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General blood tests
Diagnostics: Increased red blood cells and hemoglobin: The number of red blood cells and the amount of hemoglobin per unit volume of blood are higher than the upper limit of the reference value.
Edited at 2022-12-28 11:05:13
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General blood tests
Overview
blood function
Transport: oxygen, carbon dioxide, nutrients, metabolic end products
Maintain homeostasis of the internal environment: buffer changes in blood pH; maintain a constant body temperature
Defense and protection: Participate in physiological hemostasis and various immune responses of the body
The role of blood testing: testing blood can determine or determine diseases of the blood system and other tissues and organs
General blood testing includes routine blood testing, morphological observation of formed components, erythrocyte sedimentation rate testing, etc.
Routine blood tests (complete blood count (CBC)) include red blood cell count, hemoglobin determination, white blood cell count and classification
Red blood cell and hemoglobin testing
clinical significance
Increased red blood cells and hemoglobin
The number of red blood cells and the amount of hemoglobin per unit volume of blood are higher than the upper limit of the reference value
Adult male RBC>6.0×1012/L, Hb>170g/L Female RBC>5.5×1012/L, Hb>160g/L
relative increase
Decrease in plasma volume (hemoconcentration) and relative increase in red blood cells
Seen in severe vomiting, diarrhea, profuse sweating, extensive burns, diabetes insipidus, hyperthyroidism crisis, diabetic ketoacidosis, etc.
absolute increase
Polycythemia
secondary polycythemia
Non-hematopoietic diseases, increased EPO
Compensatory increase in erythropoietin
Tissue hypoxia→increased erythropoietin
Physiological: fetuses, newborns, residents of plateau areas
Pathological: severe chronic heart and lung diseases such as emphysema, cor pulmonale, cyanotic congenital heart disease, and abnormal hemoglobinopathy
Uncompensated increase in erythropoietin
Increased erythropoietin without tissue hypoxia
Seen in cancer (kidney, liver, ovary), hydronephrosis, polycystic kidney, uterine fibroids, etc.
primary polycythemia (polycythemia vera)
Involvement of pluripotent hematopoietic stem cells
Characteristics: ① Continuous and significant increase in red blood cells; ② Simultaneous increase in white blood cells and platelets; ③ Increase in total blood volume; ④ Can be transformed into leukemia
Decreased red blood cells and hemoglobin (anemia)
The number of red blood cells and the amount of hemoglobin per unit volume of blood are lower than the lower limit of the reference value
Hemoglobin: <120g/L for men, <110g/L for women
Grading: mild Hb<lower limit of reference value -90g/L; moderate Hb<90-60g/L Severe Hb<60-30g/L; Extremely severe Hb<30g/L
Physiological reduction
Infants and children under 15 years old, middle and late pregnancy, some elderly people
Pathological reduction
Decreased red blood cell production
Features
Abnormal proliferation and differentiation of hematopoietic stem cells: aplastic anemia (AA)
DNA synthesis disorder: macropoverty
Hb synthesis disorders: IDA, sideroblastic anemia
Dysregulation of RBC production: hypoxia-avid hepatitis B disease
Unclassifiable or multiple mechanisms: anemia of chronic disease, myelopathy anemia, nutritional deficiency anemia
clinical significance
Increased destruction of red blood cells
Intrinsic abnormalities in red blood cells
hereditary
Membrane defects: hereditary spherocytosis
Enzyme Deficiency: G6PD Deficiency
Abnormalities in globin synthesis: sickle cell anemia, thalassemia
Acquisition
Paroxysmal nocturnal hemoglobinuria (PNH)
External abnormalities of red blood cells: immune, mechanical, chemical and physical, infectious and biological, mononuclear phagocytic system hyperfunction
Excessive loss of red blood cells (blood loss): divided into acute blood loss anemia and chronic blood loss anemia
Red blood cell morphological changes
Meaning: The disease changes from quantitative to qualitative change. With diagnostic and differential diagnosis function
Performance: cell size, morphology, staining reaction, structural abnormalities
nucleated red blood cells
Normal adult peripheral blood (-), ( ) are pathological phenomena
Mainly seen in: ① Hemolytic anemia; ② Leukemia; ③ Extramedullary hematopoiesis such as myelofibrosis ④ Bone marrow metastasis, severe hypoxia, etc.; ⑤ Loss of blood filtration and clearance functions after splenectomy
White blood cell test
divided into
White blood cell (WBC) count: Determines the total number of various white blood cells in circulating blood
Reference value: ①Adult (4~10)xl09/L; ②Newborn (15~20)xl09/L; ③6 months to (11~12) xl09/L
Clinical significance: The total number of white blood cells higher than the reference value (10x109L for adults) is called leukocytosis. Less than the reference value (4x109L for adults) is called leukopenia
Differential white blood cell count (DC)
Reference
clinical significance
Neutrophilia
Mechanism: ① Increased production; ② Accelerated release; ③ Moved edge pool to circulating pool; ④ Decreased release into tissue; ⑤ Joint action
Physiological
Newborns, menstrual period, late pregnancy, delivery, after a meal or shower, emotional excitement, strenuous exercise, high temperature, severe cold
Characteristics: short-lived, transient, qualityless changes
pathological
Acute infection: most common
Severe tissue damage and massive blood cell destruction: severe trauma, major surgery, large area burns, acute myocardial infarction, acute hemolysis
Acute massive hemorrhage: significance of early diagnosis
acute poisoning
Leukemia, myeloproliferative diseases and malignant tumors
Neutropenia
concept
Leukopenia: WBC < 4 ×109/L
Granulopenia: absolute neutrophil count < 1.5 ×109/L
Agranulocytosis: absolute neutrophil count < 0.5 ×109/L
Mechanism: ① Reduction in generation or invalid generation; ② Increase in utilization; ③ Moving the circulation pool to the edge pool; ④ Working together
Reasons for the decrease
Infect
G-bacilli, viruses (common), protozoa (malaria)
Features: Although leukocytes decrease, the differential count of leukocytes increases and the nucleus shifts to the left.
blood system diseases
Aplastic anemia (AA), severe iron deficiency anemia (IDA), paroxysmal nocturnal hemoglobinuria (PNH), megaloblastic anemia, hypoproliferative (non-leukemic) leukemia, bone marrow metastasis cancer
Characteristics: leukopenia accompanied by decrease in red blood cells and platelets
Damage caused by physical and chemical factors: radiation, benzene, drugs, etc.
Hyperfunction of the monocyte-phagocytic system: hypersplenism
Autoimmune Disease: Systemic Lupus Erythematosus (SLE)
Nuclear image changes of neutrophils
Definition: Nuclear image refers to the lobulation status of granulocytes, which reflects the maturity of granulocytes. Changes in nuclear image can reflect the condition and prognosis of certain diseases.
In normal blood, lobulated nuclei account for the majority (50-70%), with 2-3 lobed nuclei being the most common; Unlobulated nuclei (rod nuclei account for 0% to 5%) or excessively lobulated nuclei are rare
Neutrophil nuclei shift to the left
Increased percentage of peripheral blood granulocytes (rod-shaped, late juvenile, intermediate juvenile, early juvenile) (>5%)
Seen in ① infection (purulent); ② acute blood loss; ③ acute poisoning ④ Acute hemolytic reaction; ⑤ Leukemia and leukemia-like reaction
Neutrophil nuclei shift to the right
Peripheral blood 5-lobed nuclei or more lobes>3%. The more leaves there are, the more senescent the cells are.
Seen in ① Megaloblastic anemia; ② Decreased bone marrow hematopoiesis ③After using anti-metabolite drugs, such as Ara-C, 6-MP ④Infection recovery stage (normal), disease progression stage (poor prognosis)
Abnormal neutrophil morphology
Toxic changes in neutrophils
Uneven cell size: long-term purulent inflammation or chronic inflammation
Poisonous particles: severe purulent infection, increased NAP activity
vacuolation: sepsis
Dürer bodies: imbalance of nucleocytoplasmic development
Nuclear degeneration: pyknosis, dissolution, fragmentation
Clinical significance: Toxic or degenerative manifestations of neutrophils are seen in severe infections, poisonings and infectious diseases. For example, scarlet fever, purulent infection, sepsis, malignant tumors, extensive burns, etc.
Hypersegmented neutrophil nuclei
Performance: The nucleus is divided into more than 5 leaves, or even more than 10 leaves.
Significance: Seen in megaloblastic anemia and after application of antimetabolite drugs
rod body
Red thin rod-shaped bodies appearing in the cytoplasm of white blood cells
Acute leukemia can be diagnosed once it appears
Neutrophils and monocytes may appear, but lymphocytes do not.
Abnormal morphological changes related to genetics
Familial granulocytic abnormalities (autosomal dominant inheritance)
Eosinophilia
①Allergic diseases Asthma
② Parasitic diseases
③Skin diseases
④Hematology disease: CML
⑤Certain malignant tumors: lung cancer
⑥Certain infectious diseases: Most acute infectious diseases, but scarlet fever
⑦Others: rheumatic diseases, decreased adrenocortical hormones, allergic interstitial nephritis
eosinophilia
①Typhoid fever; ②Corticosteroid application; ③Stress state
basophilia
①Allergic diseases colitis
②Hematology CML, basophilic leukemia
③Malignant tumor metastasis cancer
④Other diabetes
basophilia
No clear clinical significance
lymphocytosis
Physiological
Children from 4-6 days after birth to 4-6 years old
pathological
①Infectious diseases Viruses (measles, flyers), bacteria (tuberculosis, Brucella)
②Tumor diseases ALL, CLL, NHL, HL
③The recovery period of acute infectious diseases
④Transplant rejection GVHD
⑤Other AA, grain loss and grain deficiency, the proportion of L is relatively high
lymphopenia
Glucocorticoids, alkylating agents, radiation, ATG, ALG, HIV
Abnormal lymphocytes
Definition: Also known as reactive lymphocytes, they are atypical lymphocytes with morphological variation
It can even be seen in peripheral blood of normal people, but < 2%
The increase is seen in: ① Infectious: viruses (most common), bacteria, spirochetes ②Drug allergy ③Blood transfusion, hemodialysis, extracorporeal circulation ④Others: immune diseases, granulocyte deficiency, and post-radiotherapy
mononucleosis
Physiological
Infants and children
pathological
① Certain infections: infective endocarditis, malaria, tuberculosis
②Certain hematological diseases: acute monotonia, granulocyte deficiency (recovery period), MM
Monocytopenia
It is not meaningful
Reticulocyte testing
Definition and Principle
The cells after denucleation of late erythrocytes are immature erythrocytes between late erythrocytes and mature erythrocytes. Due to the residual ribosomes and other basophilic substances in the cytoplasm, a network structure appears in the cytoplasm after staining with bright tar blue or new methylene blue.
Reference
Percentage 0.005 ~0.015 (0.5% ~ 1.5%, average 1%)
Absolute value (24~ 84) ×109/L
clinical significance
increase
Indicates strong proliferation of BM erythroid system
Seen in ① hemolytic anemia; ② acute blood loss ③Iron deficiency anemia (IDA) or megaloblastic anemia ④After treatment for some anemia patients, such as iron supplementation, VitB12 and folic acid supplementation
reduce
Indicates reduced BM hematopoietic function
Seen in ① aplastic anemia (AA); ② myelopathy anemia (such as AL)
Platelet test
Platelet count (PC or PLT)
Count the number of platelets in peripheral blood per unit volume (L)
Reference value (100-300)×109/L
Determination of mean platelet volume and platelet distribution width
Peripheral blood platelet morphology
General blood tests
Erythrocyte sedimentation rate test (ESR)
Definition: The rate at which red blood cells settle under certain conditions
Influencing factors
①Plasma ②Number and shape of RBCs
Promoting factors: globulin (γαβ), fibrinogen, immune complexes, cholesterol (positively charged)
Inhibiting factors: albumin (albumin), lecithin
Method: Place the anticoagulated blood in a small vertical glass tube. Due to the large specific gravity of red blood cells, they naturally sink due to gravity. Normally, the blood sinks very slowly. The red blood cells often sink at the end of the first hour. The sedimentation distance represents the speed of red blood cell sedimentation.
Reference
Adult male 0~15mm/end of 1h
Adult women 0~20mm/end of 1h
clinical significance
increase speed
Physiological: children under 12 years old; women during menstruation and pregnancy (more than 3 months); the elderly
pathological
①Inflammatory disease Is the disease active?
②Tissue damage and necrosis
③Malignant tumors
④Elevated plasma globulin due to various reasons
⑤Other anemia, arteriosclerosis, DM, nephrotic syndrome, hypercholesterolemia
slow down
Less clinical significance
ESR is non-specific and is only for clinical reference and auxiliary diagnosis.
Hematocrit determination and Application of red blood cell related parameters
Hematocrit (HCT) measurement
Definition and Principle: Also known as hematocrit (PCV), it refers to the ratio of the volume occupied by blood cells in the blood.
Reference
Micromethod: Male 0.467±0.039L/L Female 0.421±0.054L/L
Wen's method: Male 0.40~0.50L/L (40~50 volume%) Average 0.45L/L Female 0.37~0.48L/L (37~48% volume) Average 0.40L/L
clinical significance
It can reflect the increase or decrease of red blood cells and is affected by plasma volume and red blood cell size.
increase height
① Relative increase: blood concentration, HCT reaches above 0.5, clinically used as a reference for calculating fluid replenishment volume
②Absolute increase: true red, reaching above 0.6 or even 0.8
reduce
Various anemias
Calculation of average red blood cell count