of monocytes in the blood is associated with age. For example, during periods when teething and tooth change are observed. Monocytes are often overestimated after removal of adenoids or palatine tonsils. What is the normal white blood cell count for children?

With chickenpox in a child, monocytes can be increased

Having figured out what this means, you should find out what to do with monocytosis in an adult. Tactics depend on the circumstances of the pathology.

If an increase in blood monocytes in a man or woman was detected by chance, with prophylactic screening, it is advisable to repeat the analysis. For comparison, it is better to choose a different laboratory.

If there are a lot of monocytes in the blood, this means that it is necessary to follow the process in dynamics.

If the result is confirmed, it becomes necessary to conduct a more in-depth examination to establish the exact cause of the deviation.

The following specialists are involved in the treatment of diseases that cause monocytosis:

  • infectious disease specialist;
  • rheumatologist;
  • TB specialist;
  • gastroenterologist;
  • dermatologist.

In their practice, such a problem is faced by a pulmonologist in the treatment of severe pneumonia and an allergist. The most directly related to the problem of a high level of monocytes in an adult are specialists such as an immunologist and a hematologist.

It looks like a monocyte cell (in the center) under a microscope

Monocyte cells are nothing more than large white blood cells. First of all, you should understand what cells of this type are responsible for. Their main functions are to protect the human body from foreign cells, purifying the blood from physical agents. Monocytes have the ability to absorb not only parts of foreign microorganisms, but also their entirety.

These cells are also in the lymph nodes and tissues, not only in the blood.

Important! Monocytes cleanse the body. The main function of these cells is to create certain conditions under which regeneration processes start in the tissues. Such a function is activated if the tissues were damaged by foreign organisms, as a result of transferred inflammatory processes and lesions, due to the development of tumors.

We examined what monocytes are in a blood test, now it’s time to make out what their rate is the norm. Since these cells are one of the types of white blood cells, their measurement involves determining the percentage of monocytes in the number of white blood cells.

Important! This indicator is absolutely independent of gender or age differences, and therefore the norm of monocytes in women and men is at the same level. There are only small differences in age and at certain periods in pregnant women.

The normal content of these cells is as follows:

  • Under the age of 10 years is from 2 to 12%.
  • Upon reaching the age of 12 – 3-10%.

Table of the content of all forms of white blood cells in the blood

In the case of measuring monocytes, their absolute content in the blood plays a very important role, and not just the percentage. The fact is that a general blood test determines their number only relatively. Therefore, a special technique was developed to determine the absolute content of monocytes in the cells of one liter of blood.

This indicator is recorded as “monocytes abs.” Or Mon #. “Abs.” In this case means “absolute.”

Monocytes absolute norm in adults is 0-0,08 × 109 / L. In children under 12 years of age, this indicator ranges from 0,05-1,1 × 109 / l.

If the monocytes are elevated, then this disease is called monocytosis. When blood monocytes are elevated, this indicates the presence of foreign agents in the blood, which may indicate the development of neoplasms and infections.

Let us consider in more detail what this means – increased monocytes in the blood. This phenomenon can develop against the background of a number of diseases, because such signs can in no way be ignored:

  • This may indicate the development of tuberculosis.

Very often, an increase in monocytes indicates the development of tuberculosis

  • Lymphoma or leukemia is possible.
  • An increased level of monocytes in an adult may indicate the presence of diseases of an infectious nature in an acute form in the recovery phase. It can be measles, rubella, mononucleosis, diphtheria, etc.
  • Lupus erythematosus, rheumatism, etc.

Important! An abnormal level of monocytes in the blood is observed with mononucleosis. This infectious blood disease very often affects children.

If the monocytes are lowered, the disease is diagnosed with monocytopenia, against the background of which anemia can develop and the level of other blood elements decreases sharply.

Folic acid deficiency anemia and aplastic anemia are two of the most common causes of falling monocyte levels. Also, monocytopenia is one of the most common symptoms of treatment with glucocorticoid type drugs.


Monocytes form in the red bone marrow and enter the bloodstream. There they begin to function actively, but this does not last long, only for 2-3 days. Then, using their ability to move, they go beyond the vessels through special small pores between the cells and move into the tissue.


Monocyte counts are measured during a white blood cell count in a clinical blood test. The detection of monocytosis requires the consultation of a medical specialist, preferably a therapist. The doctor should conduct a survey of patient complaints, collect anamnestic data, perform a general examination for signs of a disease. The data obtained help to appoint an additional examination to find out the causes of monocytosis:

  • Blood tests . In a general blood test, the total amount, the percentage of all forms of leukocytes (leukocyte formula) is calculated, the ESR is determined. The presence of atypical mononuclear cells is checked in a blood smear. The level of autoantibodies (to DNA, muscle cells, topoisomerase), antigranulocyte antibodies, CRP is investigated. An immunohistochemical analysis and immunophenotyping of cells is performed to detect surface specific or tumor CD markers.
  • Microbiological studies. To identify the infectious agent, bacteriological culture and sputum microscopy are performed. Antibodies to viruses, bacteria, their DNA are determined by enzyme-linked immunosorbent assay and polymerase chain reaction. Serological tests (indirect hemagglutination reactions, microprecipitation) are carried out.
  • Roentgenography. With tuberculosis and sarcoidosis, an increase in mediastinal, radical lymph nodes is detected on lung X-ray, and with histiocytosis, bilateral small focal dimming. Also, histiocytosis is characterized by areas of osteolysis and destruction on radiographs of flat skull bones, long tubular bones.
  • Sonography During abdominal ultrasound in patients with infectious mononucleosis, brucellosis, and hematologic diseases, splenomegaly is noted, less often hepatomegaly. On echocardiography in patients with collagenoses, it is sometimes possible to detect thickening of the leaves of the pericardium, effusion in the pericardial bag.
  • Histological studies. In malignant blood diseases, a large number of blast cells are found in a bone marrow smear obtained by sternal puncture or trepanobiopsy. Microscopic examination of bronchoalveolar fluid in patients with histiocytosis shows giant Langerhans cells with eosinophilic cytoplasm. In the lymph node biopsy with lymphomas, proliferation of lymphoid cells, Berezovsky-Sternberg cells are detected.

The “behavior” of these cells in the blood is quite predictable, because monocytes are leukocytes capable of phagocytosis. Having discovered the presence in the body of a bacterium, virus or other foreign particle, they begin to actively move towards them. This occurs through chemotaxis.

A harmful object secretes certain chemicals, the presence of which is “sensed” by monocytes. By capturing these substances, cells move to those areas where their concentration is higher, that is, to where their source is. In this they are helped by other cells of the immune system, which also feel the presence of the “enemy”, also move towards it and “indicate the direction” to their allies.

Monocyte in a blood smear (center)

Unlike lymphocytes, monocytes destroy the aggressor not by touching or secreting antibodies. They have a direct destructive effect on foreign particles. Changing their shape, monocytes envelop the object, completely absorb it, and then destroy the enzymes of their lysosomes.

Many other phagocytes of our body, such as neutrophils or macrophages, die after meeting with the aggressor. In contrast, monocytes have a “reusable” effect, they are able to neutralize a large number of harmful particles and maintain viability after that. That is why, despite its small amount, monocytes effectively protect our blood from foreign agents.

Once the monocytes neutralize the threat, they continue their mission. They move to other cells of the immune system, lymphocytes, and give them information about what kind of object they just destroyed. In addition, lymphocytes receive from them “instructions” on how in the future they need to behave when meeting with a similar aggressor. This allows you to create a memory of immunity and increase the efficiency of its work.


It is impossible to directly bring the level of monocytes to normal values. To do this, you must deal with the cause, i.e. treat the main pathology, against the background of which monocytosis developed. If monocytosis is found in the blood of a person who has recently had an acute infectious disease, then treatment is not required. This is an absolutely normal phenomenon, the concentration of monocytes independently normalizes after a few days. In the case of prolonged and, especially, high monocytosis, medical intervention is necessary:

  • Anti-infective treatment. For the treatment of most viral infections, only bed rest, plentiful hot drinking, the use of non-steroidal anti-inflammatory drugs (paracetamol, ibuprofen), as well as symptomatic therapy (rinsing or irrigation of the throat with antiseptic, analgesic solutions, sprays, vasoconstrictor drops in the nose) are enough to treat most viral infections. With bacterial infections, antibiotics are prescribed, with tuberculosis – a combination of anti-TB drugs.
  • Anti-inflammatory treatment. As a pathogenetic treatment of chronic granulomatous diseases, collagenoses, drugs that suppress inflammation – glucocorticosteroids (prednisone, methylprednisolone) are used. For a more powerful anti-inflammatory effect, immunosuppressants are effective – methotrexate, cyclophosphamide.
  • Chemotherapy For the treatment of malignant blood diseases, histiocytosis, it is necessary to conduct courses of chemotherapeutic treatment. Sometimes you have to resort to intrathecal administration of drugs (introduction to cerebrospinal fluid).

There is a surgical method for the treatment of hematologic diseases and some types of congenital neutropenia, which allows to achieve full healing from the disease – a transplant of donor hematopoietic stem cells. To perform this operation, it is necessary to perform HLA typing (a genetic test that determines histocompatibility antigens) in order to select a suitable donor.

Monocytes are an indispensable component of the immune system, which in its significance even surpasses its other elements in something. So, it is known that monocytes can absorb harmful particles of very large size – those that eosinophils and neutrophils are not able to “eat”. In addition, monocytes destroy pathogens in conditions when more numerous neutrophils cannot cope with this task (for example, in an acidic environment).

Finally, these cells are not without reason called “janitors.” In the focus of inflammation, where the fight against a harmful object occurs, they not only devour microbes and other harmful particles, but also get rid of the remnants of other immune cells that died as a result of phagocytosis. Thus, there is a “cleaning of the territory” from all that is superfluous, so that later the tissues can better heal.

The optimal content and quality of work of monocytes is what largely determines the state of our health. It is very important that these cells function well. Unfortunately, many diseases lead to a change in the monocyte-macrophage system, which is reflected in the well-being of a person and the number of his diagnoses.

To maintain the ideal state of the immune system, as well as to treat diseases that have already arisen, you can use the Transfer Factor drug. It contains informational molecules that “teach” lymphocytes to work properly and pass on information about possible aggressors that the human body may encounter throughout life. All this “unloads” monocytes and helps them work better for the good of their health.


Monocytosis itself is not an indicator of prognosis. The outcome is directly determined by the cause of monocytosis. For example, physiological monocytosis in children does not affect life expectancy. Some chronic granulomatous diseases, in particular, sarcoidosis, sometimes even without any treatment end in independent remission. Oncohematological pathologies and hereditary neutropenia in children, on the contrary, are characterized by an unfavorable prognosis and a high probability of death.

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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.