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Clinical blood test. General blood analysis

Клинический анализ крови

A general clinical blood test is the most common test that every person has to take. Changes in the blood are most often non-specific, but at the same time reflect changes in the whole body.

A complete blood count is widely used as one of the most important examination methods for most diseases, and in the diagnosis of diseases of the hematopoietic system, he 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 the content of hemoglobin in them;
    • determination of hematocrit (ratio of blood plasma volume and uniform 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 the blood of a healthy person is quite constant. Therefore, various changes occurring in diseases can have important diagnostic value. Under certain 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, blood for repeated analyzes 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 that blood be taken 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 fully interpret a general 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 main indicators.

Hemoglobin

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

Physiological forms of hemoglobin:

  1. oxyhemoglobin (HbO2) - a 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 gives oxygen to tissues
  3. carboxyhemoglobin (HbCO2) - a combination of hemoglobin with carbon dioxide - is formed mainly in venous blood, which consequently 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 old 115 - 145
9-12 years old 120 - 150
12 - 15 years old 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 F 117 - 161
M 126 - 174


Hemoglobin level increase:

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

Decrease in hemoglobin level (anemia):

  • Increased hemoglobin loss due to bleeding - hemorrhagic anemia
  • Increased destruction (hemolysis) of red blood cells - hemolytic anemia
  • 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-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 with various kinds of chronic non-hematological diseases.

Pathological forms of hemoglobin:

  • Carbhemoglobin (HbCO) - is formed during carbon monoxide poisoning (CO), while hemoglobin loses its ability to attach oxygen
  • Methemoglobin - formed under the influence of nitrites, nitrates and certain medications (ferrous iron is converted to ferric iron 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. They are formed from reticulocytes upon their exit from the bone marrow. Mature red blood cells do not contain a nucleus, have the form of a biconcave disc. The average lifespan of red blood cells is 120 days.

Units: - 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 old 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


Red blood cell elevation (erythrocytosis):

  • Absolute erythrocytosis (due to increased production of red blood cells)
    • Erythremia, or Wakez’s disease, is one of the variants of chronic leukemia (primary erythrocytosis)
    • Secondary erythrocytosis:
      • caused by hypoxia (chronic lung diseases, congenital heart defects, 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 cancer, benign family erythrocytosis)
      • associated with an excess of adrenocorticosteroids or androgens (pheochromocytoma, Itsenko-Cushing's disease / syndrome, hyperaldosteronism, cerebellar hemangioblastoma)
  • Relative - with a thickening of the blood, when the plasma volume decreases while maintaining the number of red blood cells
    • dehydration (excessive sweating, vomiting, diarrhea, burns, growing edema and ascites)
    • emotional stress
    • alcoholism
    • smoking
    • systemic hypertension


Lowering the level (erythrocytopenia):

  • Acute blood loss
  • Deficiency anemia of various etiologies - as a result of a deficiency of iron, protein, vitamins
  • Hemolysis
  • May occur a second time with various kinds 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 taking blood while lying down.


In addition to determining the number of red blood cells in diagnostics, a number of morphological characteristics of red blood cells are used , which are evaluated using an automatic analyzer (see RBC indices MCV, MCH, MCHC), or visually - in a blood smear under a microscope when counting leukoformulas. Normally, the diameter of red blood cells 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 50% or more of the total number of red blood cells is made up of macrocytes (noted in B12 and folic acid deficiency anemia, liver disease). Microcytosis is a condition in which microcytes make up 30-50%. It is observed with iron deficiency anemia, microspherocytosis, thalassemia, lead intoxication. Anisocytosis refers to the presence of red blood cells of different sizes. Poikilocytosis - a change in the shape of red blood cells (ovalocytes, schizocytes, spherocytes, target erythrocytes), develops with severe anemia and is an unfavorable sign. Nuclear forms of red blood cells (normocytes), as well as red blood cells with a changed color and with the presence of inclusions, may be present. Inclusions are elements of pathological regeneration: Kebot rings (found in megaloblastic anemia, thalassemia), Jolly bodies (found after splenectomy, poisoning with hemolytic poisons, anemia of various origins), basophilic granularity (found in lead poisoning, sidero- and megaloblastic anemia) , Heinz-Erlich bodies (sign of impending hemolysis).

Counting reticulocytes (young red blood cells) is performed in a separate test.

Erythrocyte indices

Erythrocyte indices are calculated values ​​that quantitatively characterize important indicators of the state of red blood cells.

MCV - mean erythrocyte 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 if there are a large number of abnormal red blood cells (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 old 75 - 87
9-12 years old 76 - 90
12 - 15 years old 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 F 81 - 102
M 81 - 103


Based on the MCV value, microcytic anemia (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 folate deficiency
  • Normocytic anemia - hemolytic, anemia after blood loss, hemoglobinopathy
  • Aplastic anemia is normal or macrocytic.


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

Units: - 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 old 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 with hemolytic and aplastic anemia, 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 red blood cell of a normal volume. Those. hypochromia can be combined both with a decrease in the volume of red blood cells, and observed with normo- and macrocytosis. It occurs in iron deficiency anemia, anemia in chronic diseases, thalassemia, with some hemoglobinopathies, lead poisoning, impaired porphyrin synthesis
  • Hyperchromia does not depend on the degree of saturation of red blood cells, hemoglobin, and is due only to the volume of red blood cells. It is observed in megaloblastic, many chronic hemolytic anemia, hypoplastic anemia after acute blood loss, hypothyroidism, liver diseases, when taking cytostatics, contraceptives, anticonvulsants.


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

Units: 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 old 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


ICSU Enhancement:

  • Hyperchromic anemia (congenital spherocytosis and other spherocytic anemia)


Lower ICSU:

  • Iron deficiency anemia
  • Sideroblastic Anemia
  • Thalassemia

Hematocrit

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

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

The hematocrit may decrease slightly when taking blood while lying down and increase with prolonged compression of the vein with a tourniquet during blood sampling.

Units: %

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 to 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 old 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 F 35 - 47
M 37 - 51


Hematocrit increase:

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


Hematocrit reduction:

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

White blood cells

White blood cells (white blood cells, white blood cells, WBC) are blood cells whose main function is to protect the body from foreign agents (toxins, viruses, bacteria, dying cells of their own body, etc.).

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

The number of leukocytes in the circulating blood is an important diagnostic indicator, which depends on the rate of influx of cells from the bone marrow and the rate of their exit into the tissue.

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

A physiological increase in the level of leukocytes (physiological leukocytosis) occurs, for example, after eating (therefore, it is advisable to perform an analysis on an empty stomach), after physical exertion (physical effort is 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: x 10 ^ 9 cells / l

Reference Values:

Age White blood cell 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 to 6 years 5.0 - 14.5
6 to 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


Level increase (leukocytosis):

  • Acute infections, especially if their causative agents are 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 fever
  • Intoxications, including endogenous (diabetic acidosis, eclampsia, uremia, gout)
  • Malignant neoplasms
  • Injuries, burns
  • Acute bleeding (especially if the bleeding is internal: into the abdominal cavity, pleural space, joint, or in the immediate vicinity of the dura mater)
  • Surgery
  • Heart attacks of internal organs (myocardium, lungs, kidneys, spleen)
  • Myelo and lymphocytic leukemia
  • The result of adrenaline and steroid hormones
  • Reactive (physiological) leukocytosis: exposure to physiological factors (pain, cold or hot bath, physical activity, emotional stress, exposure to sunlight and UV rays); menstruation; childbirth


Lowering the level (leukopenia):

  • Some viral and bacterial infections (influenza, typhoid fever, tularemia, measles, malaria, rubella, mumps, infectious mononucleosis, miliary tuberculosis, AIDS)
  • Sepsis
  • Bone marrow hypo- and aplasia
  • Damage to bone marrow by chemicals, drugs
  • Exposure to ionizing radiation
  • Splenomegaly, hypersplenism, condition after splenectomy
  • Acute leukemia
  • Myelofibrosis
  • Myelodysplastic syndromes
  • Plasmacytoma
  • Bone marrow metastases
  • Addison's Disease - Birmer's
  • Anaphylactic shock
  • Systemic lupus erythematosus, rheumatoid arthritis and other collagenoses
  • Reception of sulfonamides, chloramphenicol, analgesics, non-steroidal anti-inflammatory drugs, thyreostatics, cytostatics

Leukocyte formula

White blood cell count (Differential White Blood Cell Count, leukogram) is the percentage of different types of white blood cells. According to morphological characteristics (type of nucleus, presence and nature of cytoplasmic inclusions), 5 main types of leukocytes are distinguished:

  • neutrophils
  • lymphocytes
  • monocytes
  • eosinophils
  • basophils


In addition, white blood cells vary in degree of maturity. Most of the progenitor cells of mature forms of leukocytes (young, myelocytes, promyelocytes, blast cell forms), as well as plasma cells, young nuclear cells of the erythroid series and others. Appear in the peripheral blood only in case of pathology.

Different types of leukocytes perform different functions, therefore, determining the ratio of different types of leukocytes, the content of young forms, identifying pathological cell forms, describing characteristic changes in the morphology of cells, reflecting changes in their functional activity, carries valuable diagnostic information. At the same time, changes in the leukocyte formula are not specific - they can be similar in nature with different diseases or, on the contrary, there may be dissimilar changes in the same pathology in different patients.

The leukocyte formula has age-related features, so its shifts 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
PO Box (%)
Neutrophils
s / i (%)
Eosinophils
(%)
Basophils
(%)
Lymphocytes
(%)
Monocytes
(%)
from 0 to 2 weeks fifteen 30 - 50 16 0 - 1 22 - 55 5 - 15
from 2 weeks to 1 year fifteen 16 - 45 fifteen 0 - 1 45 - 70 4 - 10
from 1 year to 2 years fifteen 28 - 48 1 - 7 0 - 1 37 - 60 3 - 10
from 2 years to 5 years fifteen 32 - 55 16 0 - 1 33 - 55 3 - 9
from 5 years to 7 years fifteen 38 - 58 fifteen 0 - 1 30 - 50 3 - 9
from 7 years to 9 years fifteen 41 - 60 fifteen 0 - 1 30 - 50 3 - 9
from 9 years to 11 years fifteen 43 - 60 fifteen 0 - 1 30 - 46 3 - 9
from 11 years to 15 years fifteen 45 - 60 fifteen 0 - 1 30 - 46 3 - 9
from 15 years and older fifteen 47 - 72 fifteen 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 more youthful 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 segmented and polysegmented forms (occurring with megaloblastic anemia; diseases of the kidneys and liver; condition after blood transfusion) - called a shift to the right . Significant cell rejuvenation (the presence of metamyelocytes, myelocytes, promyelocytes, blast cells in the blood is noted) may indicate chronic leukemia; erythroleukemia; myelofibrosis; metastases of malignant neoplasms; acute leukemia. In such cases, it is customary to talk about a leukemoid reaction .

For leukocytosis (leukopenia), a proportional increase (decrease) in the number of leukocytes of all types is uncharacteristic; in most cases, there is an increase (decrease) in the number of any one type of cell, therefore the terms “neutrophilia”, “neutropenia”, “lymphocytosis”, “lymphopenia”, “eosinophilia”, “eosinopenia”, etc. are used.

Neutrophils (Neutrophils) - the most numerous variety of white blood cells, they make up 50-75% of all white blood cells.

Depending on the degree of maturity and shape of the nucleus in the peripheral blood, segmented (mature) neutrophils and a relatively small number of stab neutrophils are isolated. Younger neutrophilic cells — metamyelocytes, myelocytes, promyelocytes — appear in the peripheral blood in 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 carried out mainly with the help of phagocytosis (absorption and digestion of foreign microorganisms).

An 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 intoxication (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 stress and emotional stress and stressful situations: exposure to heat, cold, pain, burns and childbirth, pregnancy, fear, anger, joy


Decrease in the level of neutrophils (neutropenia):

  • Some infections caused by bacteria (typhoid and paratyphoid fever, brucellosis), viruses (influenza, measles, chickenpox, viral hepatitis, rubella), protozoa (malaria), rickettsia (typhus), protracted infections in the elderly and debilitated
  • 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 various origins
  • Thyrotoxicosis
  • Ionizing radiation
  • The impact of cytostatics, antitumor drugs
  • Medicinal neutropenia associated with increased sensitivity of individuals to the action of certain drugs (non-steroidal anti-inflammatory drugs, anticonvulsants, antihistamines, antibiotics, antiviral drugs, psychotropic drugs, drugs that affect 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. Myelotoxic (resulting from the action of cytostatic factors) and immune agranulocytosis are distinguished depending on the mechanism of occurrence.

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

The main function of lymphocytes is to recognize a foreign antigen and participate in an adequate immunological response of the body. Different subpopulations of lymphocytes perform different functions - provide effective cellular immunity (including transplant rejection, destruction of tumor cells), a humoral response (in the form of 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 a foreign agent).

In adults, lymphocytes make up 20 - 40% of the total number of leukocytes. In children under 4-6 years of age, lymphocytes predominate in the total number of leukocytes, i.e. they are characterized by absolute lymphocytosis, after 6 years a cross 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 types, and an increase or decrease in the percentage of lymphocytes may not reflect true (absolute) lymphocytosis or lymphopenia, but may be a result 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, SARS, toxoplasmosis, herpes, rubella, HIV infection
  • Diseases of the blood system (chronic lymphocytic leukemia; lymphosarcoma, heavy chain disease - Franklin's disease)
  • Poisoning with carbon tetrachloride, lead, arsenic, carbon disulfide
  • 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 failure
    • Circulatory failure
    • The terminal stage of cancer
    • Immunodeficiencies (with T-cell deficiency)
    • X-ray therapy
    • Taking drugs with a cytostatic effect (chlorambucil, asparaginase), glucocorticoids


    Monocytes (Monocytes) - the largest cells among white blood cells, do not contain granules. They are formed 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 organ- and tissue-specific macrophages.

    Macrophages play a crucial role in the processes of phagocytosis. They are able to absorb up to 100 microbes, while neutrophils - only 20-30. Macrophages appear in the focus of inflammation after neutrophils and exhibit maximum activity in an acidic environment in which neutrophils lose their activity. In the focus of inflammation, macrophages phagocytose microbes, dead white blood cells, and damaged cells of the inflamed tissue, cleansing the focus of inflammation and preparing it for regeneration. For this function, monocytes are called "body wipers."

    Increased monocyte count (monocytosis):

    • Infections (viral (infectious mononucleosis), fungal, protozoal (malaria, leishmaniasis) and rickettsial etiologies), septic endocarditis, as well as the period of convalescence after acute infections
    • Granulomatosis: tuberculosis, syphilis, brucellosis, sarcoidosis, ulcerative colitis (non-specific)
    • Blood diseases (acute monoblastic and myelomnoblastic leukemia, myeloproliferative diseases, myeloma, lymphogranulomatosis)
    • Systemic collagenoses (systemic lupus erythematosus), rheumatoid arthritis, periarteritis nodosa
    • Phosphorus poisoning, tetrachloroethane


    Decrease in the level of monocytes (monocytopenia):

    • Aplastic anemia (bone marrow damage)
    • Hairy Cell Leukemia
    • Surgery
    • Shock conditions
    • 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 with the ability to phagocytosis, but their phagocytic activity is lower than that of neutrophils. Eosinophils in the bone marrow mature, they are in the circulating blood for less than 12 hours and then pass into the tissues. Their targets are organs such as the skin, lungs, and gastrointestinal tract.

    Eosinophils are characterized by a daily rhythm of 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, which is accompanied by IgE hyperproduction, is included in the pathogenesis of the disease.

    Assessment of the dynamics of changes in the number of eosinophils during the inflammatory process is prognostic. Eosinopenia (a 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 onset 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 the incompleteness of the immune reaction with its allergic component. 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.

    Level increase (eosinophilia):

    • Allergic reactions of the body (bronchial asthma, allergic rhinitis, pollinosis, atopic dermatitis, eczema, eosinophilic granulomatous vasculitis, food allergy)
    • Drug allergy
    • Skin diseases (eczema, herpetiform dermatitis)
    • Parasitic (helminth and protozoal) infestations: giardiasis, echinococcosis, ascariasis, trichinosis, strongyloidosis, opisthorchiasis, toxocariasis, etc.
    • Acute period of infectious diseases (scarlet fever, chicken pox, 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, condition after splenectomy, hypereosinophilic syndrome)
    • Inflammatory processes of connective tissue (periarteritis nodosa, rheumatoid arthritis, systemic scleroderma)
    • Lung diseases - sarcidosis, pulmonary eosinophilic pneumonia, Langerhans cell histiocytosis, eosinophilic pleurisy, pulmonary eosinophilic infiltrate (Lefler’s disease)
    • Myocardial infarction (adverse sign)


    Decrease (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 white blood cells. The 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 the anaphylactic reaction of immediate hypersensitivity. They also participate in delayed 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 the mast cells of connective tissue).

    Increased basophils (basophilia):

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


    A decrease in the level of basophils (basopenia) - it is difficult to evaluate because of the low content of basophils in the norm.

    Platelets

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

    The platelet count varies with the time of day, as well as throughout the year. A physiological decrease in platelet count is observed during menstruation (by 25-50%) and during pregnancy, and an increase after physical exertion.

    Units: x 10 ^ 9 cells / l

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

    Level increase (thrombocytosis):

    • Primary thrombocytosis (as a result of proliferation of megakaryocytes)
      • Essential thrombocythemia
      • Erythremia
      • Myeloproliferative Disorders (myelogenous leukemia)
    • Secondary thrombocytosis (arising from 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)
      • Conditions after surgery (within 2 weeks)


    Lowering the level (thrombocytopenia):

    • Congenital thrombocytopenia:
      • Wiskott - Aldrich Syndrome
      • Chediak Syndrome - Higashi
      • Fanconi Syndrome
      • May-Hegglin Anomaly
      • Bernard Syndrome - Soulier (Giant Platelet)
    • 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 myelophthis (bone marrow replacement with tumor cells or fibrous tissue)
      • Bone marrow tumor metastases
      • Megaloblastic Anemia
      • Paroxysmal nocturnal hemoglobinuria (Markiafava-Mikeli disease)
      • Evans Syndrome (autoimmune hemolytic anemia and thrombocytopenia)
      • DIC-syndrome (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) - an indicator of the rate of blood separation in a test tube with added anticoagulant into 2 layers: upper (clear plasma) and lower (settled red blood cells). The erythrocyte sedimentation rate is estimated by the height of the formed plasma layer (in mm) for 1 hour. The specific gravity of erythrocytes is higher than the specific gravity of the plasma, therefore, in a test tube in the presence of an anticoagulant under the influence of gravity, red blood cells 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 the protein composition of blood plasma. Red blood cells normally carry a negative charge (zeta potential) and repel each other. The degree of aggregation (and hence ESR) increases with increasing plasma concentration of the so-called acute phase proteins - markers of the inflammatory process. First of all - fibrinogen, C-reactive protein, ceruloplasmin, immunoglobulins and others. In contrast, ESR decreases with increasing albumin concentrations. Other factors influence the erythrocyte zeta potential: plasma pH (acidosis reduces ESR, alkalosis increases), 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 red blood cell count (anemia) in the blood leads to an acceleration of ESR and, conversely, an increase in red blood cell count 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 an increase in temperature and an increase in the number of leukocytes.

    The ESR indicator varies depending on many physiological and pathological factors. ESR values ​​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, values ​​may fluctuate, the maximum level is observed in the daytime.

    IMPORTANT!

    In CMD, ESR is determined by the Westergren method. This is an international method for determining ESR. The results obtained by this method in the normal range coincide with the results obtained when determining ESR by the Panchenkov method. But the Westergren method is more sensitive to an increase in ESR, and the results in the zone of increased values ​​obtained by the Westergren method are higher than the results 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 old 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, a condition after blood loss
    • Intoxication
    • Injuries, bone fractures
    • Condition after shock, surgery
    • Hyperfibrinogenemia
    • In women during pregnancy, menstruation, in the postpartum period
    • Elderly age
    • Taking medications (estrogens, glucocorticoids)


    Decrease (slowdown of ESR):

    • Erythremia and reactive erythrocytosis
    • Severe effects of circulatory failure
    • Epilepsy
    • Starvation, decreased muscle mass
    • Corticosteroids, salicylates, calcium and mercury
    • Pregnancy (especially 1st and 2nd semester)
    • Vegetarian diet
    • Myodystrophy