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Clinical blood test. General blood analysis

Клинический анализ крови

General clinical blood test - the most common analysis, which had to pass each person. Changes in the blood, most often not specific, but at the same time reflect the changes occurring in the whole organism.

Complete blood count is widely used as one of the most important methods of examination in most diseases, and in the diagnosis of diseases of the hematopoietic system - it plays a 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 their hemoglobin content;
    • determination of hematocrit (the ratio of the volume of blood plasma and formed elements);
    • determination of the total number of leukocytes and the percentage of individual forms among them (leukocyte formula);
    • platelet count
  • ESR study

The cellular composition of a healthy person’s blood is fairly constant. Therefore, its various changes occurring in diseases may have an important diagnostic value. In some physiological conditions of the body, the qualitative and quantitative composition of the blood often changes (pregnancy, menstruation). However, small fluctuations occur throughout the day under the influence of eating, working, etc. To eliminate the influence of these factors, blood for repeated tests should be taken at the same time and under the same conditions.

Preparation for the study: Special preparation for the study is not required. It is recommended to take blood on an empty stomach or at least 2 hours after the last meal.

Material for research: whole blood (with EDTA).

Deadline: 1 day.

Interpretation of the result: Only a doctor can completely interpret the complete blood count. However, looking at your analysis, you can also have a general idea of ​​your health. What can you find out by your general blood test? You can learn a lot. Take the main indicators.

Hemoglobin

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

Physiological forms of hemoglobin:

  1. oxyhemoglobin (HbO2) - the combination of hemoglobin with oxygen - is formed mainly in arterial blood and gives it a scarlet color
  2. restored hemoglobin or deoxyhemoglobin (HbH) - hemoglobin that donated oxygen to tissues
  3. carboxyhemoglobin (HbCO2) - a compound of hemoglobin with carbon dioxide - is formed mainly in the venous blood, which consequently becomes 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 old 115 - 145
9 - 12 years old 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


Hemoglobin level increase:

  • Diseases accompanied by an increase in the number of red blood cells (primary and secondary erythrocytosis)
  • Blood thickening (dehydration)
  • Congenital heart defects, pulmonary heart disease
  • Smoking (formation of functionally inactive HbCO)
  • Physiological causes (among residents of high mountains, pilots after high-altitude flights, climbers, after increased physical activity)

Reduced hemoglobin level (anemia):

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

Anemia can also occur a second time for all sorts of chronic non-hematological diseases.

Pathological forms of hemoglobin:

  • Carbhemoglobin (HbCO) - is formed when carbon monoxide poisoning (CO), while hemoglobin loses the ability to attach oxygen
  • Methemoglobin - formed by the action of nitrites, nitrates and some drugs (the transition of ferrous iron to ferric occurs with the formation of methemoglobin - HbMet)

Red blood cells

Red blood cells - (red blood cells, red blood cells, RBC) - the most numerous blood cells that contain hemoglobin, transporting oxygen and carbon dioxide. Formed from reticulocytes on leaving them from the bone marrow. Mature erythrocytes do not contain a nucleus, have the shape of a biconcave disc. The average lifetime of red blood cells is 120 days.

Units of measure: - 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 old 3.8 - 4.9
9 - 12 years old 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


Erythrocyte level increase (erythrocytosis):

  • Absolute erythrocytosis (due to increased production of red blood cells)
    • Erythremia, or Vaquez's 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 exertion, stay at high altitudes)
      • associated with increased production of erythropoietin, which stimulates erythropoiesis (kidney parenchyma cancer, hydronephrosis and polycystic kidney cancer, liver parenchyma cancer, benign familial erythrocytosis)
      • associated with an excess of adrenocorticosteroids or androgens (pheochromocytoma, Cushing's disease / syndrome, hyperaldosteronism, cerebellar hemangioblastoma)
  • Relative - with thickening of the blood, when the plasma volume is reduced while maintaining the number of red blood cells
    • dehydration (excessive sweating, vomiting, diarrhea, burns, increasing edema and ascites)
    • emotional stress
    • alcoholism
    • smoking
    • systemic hypertension


Lowering the level (erythrocytopenia):

  • Acute Blood Loss
  • Deficient anemia of different etiology - as a result of iron deficiency, protein, vitamins
  • Hemolysis
  • May occur again with all sorts of chronic non-hematological diseases.
  • The number of red blood cells may physiologically decrease slightly after eating, between 17.00 and 7.00, as well as when blood is drawn while lying down.


In addition to determining the number of erythrocytes, a number of morphological characteristics of erythrocytes are used in diagnostics, which are evaluated using an automatic analyzer (see Erythrocyte indices MCV, MCH, MCHC), or visually in a blood smear under a microscope when calculating the leukoformula. Normally, the diameter of erythrocytes is 7.2 - 7.5 microns. Red blood cells with a diameter of 6.7 microns or less are called microcytes, more than 7.7 microns - macrocytes, more than 9.5 microns in diameter - megalocytes. Macrocytosis is a condition where macrocytes constitute 50% or more of the total number of erythrocytes (noted in B12 and folic deficiency anemias, and liver diseases). Microcytosis is a condition in which 30–50% are microcytes. Observed with iron deficiency anemia, microspherocytosis, thalassemia, lead intoxication. Anisocytosis refers to the presence of red blood cells of various sizes. Poikilocytosis is a change in the shape of red blood cells (oval cells, schizocytes, spherocytes, target erythrocytes), develops with strongly expressed anemias and is an unfavorable sign. Nuclear forms of erythrocytes (normocytes) may be present, as well as erythrocytes with a changed color and with the presence of inclusions. Inclusions are elements of pathological regeneration: Kebot rings (found in megaloblastic anemias, thalassemia), Jolly bodies (found after splenectomy, in hemolytic poisons, anemias of various genesis), basophilic granularity (found in lead poisoning, sideroma and meridian mars); , Heinz-Ehrlich calf (sign of advancing hemolysis).

The counting of reticulocytes (young red blood cells) is performed in a separate test.

Erythrocyte indices

Erythrocyte indices are calculated values ​​that allow quantitatively characterize important indicators of the state of erythrocytes.

MCV - mean cell volume (mean cell volume) is a more accurate parameter than a visual estimate of the size of red blood cells. However, it is not reliable in the presence of a large number of abnormal red blood cells (eg, sickle cells) in the blood of interest.

Units of measure: 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 old 75 - 87
9 - 12 years old 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 value of MCV, microcytic anemia (MCV <80 fl), normocytic (MCV from 80 to 100 fl) and macrocytic (MCV> 100 fl) are distinguished:

  • Microcytosis is characteristic of iron deficiency anemia, thalassemia, sideroblastic anemia
  • Macrocytosis - for B12 and folate deficiency
  • Normocytic anemia - hemolytic, anemia after blood loss, hemoglobinopathy
  • Aplastic anemia is normal or macrocytic.


MCH - mean hemoglobin in the erythrocyte (mean cell hemoglobin) - this indicator determines the average hemoglobin content in a single 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 (picograms)

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 old 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 norm, hypo, and hyperchromic:

  • Normochromia is characteristic of healthy people, but can also occur with hemolytic and aplastic anemias, as well as anemia associated with acute blood loss.
  • Hypochromia is caused by a decrease in the volume of red blood cells (microcytosis) or a decrease in the level of hemoglobin in the erythrocyte of a normal volume. Those. hypochromia can be combined with a decrease in the volume of red blood cells, and observed with normo-and macrocytosis. 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 caused only by the volume of red blood cells. It is observed in megaloblastic, many chronic hemolytic anemias, hypoplastic anemia after acute blood loss, hypothyroidism, liver diseases, when taking 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 hemoglobin to cell volume. Thus, unlike the SIT, does not depend on the volume of the red blood cell.

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 old 320 - 370
9 - 12 years old 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


Enhancement ICSU:

  • Hyperchromic anemia (congenital spherocytosis and other spherocytic anemia)


Lower ICSU:

  • Iron deficiency anemia
  • Sideoblastic anemia
  • Thalassemia

Hematocrit

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

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

Hematocrit may decrease slightly when blood is taken in the supine position and increase with prolonged squeezing of the vein with a tourniquet during blood collection.

Units of measure: %

Reference values:

Age Floor Hematocrit,%
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 old 33 - 41
9 - 12 years old 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


Hematocrit elevation:

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


Hematocrit decrease:

  • Anemia
  • Increased circulating blood volume (second half of pregnancy, hyperproteinemia)
  • Hyperhydration

White blood cells

Leukocytes (white blood cells, white blood cells, WBC) are blood cells whose main function is to protect the body against foreign agents (toxins, viruses, bacteria, dead cells of the body, etc.).

The formation of leukocytes (leukopoesis) 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 the circulating blood is an important diagnostic indicator, which depends on the rate of inflow of cells from the bone marrow and the speed of their release into the tissues.

The number of leukocytes during the day can change under the influence of various factors, without going, however, beyond the limits of reference values.

A physiological increase in the level of leukocytes (physiological leukocytosis) occurs, for example, after a meal (therefore it is advisable to perform an analysis on an empty stomach), after exercise (physical effort is not recommended before taking blood) and in the second half of the day (preferably taking 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 at birth.

Units of measure: x 10 ^ 9 cells / l

Reference values:

Age Leukocyte count, x 10 9 cells / l
Children under 1 year 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 4.5 - 13.0
Children over 16 years old 4.5 - 11.0
Adults 4.0 - 9.0


Increased level (leukocytosis):

  • Acute infections, especially if their causative agents are cocci (staphylococcus, streptococcus, pneumococcus, gonococcus). Although a number of acute infections (typhus, paratyphoid fever, salmonellosis, etc.) can in some cases lead to leukopenia (decrease in the number of leukocytes)
  • Inflammatory conditions; rheumatic fever
  • Intoxications, including endogenous (diabetic acidosis, eclampsia, uremia, gout)
  • Malignant neoplasms
  • Injuries, burns
  • Acute bleeding (especially if internal bleeding: into the abdominal cavity, pleural space, joint, or in the immediate vicinity of the dura mater)
  • Surgical intervention
  • Infarctions of internal organs (myocardium, lungs, kidneys, spleen)
  • Myeloid and lymphocytic leukemia
  • The result of the action of adrenaline and steroid hormones
  • Reactive (physiological) leukocytosis: the effects of physiological factors (pain, cold or hot bath, exercise, emotional stress, exposure to sunlight and UV rays); menstruation; period of birth


Lowering (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
  • Plasmocytoma
  • Bone Marrow Metastasis
  • Addison's Disease - Birmera
  • Anaphylactic shock
  • Systemic lupus erythematosus, rheumatoid arthritis and other collagenoses
  • Taking sulfonamides, chloramphenicol, analgesics, nonsteroidal anti-inflammatory drugs, thyrostatics, 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 (type of nucleus, the presence and nature of cytoplasmic inclusions), there are 5 main types of leukocytes:

  • neutrophils
  • lymphocytes
  • monocytes
  • eosinophils
  • basophils


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

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

Leukocyte formula has age-related features, so its changes should be evaluated from the position of the age norm (this is especially important when examining children).

Reference values: in children and adults, depending on age

Age Neutrophils
pb (%)
Neutrophils
с / я (%)
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 to 15 years 15 45 - 60 15 0-1 30 - 46 3 - 9
from 15 years and older 15 47 - 72 15 0-1 19 - 37 3 - 11


In 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 emergence of more youthful forms, metamyelocytes and myelocytes. Such a change in leukogram with an increase in the percentage of young forms of neutrophils is called a left shift ; the increase is mainly due to the segmented and polysegmental forms (arising from megaloblastic anemia; diseases of the kidneys and liver; the state after blood transfusion) is called a shift to the right . Significant cell rejuvenation (the presence of metamyelocytes, myelocytes, promyelocytes, blast cells is noted in the blood) may 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), it is uncommon to proportionally increase (decrease) the number of leukocytes of all types; in most cases there is an increase (decrease) in the number of any one cell type, therefore the terms “neutrophilia,” “neutropenia,” “lymphocytosis,” “lymphopenia,” “eosinophilia,” “eosinopenia,” etc. are used.

Neutrophils (Neutrophils) are the most abundant variety of white blood cells, accounting for 50-75% of all leukocytes.

Depending on the degree of maturity and the shape of the nucleus in the peripheral blood, segmented nuclear (mature) neutrophils and a relatively small number of band (younger) neutrophils are isolated. 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 against infections, which is carried out mainly through phagocytosis (absorption and digestion of foreign microorganisms).

Increased neutrophil level (neutrophilia, neutrophilia):

  • Acute Bacterial Infections
    • localized (abscesses, osteomyelitis, acute appendicitis, acute otitis, pneumonia, acute pyelonephritis, salpingitis, meningitis, sore throats, acute cholecystitis, etc.)
    • generalized (sepsis, peritonitis, empyema, scarlet fever, cholera, etc.)
  • Inflammatory processes and tissue necrosis (myocardial infarction, extensive burns, rheumatism, rheumatoid arthritis, pancreatitis, dermatitis, peritonitis)
  • Post-operative condition
  • Endogenous intoxications (diabetes mellitus, uremia, eclampsia, hepatocyte necrosis)
  • Exogenous intoxication (lead, snake venom, vaccines)
  • Oncological diseases (tumors of various organs)
  • Taking certain medications, such as corticosteroids, digitalis, heparin, acetylcholine
  • Physical tension and emotional stress and stressful situations: the effects of heat, cold, pain, burns and childbirth, during pregnancy, with fear, anger, joy


Lowering neutrophil levels (neutropenia):

  • Some infections caused by bacteria (typhoid fever and paratyphoid fever, brucellosis), viruses (influenza, measles, chicken pox, viral hepatitis, rubella), protozoa (malaria), rickettsiae (typhus), prolonged infections in the elderly and weakened people
  • Diseases of the blood system (hypo-and aplastic, megaloblastic and iron deficient anemia, paroxysmal night hemoglobinuria, acute leukemia)
  • Congenital neutropenias (hereditary agranulocytosis)
  • Anaphylactic shock
  • Splenomegaly of different origin
  • Thyrotoxicosis
  • Ionizing radiation
  • Exposure to cytostatics, anticancer drugs
  • Drug neutropenia associated with hypersensitivity of individuals to the action of certain drugs (nonsteroidal anti-inflammatory drugs, anticonvulsants, antihistamines, antibiotics, antivirals, psychotropic drugs, drugs that affect the cardiovascular system, diuretic, antidiabetic drugs)


Agranulocytosis is a sharp decrease in the number of granulocytes in the peripheral blood, up to 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 occurrence, myelotoxic (resulting from the action of cytostatic factors) and immune agranulocytosis are distinguished.

Lymphocytes (Lymphocytes) - are the main cellular elements of the immune system. Formed in the bone marrow and actively functioning in the lymphoid tissue. They 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 lymphocyte subpopulations perform various functions — provide effective cellular immunity (including graft rejection, destruction of tumor cells), humoral response (in the form of the synthesis of antibodies to foreign proteins — immunoglobulins of various classes), as well as immunological soldering (the body’s ability to accelerate and strengthen immune response when re-meeting with an alien agent).

In adults, lymphocytes make up 20–40% of the total number of leukocytes. In children under 4–6 years old, lymphocytes predominate in the total number of leukocytes; they are characterized by absolute lymphocytosis, after 6 years there is a crossing and in the total number of leukocytes neutrophils predominate.

IMPORTANT!

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

Elevated lymphocyte levels (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 disulfide
  • Treatment with drugs such as levodopa, phenytoin, valproic acid, narcotic analgesics

  • Decrease in the level of lymphocytes (lymphopenia):

    • Severe viral diseases
    • Miliary tuberculosis
    • Lymphogranulomatosis
    • Aplastic anemia
    • Pancytopenia
    • Renal failure
    • Circulatory failure
    • Terminal stage of cancer
    • Immunodeficiency (T-cell deficiency)
    • X-ray therapy
    • Taking drugs with a cytostatic effect (chlorambucil, asparaginase), glucocorticoids


    Monocytes (Monocytes) - the largest cells among leukocytes, do not contain granules. Formed in the bone marrow of 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 organ 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 - only 20-30. Macrophages appear in the outbreak of inflammation after neutrophils and show maximum 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 the inflamed tissue, clearing the focus of inflammation and preparing it for regeneration. For this function, monocytes are called "body wipers".

    Increased monocyte levels (monocytosis):

    • Infections (viral (infectious mononucleosis), fungal, protozoal (malaria, leishmaniasis) and rickettsial etiology), septic endocarditis, and also the period of convalescence after acute infections
    • Granulomatosis: tuberculosis, syphilis, brucellosis, sarcoidosis, ulcerative colitis (non-specific)
    • Blood diseases (acute monoblastic and myelohmotic leukemia, myeloproliferative diseases, myeloma, lymphoma)
    • Systemic collagenosis (systemic lupus erythematosus), rheumatoid arthritis, periarteritis nodosa
    • Poisoning by phosphorus, tetrachloroethane


    Decrease in the level of monocytes (monocytopenia):

    • Aplastic anemia (bone marrow damage)
    • Hairy cell leukemia
    • Surgical intervention
    • Shock states
    • Reception of glucocorticoids


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

    For eosinophils characteristic daily rhythm fluctuations in the blood, the highest rates are observed at night, the lowest - during the day.

    Eosinophils are involved in body reactions to parasitic (helminth and protozoal), allergic, infectious and oncological diseases, when the allergic component is included in the pathogenesis of the disease, which is accompanied by IgE hyperproduction.

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

    Elevation (eosinophilia):

    • Allergic reactions of the body (bronchial asthma, allergic rhinitis, pollinosis, atopic dermatitis, eczema, eosinophilic granulomatous vasculitis, food allergy)
    • Drug allergy
    • Skin diseases (eczema, dermatitis herpetiformis)
    • Parasitic (helminthic and protozoal) invasions: giardiasis, echinococcosis, ascariasis, trichinosis, strongyloidiasis, opisthorchosis, toxocarosis, etc.
    • Acute period of infectious diseases (scarlet fever, chickenpox, tuberculosis, infectious mononucleosis, gonorrhea)
    • Malignant tumors (especially metastatic and with necrosis)
    • Proliferative diseases of the hematopoietic system (lymphogranulomatosis, acute and chronic leukemia, lymphoma, polycythemia, myeloproliferative diseases, the state after splenectomy, hypereosinophilic syndrome)
    • Inflammatory processes of the connective tissue (periarteritis nodosa, rheumatoid arthritis, systemic scleroderma)
    • Lung diseases - sarcoidosis, pulmonary eosinophilic pneumonia, histiocytosis from Langerhans cells, eosinophilic pleurisy, pulmonary eosinophilic infiltration (Leffler's disease)
    • Myocardial infarction (adverse symptom)


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

    Increased basophil level (basophilia):

    • Allergic reactions to food, drugs, the introduction of foreign protein
    • Chronic myeloid leukemia, myelofibrosis, erythremia
    • Lymphogranulomatosis
    • Chronic ulcerative colitis
    • Myxedema (hypothyroidism)
    • Chickenpox
    • Nephrosis
    • Condition after splenectomy
    • Hodgkin's Disease
    • Estrogen treatment


    Decrease in the level of basophils (basopenia) - it is difficult to assess because of the low content of basophils in the norm.

    Platelets

    Platelets (blood plates, platelets, PLT) are small, nuclear-free cells with a diameter of 2-4 µm, which are "fragments" of the cytoplasm of bone marrow megakaryocytes. The life span of platelets is 7-10 days. In blood vessels, platelets can be located at the walls and in the bloodstream. At rest (in the bloodstream), platelets are discoid. 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 stick to the damaged vascular wall. Platelets perform angiotrophic, adhesive-aggregation functions, participate in the processes of coagulation and fibrinolysis, provide a retraction of a blood clot. They are able to carry circulating immune complexes, coagulation factors (fibrinogen), anticoagulants, biologically active substances (serotonin) on their membranes, as well as maintain vascular spasm. Platelet granules contain blood coagulation factors, peroxidase enzyme, serotonin, calcium ion Ca2 +, ADP (adenosine diphosphate), Willebrand factor, platelet fibrinogen, platelet growth factor.

    The number of platelets varies depending on the time of day, as well as during the year. The physiological decline in platelet levels is noted during menstruation (by 25-50%) and during pregnancy, and an increase after exercise.

    Units of measure: x 10 ^ 9 cells / l

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

    Elevation (thrombocytosis):

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


    Lowering levels (thrombocytopenia):

    • Congenital thrombocytopenia:
      • Whiskott-Aldrich Syndrome
      • Chediak-Higashi syndrome
      • Fanconi syndrome
      • Anomaly Meya- Hegglin
      • Bernard syndrome - Soulier (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 myelophthisis (bone marrow replacement with tumor cells or fibrous tissue)
      • Metastasis of tumors in the bone marrow
      • Megaloblastic anemia
      • Paroxysmal nocturnal hemoglobinuria (Markiafav-Micheli disease)
      • Evans syndrome (autoimmune hemolytic anemia and thrombocytopenia)
      • DIC (disseminated intravascular coagulation)
      • Massive blood transfusions, extracorporeal circulation
      • In the neonatal period (prematurity, hemolytic disease of the newborn, neonatal autoimmune thrombocytopenic purpura)
      • Congestive heart failure
      • Renal vein thrombosis

    Erythrocyte sedimentation rate

    Erythrocyte sedimentation rate (ESR, Erythrocyte sedimentation rate, ESR) is an indicator of the rate of blood separation in a test tube with an added anticoagulant into 2 layers: upper (transparent plasma) and lower (settled erythrocytes). The erythrocyte sedimentation rate 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 plasma, therefore, in a test tube in the presence of an anticoagulant under the action of gravity, erythrocytes settle to the bottom. The rate at which erythrocyte sedimentation occurs is mainly determined by the degree of their aggregation, i.e. their ability to stick together. The aggregation of red blood cells mainly depends on their electrical properties and protein composition of blood plasma. Normally, red blood cells carry a negative charge (zeta potential) and repel each other. The degree of aggregation (and hence the ESR) increases with an increase in plasma concentration of the so-called. proteins of the acute phase - markers of the inflammatory process. In the first place - fibrinogen, C-reactive protein, ceruloplasmin, immunoglobulins and others. In contrast, ESR decreases with increasing albumin concentration. The zeta potential of erythrocytes is influenced by other factors: plasma pH (acidosis reduces ESR, increases alkalosis), plasma ionic charge, lipids, blood viscosity, the presence of anti-erythrocyte antibodies. The number, shape, and size of red blood cells also affect sedimentation. A decrease in the content of erythrocytes (anemia) in the blood leads to an accelerated ESR and, on the contrary, an increase in the content of erythrocytes in the blood slows down the rate of sedimentation (sedimentation).

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

    The indicator of ESR varies depending on many 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, fluctuation of values ​​is possible, the maximum level is noted in the daytime.

    IMPORTANT!

    In CMD, the ESR is determined by the Westergren method. This is an international method for determining ESR. The results obtained by this method in the field of normal values ​​coincide with the results obtained when determining the ESR by the Panchenkov method. But the Westergren method is more sensitive to increased ESR, and the results in the zone of elevated values ​​obtained by the Westergren method are higher than those obtained by the Panchenkov 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 (accelerated ESR):

    • Inflammatory diseases of various etiologies
    • Acute and chronic infections (pneumonia, osteomyelitis, tuberculosis, syphilis)
    • Paraproteinemia (multiple myeloma, Waldenstrom's disease)
    • Tumor diseases (carcinoma, sarcoma, acute leukemia, lymphogranulomatosis, lymphoma)
    • Autoimmune Diseases (Collagenoses)
    • Kidney disease (chronic nephritis, nephrotic syndrome)
    • Myocardial infarction
    • Hypoproteinemia
    • Anemia, condition after blood loss
    • Intoxication
    • Injuries, broken bones
    • Condition after shock, surgery
    • Hyperfibrinogenemia
    • In women during pregnancy, menstruation, in the postpartum period
    • Elderly age
    • Medication (estrogen, glucocorticoid)


    Decrease (ESR slowdown):

    • Erythremia and reactive erythrocytosis
    • Pronounced effects of circulatory failure
    • Epilepsy
    • Fasting, reduced muscle mass
    • Taking corticosteroids, salicylates, calcium and mercury preparations
    • Pregnancy (especially 1st and 2nd semester)
    • Vegetarian Diet
    • Myodystrophy