Background Mastitis is one of the most frequent diseases for transition cows, causing significant economic losses. Identification of potential biomarkers for diagnosis of mastitis is important for its prevention. Thus, this study was conducted to investigate alterations in blood inflammatory cells and serum variables that are related to health in postpartum cows. Results Seventy-six healthy Holstein dairy cows at week 4 before calving were selected. Blood samples were collected at weeks -4, -3, -2, -1, 1, 2, 3 and 4 relative to calving, respectively. Milk yield and composition were recorded weekly. According to the cutoff of somatic cell counts (SCC) for diagnosis of mastitis, 33 cows with SCC ≥ 500,000 ml -1 , 22 cows with 200,000 ≤ SCC < 500,000 ml -1 , and 23 cows with SCC < 200,000 ml -1 were defined as high, middle, and low SCC, respectively. Serum concentrations of β-hydroxybutyrate were higher ( P < 0.01) during all weeks, and non-esterified fatty acids were elevated from weeks -3 to 2 relative to calving in high SCC cows compared to low SCC cows. Higher serum concentrations of superoxide dismutase ( P < 0.01) and lower malondialdehyde levels ( P < 0.01) in low SCC than in high SCC cows indicate that the latter suffered from oxidative stress. In addition, high SCC cows exhibited higher blood neutrophil to lymphocyte ratio (NLR, P < 0.01) and platelet to lymphocyte ratio (PLR, P < 0.01) than low SCC cows, with a higher NLR ( P < 0.01) in middle SCC than in low SCC cows. The high SCC cows had lower levels of anti-inflammatory factors including IL-10 ( P = 0.05), CD4 ( P < 0.01) and CD8 ( P < 0.01), but higher levels of proinflammatory factors such as IL-6 ( P < 0.01), TNF-α ( P < 0.05), and PSGL-1 ( P < 0.01) than low SCC cows, leading to the elevated NLR and PLR in high SCC cows. Conclusions The significantly different NLR and PLR pre-partum between the middle and low SCC cows suggest their prognostic potential for postpartum mastitis risk