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Clinical blood test. General blood analysis

Клинический анализ крови

The general clinical analysis of blood is the most common analysis, which every person had to take. Changes occurring in the blood are most often nonspecific, but at the same time reflect changes that occur in the whole body.

The general analysis of blood is widely used as one of the most important methods of examination in most diseases, and in the diagnosis of diseases of the hematopoiesis system - he is given the leading role.

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General blood analysis

  • study of the quantitative and qualitative composition of blood cells (blood cells):
    • determination of the number, size, shape of red blood cells and the content of hemoglobin in them;
    • the definition of hematocrit (the ratio of the volume of blood plasma and shaped elements);
    • determination of the total number of leukocytes and the percentage ratio of individual forms among them (leukocyte formula);
    • determination of the number of platelets
  • ESR study

The cellular composition of the blood of a healthy person is quite constant. Therefore, various changes in it, occurring in diseases, can have an important diagnostic value. With some physiological conditions of the body, the qualitative and quantitative composition of the blood often changes (pregnancy, menstruation). However, small fluctuations occur during the day under the influence of food intake, work, etc. To eliminate the influence of these factors, the blood for repeated analysis should be taken at the same time and under the same conditions.

Preparation for the study: No special preparation for the study is required. It is recommended to carry out blood sampling on an empty stomach or at least 2 hours after the last meal.

Material for examination: whole blood (with EDTA).

Term of execution: 1 day.

Interpretation of the result: Only the physician can fully interpret the total blood test. However, looking at your analysis, you too can have a general idea of ​​your health. What can you learn from your general blood test? You can learn a lot. Take the basic indicators.

Hemoglobin

Hemoglobin (Hb, hemoglobin) - the main component of red blood cells (red blood cells of blood), is a complex protein consisting of gemma (iron-containing part of Hb) and globin (protein part of Hb). The main function of hemoglobin is to transfer oxygen from the lungs to the tissues, as well as to remove carbon dioxide (CO2) from the body and regulate the acid-base state (CBS).

Physiological forms of hemoglobin:

  1. oxyhemoglobin (HbO2) - a compound of hemoglobin with oxygen - is formed, mainly in the arterial blood and gives it a scarlet color
  2. restored hemoglobin or deoxyhemoglobin (HbH) - hemoglobin, which gave oxygen to tissues
  3. carboxyhemoglobin (HbCO2) - a hemoglobin compound with carbon dioxide - is formed, mainly, in the venous blood, which as a result acquires a dark cherry color


Units of measure: - g / l

Reference values:

Age Floor Hemoglobin level, g / l
less than 2 weeks 134 - 198
2 weeks - 1 month 107 - 171
1 - 2 months 94 - 130
2 - 4 months 103 - 141
4 - 6 months 111 - 141
6 - 9 months 114-140
9 - 12 months 113 - 141
16 years 110 - 140
6 - 9 years 115 - 145
9 - 12 years 120 - 150
12 - 15 years F 115 - 150
M 120 - 160
15 - 18 years old F 117 - 153
M 117 - 166
18 - 45 years old F 117 - 155
M 132 - 173
45 - 65 years old F 117 - 160
M 131 - 172
over 65 years old F 117 - 161
M 126 - 174


Increase of hemoglobin level:

  • Diseases accompanied by an increase in the number of erythrocytes (primary and secondary erythrocytosis)
  • Blood thickening (dehydration)
  • Congenital heart disease, pulmonary heart disease
  • Smoking (formation of a functionally inactive HbCO)
  • Physiological causes (in high-altitude inhabitants, airmen after high-altitude flights, climbers, after increased physical exertion)

Reduction in hemoglobin (anemia):

  • Increased hemoglobin loss in bleeding - hemorrhagic anemia
  • Increased destruction (hemolysis) of erythrocytes - hemolytic anemia
  • The lack of iron necessary for the synthesis of hemoglobin, or vitamins involved in the formation of red blood cells (mainly B12, folic acid) - iron deficiency or B12-deficiency anemia
  • Violation of the formation of blood cells in specific hematological diseases - hypoplastic anemia, sickle cell anemia, thalassemia

Anemia can also occur again in a variety of chronic non-hematological diseases.

Pathological forms of hemoglobin:

  • Carbhemoglobin (HbCO) - is formed by carbon monoxide poisoning (CO), while hemoglobin loses the ability to attach oxygen
  • Methemoglobin - is formed by the action of nitrites, nitrates and certain medications (there is a transition of ferrous iron to trivalent with the formation of methemoglobin - HbMet)

Erythrocytes

Erythrocytes - (red blood cells, red blood cells, RBC) are the most numerous blood elements that contain hemoglobin, transporting oxygen and carbon dioxide. They are formed from reticulocytes upon their exit from the bone marrow. Mature red blood cells do not contain a nucleus, they have the form of a biconcave disk. The average life span of erythrocytes is 120 days.

Units of measurement: - 10 ^ 12 cells / l

Reference values:

Age Floor The level of red blood cells, x10 12 cells / l
less than 2 weeks 3.9-5.9
2 weeks - 1 month 3.3 - 5.3
1 - 4 months 3.5 - 5.1
4 - 6 months 3.9-5.5
6 - 9 months 4.0-5.3
9 - 12 months 4.1-5.3
1 - 3 years 3.8 - 4.9
36 years 3.7 - 4.9
6 - 9 years 3.8 - 4.9
9 - 12 years 3.9-5.1
12 - 15 years F 3.8 - 5.0
M 4.1-5.2
15 - 18 years old F 3.9-5.1
M 4.2-5.6
18 - 45 years old F 3.8 - 5.1
M 4.2-5.6
45 - 65 years old F 3.8-5.3
M 4.2-5.6
over 65 years old F 3.8 - 5.2
M 3.8 - 5.8


Increase in the level of erythrocytes (erythrocytosis):

  • Absolute erythrocytosis (due to increased production of erythrocytes)
    • Erythemia, or Vakez disease - one of the variants of chronic leukemia (primary erythrocytosis)
    • Secondary erythrocytosis:
      • caused by hypoxia (chronic lung disease, congenital heart disease, the presence of abnormal hemoglobins, increased physical activity, stay at high altitudes)
      • associated with increased production of erythropoietin, which stimulates erythropoiesis (kidney parenchyma cancer, hydronephrosis and polycystic kidney disease, liver parenchyma, benign family erythrocytosis)
      • associated with an excess of adrenocorticosteroids or androgens (pheochromocytoma, Izenko-Cushing's disease / syndrome, hyperaldosteronism, cerebellar hemangioblastoma)
  • Relative - with a thickening of the blood, when the volume of plasma decreases while maintaining the number of red blood cells
    • dehydration (excessive sweating, vomiting, diarrhea, burns, swelling and ascites)
    • emotional stress
    • alcoholism
    • smoking
    • systemic hypertension


Lowering of the level (erythrocytopenia):

  • Acute hemorrhage
  • Deficiency anemia of different etiology - as a result of deficiency of iron, protein, vitamins
  • Hemolysis
  • It can occur again in a variety of chronic non-hematological diseases
  • The number of red blood cells can physiologically decrease after eating, between 17.00 and 7.00, as well as when taking blood in a prone position.


In addition to determining the number of erythrocytes in diagnosis, a number of morphological characteristics of red blood cells are used , which are estimated using an automatic analyzer (see Erythrocyte Indexes MCV, MCH, MCHC), or visually - in a blood smear under a microscope when calculating leukoformula. Normally, the erythrocyte diameter is 7.2 - 7.5 microns. Erythrocytes with a diameter of 6.7 μm or less are called microcytics, more than 7.7 μm are macro-cells, more than 9.5 μm in diameter are called megalocytes. Macrocytosis - a condition where 50% or more of the total number of erythrocytes are macro-cells (noted with B12 and folic deficiency anemia, liver disease). Microcytosis is a condition in which 30-50% are microcytomas. It is observed in iron deficiency anemia, microspherocytosis, thalassemia, lead intoxication. Anisocytosis is the presence of red blood cells of different sizes. Poikilocytosis - a change in the form of erythrocytes (ovalocytes, schizocytes, spherocytes, target red blood cells), develops with severe anemia and is an unfavorable sign. There may be nuclear forms of erythrocytes (normocytes), as well as red blood cells with altered color and presence of inclusions. Inclusions are elements of pathological regeneration: Quebot rings (found in megaloblastic anemia, thalassemia), Jolly's body (found after splenectomy, with hemolytic poisoning, anemia of various origins), basophilic granularity (occurs in lead poisoning, sidero- and megaloblastic anemia, thalassemia) , the body of Heinz-Ehrlich (a sign of an impending hemolysis).

Counting of reticulocytes (young erythrocytes) is performed in a separate test.

Erythrocyte Indexes

Erythrocyte indices are calculated values ​​that allow quantitative characterization of important indicators of the state of erythrocytes.

MCV - mean cell volume is a more accurate parameter than a visual estimate of the size of red blood cells. However, it is not reliable when there are a large number of abnormal erythrocytes (for example, sickle cells) in the test blood.

Units of measurement: - fl (femtoliters)

Reference values:

Age Floor MCV, fl
less than 2 weeks 88 - 140
2 weeks - 1 month 91 - 112
1 - 2 months 84 - 106
2 - 4 months 76 - 97
4 - 6 months 68 - 85
6 - 9 months 70 - 85
9 - 12 months 71 - 84
16 years 73 - 86
6 - 9 years 75 - 87
9 - 12 years 76 - 90
12 - 15 years F 73 - 95
M 77 - 94
15 - 18 years old F 78 - 98
M 79 - 95
18 - 45 years old F 81 - 100
M 80 - 99
45 - 65 years old F 81 - 101
M 81 - 101
over 65 years old F 81 - 102
M 81 - 103


Based on the MCV value, microcancer anaemias (MCV <80 fl), normocytic (MCV from 80 to 100 fl) and macrocytic (MCV> 100 fl) are distinguished:

  • Microcytosis is characteristic for iron deficiency anemia, thalassemia, sideroblastic anemia
  • Macrocytosis - for B12- and folic acid-deficient
  • Normocytic anemia - hemolytic, anemia after hemorrhage, hemoglobinopathies
  • Aplastic anemia is normal or macrocytic.


MCH is the mean content of hemoglobin in the erythrocyte (mean cell hemoglobin) - this indicator determines the average hemoglobin content in a separate erythrocyte. It is similar to the color index, but more accurately reflects the synthesis of Hb and its level in the erythrocyte.

Units of measure: - pg (picogram)

Reference values:

Age Floor MCH, pg
less than 2 weeks 30 - 73
2 weeks - 1 month 29 - 36
1 - 2 months 27 - 34
2 - 4 months 25 - 32
4 - 6 months 24 - 30
6 - 9 months 25 - 30
9 - 12 months 24 - 30
1 - 3 years 22 - 30
39 years 25 - 31
9 - 12 years 26 - 32
12 - 15 years F 26 - 34
M 27 - 32
15 - 18 years old F 26 - 34
M 27 - 32
18 - 45 years old F 27 - 34
M 27 - 34
45 - 65 years old F 27 - 34
M 27 - 34
over 65 years old F 27 - 35
M 27 - 34


Based on this index, anemia can be divided into normo-, hypo- and hyperchromic:

  • Normochromia is characteristic of healthy people, but can also occur in hemolytic and aplastic anemia, as well as anemia associated with acute blood loss
  • Hypochromia is caused by a decrease in the volume of erythrocytes (microcytosis) or a decrease in the level of hemoglobin in the erythrocyte of normal volume. Those. hypochromia can be combined with a decrease in the volume of erythrocytes, and can be observed with normo- and macrocytosis. It occurs with iron deficiency anemia, anemia in chronic diseases, thalassemia, with some hemoglobinopathies, lead poisoning, impaired synthesis of porphyrins
  • Hyperchromia does not depend on the degree of saturation of erythrocytes, hemoglobin, but is due only to the volume of red blood cells. It is observed in megaloblastic, many chronic hemolytic anemias, hypoplastic anemia after acute blood loss, hypothyroidism, liver diseases, with the use of cytotoxic drugs, contraceptives, anticonvulsants.


MCHC (mean cell hemoglobin concentration) - the average concentration of hemoglobin in the erythrocyte - reflects the saturation of the erythrocyte with hemoglobin and characterizes the ratio of the amount of hemoglobin to the cell volume. Thus, unlike SIT, it does not depend on the volume of the erythrocyte.

Units of measure: g / l

Reference values:

Age Floor MCHC, g / l
less than 2 weeks 280 - 350
2 weeks - 1 month 280 - 360
1 - 2 months 280 - 350
2 - 4 months 290 - 370
4 months - 1 year 320 - 370
1 - 3 years 320 - 380
36 years 320 - 370
6 - 9 years 320 - 370
9 - 12 years 320 - 370
12 - 15 years F 320 - 360
M 320 - 370
15 - 18 years old F 320 - 360
M 320 - 360
18 - 45 years old F 320 - 360
M 320 - 370
45 - 65 years old F 310 - 360
M 320 - 360
over 65 years old F 320 - 360
M 310 - 360


Increase of ICSU:

  • Hyperchromic anemia (congenital spherocytosis and other spherocytic anemia)


Lowering ICSU:

  • Iron deficiency anemia
  • Sideroblastic anemia
  • Thalassemia

Hematocrit

Hematocrit (Ht, hematocrit) is a volume fraction of erythrocytes in whole blood (ratio of volumes of erythrocytes and plasma), which depends on the number and volume of erythrocytes.

The value of hematocrit is widely used to assess the severity of anemia, in which it can be reduced to 25-15%. But this indicator can not be evaluated soon after a loss of blood or blood transfusion, because you can get falsely elevated or falsely understated results.

The hematocrit may decrease slightly when taking blood in the prone position and rise with prolonged compression of the vein with a tourniquet upon blood sampling.

Units of measure: %

Reference values:

Age Floor Hematocrit value,%
less than 2 weeks 41 - 65
2 weeks - 1 month 33 - 55
1 - 2 months 28 - 42
2 - 4 months 32 - 44
4 - 6 months 31 - 41
6 - 9 months 32 - 40
9 - 12 months 33 - 41
1 - 3 years 32 - 40
36 years 32 - 42
6 - 9 years 33 - 41
9 - 12 years 34 - 43
12 - 15 years F 34 - 44
M 35 - 45
15 - 18 years old F 34 - 44
M 37 - 48
18 - 45 years old F 35 - 45
M 39 - 49
45 - 65 years old F 35 - 47
M 39 - 50
over 65 years old F 35 - 47
M 37 - 51


Increase in hematocrit:

  • Erythremia (primary erythrocytosis)
  • Secondary erythrocytosis (congenital heart defects, respiratory failure, hemoglobinopathies, kidney neoplasms, accompanied by enhanced erythropoietin formation, polycystic kidney disease)
  • Reduction of the volume of circulating plasma (blood thickening) with burn disease, peritonitis, etc.
  • Dehydration of the body (with severe diarrhea, indomitable vomiting, excessive sweating, diabetes)


Lowering the hematocrit:

  • Anemia
  • An increase in the volume of circulating blood (the second half of pregnancy, hyperproteinemia)
  • Hyperhydration

Leukocytes

Leukocytes (white blood cells, white blood cells, WBC) are blood elements, the main function of which is to protect the body from foreign agents (toxins, viruses, bacteria, dying cells of its own organism, etc.).

The formation of leukocytes (leukopoiesis) takes place in the bone marrow and lymph nodes. There are 5 types of leukocytes: neutrophils, lymphocytes, monocytes, eosinophils, basophils (see section " Leukocyte formula ").

The number of leukocytes in circulating blood is an important diagnostic indicator that depends on the rate of inflow of cells from the bone marrow and the rate at which they exit into the tissue.

The number of white blood cells during the day can vary under the influence of various factors, without, however, exceeding the limits of reference values.

Physiological increase in the level of leukocytes (physiological leukocytosis) occurs, for example, after eating (so it is desirable to perform an analysis on an empty stomach), after physical exertion (physical efforts are not recommended before taking blood) and in the afternoon (it is desirable to take blood for analysis in the morning) stress, exposure to cold and heat. In women, a physiological increase in the number of leukocytes is noted in the premenstrual period, in the second half of pregnancy and during childbirth.

Units of measurement: x 10 ^ 9 cells / l

Reference values:

Age The level of leukocytes, x 10 9 cells / l
Children under 1 year old 6.0 - 17.5
1 - 2 years 6.0 - 17.0
24 years 5.5 - 15.5
4 - 6 years 5.0 - 14.5
6 - 10 years 4.5 - 13.5
10 - 16 years old 4.5 - 13.0
Children over 16 years of age 4.5 - 11.0
Adults 4.0 - 9.0


Increased level (leukocytosis):

  • Acute infections, especially if they are caused by cocci (staphylococcus, streptococcus, pneumococcus, gonococcus). Although a number of acute infections (typhoid, paratyphoid, salmonellosis, etc.) can in some cases lead to leukopenia (a decrease in the number of leukocytes)
  • Inflammatory conditions; rheumatic attack
  • Intoxications, including endogenous (diabetic acidosis, eclampsia, uremia, gout)
  • Malignant neoplasms
  • Injuries, burns
  • Acute bleeding (especially if bleeding is internal: to the abdominal cavity, pleural space, joint or in the immediate vicinity of the dura mater)
  • Surgical interventions
  • Infarcts of internal organs (myocardium, lungs, kidneys, spleen)
  • Myelo- and lymphocytic leukemia
  • The result of the action of adrenaline and steroid hormones
  • Reactive (physiological) leukocytosis: the impact of physiological factors (pain, cold or hot bath, physical stress, emotional stress, exposure to sunlight and UV rays); menstruation; childbirth period


Lowering of the level (leukopenia):

  • Some viral and bacterial infections (influenza, typhoid fever, tularemia, measles, malaria, rubella, mumps, infectious mononucleosis, miliary tuberculosis, AIDS)
  • Sepsis
  • Hypo- and aplasia of the bone marrow
  • Damage to the bone marrow by chemical means, drugs
  • Exposure to ionizing radiation
  • Splenomegaly, hypersplenism, condition after splenectomy
  • Acute leukemia
  • Myelofibrosis
  • Myelodysplastic syndromes
  • Plasmacytoma
  • Metastasis of neoplasm in bone marrow
  • Addison-Burmer disease
  • Anaphylactic shock
  • Systemic lupus erythematosus, rheumatoid arthritis and other collagenoses
  • The intake of sulfonamides, levomycetin, analgesics, non-steroidal anti-inflammatory drugs, thyreostatics, cytostatics

Leukocyte formula

The leukocyte formula (Differential White Blood Cell Count, leukogram) is the percentage of different types of white blood cells. According to morphological features (the type of nucleus, the presence and nature of cytoplasmic inclusions), 5 major types of leukocytes are distinguished:

  • neutrophils
  • lymphocytes
  • monocytes
  • eosinophils
  • basophils


In addition, leukocytes differ in their degree of maturity. Most of the precursor cells of mature leukocyte forms (young, myelocytes, promyelocytes, blast cells), as well as plasma cells, young nuclear cells of the erythroid series, etc. appear in the peripheral blood only in the case of pathology.

Different types of leukocytes perform different functions, so the determination of the ratio of different types of leukocytes, the content of young forms, the identification of pathological cellular forms, a description of the characteristic changes in the morphology of cells reflecting the change in their functional activity, carries valuable diagnostic information. At the same time, changes in the leukocyte formula are not specific - they may have a similar nature in different diseases or, on the contrary, there may be unlike changes in the same pathology in different patients.

The leukocyte formula has age characteristics, therefore its shifts should be estimated from the point of view of the age norm (this is especially important when examining children).

Reference values: in children and adults, depending on the age

Age Neutrophils
n / a (%)
Neutrophils
s / i (%)
Eosinophils
(%)
Basophils
(%)
Lymphocytes
(%)
Monocytes
(%)
from 0 to 2 weeks 15 30 - 50 16 0 - 1 22 - 55 5 - 15
from 2 weeks to 1 year 15 16 - 45 15 0 - 1 45 - 70 4 - 10
from 1 year to 2 years 15 28 - 48 1 - 7 0 - 1 37 - 60 3 - 10
from 2 years to 5 years 15 32 - 55 16 0 - 1 33 - 55 3 - 9
from 5 years to 7 years 15 38 - 58 15 0 - 1 30 - 50 3 - 9
from 7 years to 9 years 15 41 - 60 15 0 - 1 30 - 50 3 - 9
from 9 years to 11 years 15 43 - 60 15 0 - 1 30 - 46 3 - 9
from 11 years to 15 years 15 45 - 60 15 0 - 1 30 - 46 3 - 9
from 15 years and over 15 47 - 72 15 0 - 1 19 - 37 3 - 11


With many severe infections, septic and purulent processes, the leukocyte formula changes due to an increase in the number of stab neutrophils, as well as the possible appearance of younger forms - metamyelocytes and myelocytes. Such a change in the leukogram with an increase in the percentage of young forms of neutrophils is called a left shift ; The increase is mainly due to segment-nuclear and polyspecific-nuclear forms (arising from megaloblastic anemia, kidney and liver diseases, after blood transfusion) is called a shift to the right . Significant rejuvenation of cells (the presence of metamyelocytes, myelocytes, promyelocytes, blast cells) in the blood can indicate chronic leukemia; erythroleukemia; myelofibrosis; metastasis of malignant neoplasms; acute leukemia. In such cases it is customary to speak of a leukemoid reaction .

For leukocytosis (leukopenia), an uncharacteristically proportional increase (decrease) in the number of leukocytes of all kinds; in most cases there is an increase (decrease) in the number of any one type of cells, so the terms "neutrophilia", "neutropenia", "lymphocytosis", "lymphopenia", "eosinophilia", "eosinopenia", etc. are used.

Neutrophils are the most numerous species of white blood cells, they constitute 50-75% of all leukocytes.

Depending on the degree of maturity and the shape of the nucleus in the peripheral blood, segmented (mature) neutrophils and a relatively small number of stab neutrophils (young) are isolated. The younger cells of the neutrophilic series - metamyelocytes, myelocytes, promyelocytes - appear in the peripheral blood in the case of pathology and are evidence of stimulation of the formation of cells of this species.

The main function of neutrophils is to protect the body from infections, which is mainly carried out with the help of phagocytosis (absorption and digestion of foreign microorganisms).

Increase in the level of neutrophils (neutrophilia, neutrophilia):

  • Acute bacterial infections
    • localized (abscesses, osteomyelitis, acute appendicitis, acute otitis media, pneumonia, acute pyelonephritis, salpingitis, meningitis, tonsillitis, acute cholecystitis, etc.)
    • generalized (sepsis, peritonitis, empyema of the pleura, scarlet fever, cholera, etc.)
  • Inflammatory processes and tissue necrosis (myocardial infarction, extensive burns, rheumatism, rheumatoid arthritis, pancreatitis, dermatitis, peritonitis)
  • Condition after surgery
  • Endogenous intoxications (diabetes mellitus, uremia, eclampsia, necrosis of hepatocytes)
  • Exogenous intoxications (lead, snake venom, vaccine)
  • Oncological diseases (tumors of various organs)
  • Acceptance of certain medications, for example, corticosteroids, digitalis preparations, heparin, acetylcholine
  • Physical stress and emotional stress and stressful situations: exposure to heat, cold, pain, with burns and childbirth, during pregnancy, with fear, anger, joy


Lowering the level of neutrophils (neutropenia):

  • Some infections caused by bacteria (typhoid and paratyphoid, brucellosis), viruses (influenza, measles, chickenpox, viral hepatitis, rubella), protozoa (malaria), rickettsia (typhus), protracted infections in elderly and weakened people
  • Diseases of the blood system (hypo- and aplastic, megaloblastic and iron deficiency anemia, paroxysmal nocturnal hemoglobinuria, acute leukemia)
  • Congenital neutropenia (hereditary agranulocytosis)
  • Anaphylactic shock
  • Splenomegaly of different origin
  • Thyrotoxicosis
  • Ionizing radiation
  • The effects of cytostatics, antitumor drugs
  • Medicinal neutropenia associated with the increased sensitivity of individuals to the action of certain medicines (nonsteroidal anti-inflammatory drugs, anticonvulsants, antihistamines, antibiotics, antiviral agents, psychotropic drugs, drugs affecting the cardiovascular system, diuretics, antidiabetic drugs)


Agranulocytosis - a sharp decrease in the number of granulocytes in the peripheral blood until their complete disappearance, leading to a decrease in the body's resistance to infection and the development of bacterial complications. Depending on the mechanism of origin, the myelotoxic (resulting from the action of cytostatic factors) and immune agranulocytosis are distinguished.

Lymphocytes (Lymphocytes) - are the main cellular elements of the immune system. They form in the bone marrow and actively function in the lymphoid tissue. Relate to agranulocytes, i.e. do not contain granules in the cytoplasm.

The main function of lymphocytes is to recognize the foreign antigen and participate in an adequate immunological response of the body. Different subpopulations of lymphocytes perform various functions - they provide effective cellular immunity (including transplant rejection, destruction of tumor cells), humoral response (in the form of synthesis of antibodies to foreign proteins - immunoglobulins of various classes), as well as immunological soldering (the ability of the organism to accelerate and strengthen immune response when re-encountering a foreign agent).

In adults, lymphocytes make up 20-40% of the total number of leukocytes. In children up to 4 - 6 years in the total number of leukocytes, lymphocytes predominate; they are characterized by absolute lymphocytosis, after 6 years a cross-over occurs and neutrophils prevail in the total number of leukocytes.

IMPORTANT!

It should be borne in mind that the leukocyte formula reflects the relative (percentage) content of leukocytes of various species, and an increase or decrease in the percentage of lymphocytes may not reflect true (absolute) lymphocytosis or lymphopenia, but be a consequence of a decrease or increase in the absolute number of leukocytes of other species (usually neutrophils ).

Increase in the level of lymphocytes (lymphocytosis):

  • Infectious diseases: infectious mononucleosis, viral hepatitis, cytomegalovirus infection, whooping cough, ARVI, toxoplasmosis, herpes, rubella, HIV infection
  • Diseases of the blood system (chronic lymphocytic leukemia, lymphosarcoma, heavy chain disease - Franklin's disease)
  • Poisoning with tetrachloroethane, lead, arsenic, carbon disulphide
  • Treatment with drugs such as levodopa, phenytoin, valproic acid, narcotic analgesics

  • Lowering the level of lymphocytes (lymphopenia):

    • Severe viral diseases
    • Miliary tuberculosis
    • Lymphogranulomatosis
    • Aplastic anemia
    • Pancytopenia
    • Renal insufficiency
    • Insufficiency of blood circulation
    • Terminal stage of cancer
    • Immunodeficiencies (with a deficiency of T cells)
    • X-ray therapy
    • Taking drugs with cytostatic action (chlorambucil, asparaginase), glucocorticoids


    Monocytes are the largest cells among leukocytes, do not contain granules. They form in the bone marrow from monoblasts and belong to the system of phagocytic mononuclear cells. Monocytes circulate in the blood from 36 to 104 hours, and then migrate to tissues, where they differentiate into organo- and tissue-specific macrophages.

    Macrophages play an important role in the processes of phagocytosis. They are able to absorb up to 100 microbes, while neutrophils are only 20-30. Macrophages appear in the inflammatory focus after neutrophils and show a maximum of activity in an acidic environment in which neutrophils lose their activity. In the focus of inflammation, macrophages phagocytize microbes, dead leukocytes, as well as damaged cells of inflamed tissue, clearing the inflammation focus and preparing it for regeneration. For this function, monocytes are called "janitors of the body."

    Increase in the level of monocytes (monocytosis):

    • Infections (viral (infectious mononucleosis), fungal, protozoal (malaria, leishmaniasis) and rickettsial aetiology), septic endocarditis, as well as the period of convalescence after acute infections
    • Granulomatosis: tuberculosis, syphilis, brucellosis, sarcoidosis, ulcerative colitis (nonspecific)
    • Diseases of the blood (acute monoblast and myelomoblast leukemia, myeloproliferative diseases, myeloma, lymphogranulomatosis)
    • Systemic collagenoses (systemic lupus erythematosus), rheumatoid arthritis, nodular periarteritis
    • Poisoning with phosphorus, tetrachloroethane


    Decrease in the level of monocytes (monocytopenia):

    • Aplastic anemia (bone marrow injury)
    • Hairy cell leukemia
    • Surgical interventions
    • Shock states
    • Admission of glucocorticoids


    Eosinophils (Eosinophils) are present in the peripheral blood in a relatively small amount - from 0.5 to 5% of the total number of leukocytes. These are mobile cells that have the ability to phagocytosis, but their phagocytic activity is lower than that of neutrophils. Ripen eosinophils in the bone marrow, in the circulating blood they are less than 12 hours and then pass into tissues. Their targets are such organs as the skin, lungs and gastrointestinal tract.

    For eosinophils, the daily rhythm of fluctuations in the blood is characteristic, the highest indices are observed at night, the lowest values ​​are observed during the day.

    Eosinophils participate in the body's reactions to parasitic (helminth and protozoal), allergic, infectious and oncological diseases, with the inclusion of the allergic component in the pathogenesis of the disease, which is accompanied by hyperproduction of IgE.

    Estimation of the dynamics of changes in the number of eosinophils during the inflammatory process is of prognostic significance. Eosinopenia (decrease in the number of eosinophils) is often observed at the onset of inflammation. Eosinophilia (an increase in the number of eosinophils) corresponds to the beginning of recovery. However, a number of infectious and other diseases with a high IgE level are characterized by eosinophilia after the end of the inflammatory process, which indicates the incompleteness of the immune reaction with its allergic component. Reducing the number of eosinophils in the active phase of the disease or in the postoperative period often indicates a serious condition of the patient.

    Increased level (eosinophilia):

    • Allergic reactions of the body (bronchial asthma, allergic rhinitis, pollinosis, atopic dermatitis, eczema, eosinophilic granulomatous vasculitis, food allergy)
    • Medicinal allergy
    • Diseases of the skin (eczema, herpetiform dermatitis)
    • Parasitic (helminthic and protozoal) invasions: giardiasis, echinococcosis, ascariasis, trichinosis, strongyloidiasis, opisthorchiasis, toxocarosis, etc.
    • An acute period of infectious diseases (scarlet fever, chicken pox, tuberculosis, infectious mononucleosis, gonorrhea)
    • Malignant tumors (especially metastasizing and with necrosis)
    • Proliferative diseases of the hematopoietic system (lymphogranulomatosis, acute and chronic leukemia, lymphoma, polycythemia, myeloproliferative diseases, condition after splenectomy, hypereosinophilic syndrome)
    • Inflammatory processes of connective tissue (nodular periarteritis, rheumatoid arthritis, systemic scleroderma)
    • Lung diseases - sarcoidosis, pulmonary eosinophilic pneumonia, histiocytosis from Langerhans cells, eosinophilic pleurisy, pulmonary eosinophilic infiltrate (Lefler's disease)
    • Myocardial infarction (adverse trait)


    Lowering the level (eosinopenia):

    • The initial phase of the inflammatory process
    • Severe purulent infections
    • Shock, stress
    • Intoxication with various chemical compounds, heavy metals


    Basophils (Basophils) - the smallest population of leukocytes. Life expectancy of basophils is 8-12 days; the circulation time in the peripheral blood, like all granulocytes, is short - several hours. The main function of basophils is to participate in an anaphylactic reaction of immediate type hypersensitivity. They also participate in delayed-type reactions through lymphocytes, in inflammatory and allergic reactions, in the regulation of vascular wall permeability. Basophils contain such biologically active substances as heparin and histamine (similar to mast cells of connective tissue).

    Increase in the level of basophils (basophilia):

    • Allergic reactions to food, drugs, introduction of foreign protein
    • Chronic myelogenous leukemia, myelofibrosis, erythremia
    • Lymphogranulomatosis
    • Chronic ulcerative colitis
    • Myxedema (hypothyroidism)
    • Chickenpox
    • Nephrosis
    • Condition after splenectomy
    • Hodgkin's disease
    • Treatment with estrogen


    The decrease in the level of basophils (basbopenia) is difficult to assess because of the low content of basophils in norm.

    Platelets

    Platelets (blood plates, platelets, PLT) are small, denuclearized cells 2-4 μm in diameter, which are "fragments" of the cytoplasm of the megakaryocytes of the bone marrow. The life span of platelets is 7-10 days. In blood vessels, platelets can be located at the walls and in the bloodstream. In a calm state (in the bloodstream), the platelets have a disk-like shape. When cells are activated, platelets acquire sphericity and form special outgrowths (pseudopodia). With the help of such outgrowths, the blood plates can stick together or adhere to the damaged vascular wall. Platelets perform angiotrophic, adhesive-aggregation functions, participate in the processes of clotting and fibrinolysis, provide retraction of the blood clot. They are able to transfer circulating immune complexes, clotting factors (fibrinogen), anticoagulants, biologically active substances (serotonin) on their membrane, and also to maintain vasospasm. The granules of platelets contain blood clotting factors, peroxidase enzyme, serotonin, calcium ions Ca2 +, ADP (adenosine diphosphate), von Willebrand factor, platelet fibrinogen, platelet growth factor.

    The number of platelets varies depending on the time of day, and also throughout the year. Physiological decline in platelet levels is noted during menstruation (by 25-50%) and during pregnancy, and increase - after physical exertion.

    Units of measurement: x 10 ^ 9 cells / l

    Reference values: 150-350 x 10 9 cells / l

    Increased level (thrombocytosis):

    • Primary thrombocytosis (as a result of the proliferation of megakaryocytes)
      • Essential thrombocythemia
      • Erythremia
      • Myeloproliferative disorders (myeloid leukemia)
    • Secondary thrombocytosis (arising from a background of a disease)
      • Inflammatory processes (systemic inflammatory diseases, osteomyelitis, ulcerative colitis, tuberculosis)
      • Cirrhosis of the liver
      • Acute hemorrhage or hemolysis
      • Condition after splenectomy (for 2 months or more)
      • Oncological diseases (cancer, lymphoma)
      • States after surgery (within 2 weeks)


    Lowering of the level (thrombocytopenia):

    • Congenital thrombocytopenia:
      • Wiskott-Aldrich Syndrome
      • Chediak syndrome - Higashi
      • Fanconi Syndrome
      • The May-Heglin anomaly
      • The Bernard-Soulier syndrome (giant platelets)
    • Acquired thrombocytopenia:
      • Idiopathic autoimmune thrombocytopenic purpura
      • Drug thrombocytopenia
      • Systemic lupus erythematosus
      • Thrombocytopenia associated with infection (viral and bacterial infections, rickettsiosis, malaria, toxoplasmosis)
      • Splenomegaly
      • Aplastic anemia and myelofthisis (replacement of the bone marrow with tumor cells or fibrous tissue)
      • Metastasis of tumors in the bone marrow
      • Megaloblastic anemia
      • Paroxysmal nocturnal hemoglobinuria (Marciafawa-Micheli's disease)
      • Evans syndrome (autoimmune hemolytic anemia and thrombocytopenia)
      • DIC-syndrome (disseminated intravascular coagulation)
      • Massive blood transfusion, extracorporeal circulation
      • During the newborn period (prematurity, hemolytic disease of the newborn, neonatal autoimmune thrombocytopenic purpura)
      • Congestive heart failure
      • Thrombosis of renal veins

    Erythrocyte sedimentation rate

    Erythrocyte sedimentation rate (ESR) is a measure of the rate of blood separation in a test tube with anticoagulant added to 2 layers: the upper (transparent plasma) and the lower (settled red blood cells). The rate of erythrocyte sedimentation is estimated from the height of the plasma layer formed (in mm) in 1 hour. The specific mass of erythrocytes is higher than the specific mass of the plasma, therefore in a test tube in the presence of an anticoagulant under the influence of gravity erythrocytes settle to the bottom. The rate at which erythrocyte sedimentation occurs is mainly determined by the degree of aggregation, that is, by their ability to stick together. Aggregation of erythrocytes mainly depends on their electrical properties and the protein composition of the blood plasma. Normally, red blood cells carry a negative charge (zeta potential) and repel each other. The degree of aggregation (and hence ESR) increases with an increase in the concentration in the so-called plasma. proteins of the acute phase - markers of the inflammatory process. In the first place - fibrinogen, C-reactive protein, ceruloplasmin, immunoglobulins and others. On the contrary, ESR decreases with increasing albumin concentration. Other factors influence the zeta potential of erythrocytes: pH of the plasma (acidosis reduces ESR, alkalosis increases), ion charge of plasma, lipids, blood viscosity, presence of anti-erythrocyte antibodies. The number, shape and size of red blood cells also affect sedimentation. Reduction of red blood cells (anemia) in the blood leads to an acceleration of ESR and, on the contrary, an increase in the red blood cell content in the blood slows down the rate of sedimentation (sedimentation).

    In acute inflammatory and infectious processes, the change in erythrocyte sedimentation rate is observed 24 hours after the temperature rises and the number of leukocytes increases.

    The index of ESR varies depending on a variety of physiological and pathological factors. The values ​​of ESR in women are slightly higher than in men. Changes in the protein composition of the blood during pregnancy lead to an increase in ESR during this period. During the day, fluctuations in the values ​​are possible, the maximum level is noted in the daytime.

    IMPORTANT!

    In CMD, the determination of ESR is carried out by the method of Westergren. This is an international method for determining ESR. The results obtained by this method in the range of normal values ​​coincide with the results obtained in the determination of ESR by the Panchenkov method. But Westergren's method is more sensitive to an increase in ESR, and the results in the zone of increased values ​​obtained by the method of Westergren are higher than the results obtained by Panchenkov's method.

    Units of measure: - mm / h

    Reference values:

    Age Floor ESR, mm / h
    Children under 10 years old 0 - 10
    11- 50 years F 0 - 20
    M 0 - 15
    over 50 years old F 0 - 30
    M 0 - 20


    Increase (acceleration of ESR):

    • Inflammatory diseases of various etiologies
    • Acute and chronic infections (pneumonia, osteomyelitis, tuberculosis, syphilis)
    • Paraproteinemia (multiple myeloma, Waldenstrom disease)
    • Tumor diseases (carcinoma, sarcoma, acute leukemia, lymphogranulomatosis, lymphoma)
    • Autoimmune diseases (collagenoses)
    • Kidney disease (chronic nephritis, nephrotic syndrome)
    • Myocardial infarction
    • Hypoproteinemia
    • Anemia, condition after hemorrhage
    • Intoxication
    • Injuries, fractures of bones
    • Condition after shock, surgical interventions
    • Hyperfibrinogenemia
    • In women during pregnancy, menstruation, in the puerperium
    • Elderly age
    • Reception of medications (estrogens, glucocorticoids)


    Decrease (deceleration of ESR):

    • Erythremia and reactive erythrocytosis
    • Severe phenomena of circulatory failure
    • Epilepsy
    • Starvation, reduction in muscle mass
    • Admission corticosteroids, salicylates, calcium and mercury preparations
    • Pregnancy (especially 1 and 2 semester)
    • Vegetarian Diet
    • Myodystrophy