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White blood cell test
Basics of clinical medical testing, white blood cell examination, white blood cells (WBC) originate from hematopoietic stem cells (HSC) in the bone marrow. Under the regulation of various hematopoietic growth factors in the bone marrow, they eventually differentiate, develop, mature and are released into the peripheral blood.
Edited at 2023-10-19 19:29:21
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White blood cell test
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White blood cell test
White blood cell related knowledge
White blood cells (WBCs) originate from hematopoietic stem cells (HSCs) in the bone marrow. Under the regulation of various hematopoietic growth factors in the bone marrow, they eventually differentiate, develop, mature and are released into the peripheral blood.
Includes: granulocytes (GRAN), lymphocytes (L), monocytes (M)
Granulocytes include neutrophil-baculoid granulocytes (Nst) and neutrophil-segmented granulocytes (Nsg). They eliminate pathogens and allergens through different ways and mechanisms, and are the body's main line of defense against the invasion of foreign bodies such as pathogenic microorganisms.
White blood cell count
counting method
★Microscopic counting method: The blood is diluted to a certain multiple with leukocyte diluent (such as glacial acetic acid) and mature red blood cells are destroyed. Fill the modified Neubauer blood cell counting board and count under a low-power microscope. The number of white blood cells within a certain range (volume) can be converted to the unit volume, that is, per liter of blood. The total number of white blood cells in the.
Glacial acetic acid is used to destroy red blood cells
Detection principle: dilute the blood to a certain multiple with a diluent (which destroys and dissolves red blood cells), then fills it into a counting tank, and counts the number of white blood cells within a certain range under a microscope. The number of white blood cells per liter of blood can be calculated by conversion.
Steps: 1. Prepare the counting plate: Clean the counting plate and coverslip, use the push method to push the coverslip forward from the lower edge of the counting plate, and cover it on the counting pool. 2. Add diluent: Use a pipette or pipette to draw 0.38ml of leukocyte diluent into the test tube. 3. Absorb blood: Use a micropipette to absorb 20ul of blood, and wipe off the remaining blood outside the tube. Insert the straw into the bottom of the test tube containing leukocyte diluent, gently drain out the blood, and suck the upper layer of diluent to rinse the straw 3 Second-rate . 3. Mix well: Mix the blood and diluent in the test tube thoroughly until the cell suspension turns dark brown. 5. Fill the pool: Use a micropipette to absorb the mixed cell suspension, fill the pool, and let it stand at room temperature for 2 to 3 minutes until the WBCs have completely sunk. 6. Count: Count the total number of WBCs in the four large squares at the four corners under low power. 7. Calculation: White blood cells/L = N/4×10 ×20 ×106/L = N/20 ×109/L where: N: The total number of white blood cells counted in four large squares ÷ 4: average number of white blood cells per large square ×10: Convert the number of white blood cells in 1 large square to the number of white blood cells in 1.0 μl blood × 20: dilution factor of blood × 106: Converted from 1μl to 1L
Precautions: 1. Make sure the counting plate and coverslip are clean. 2. Before filling the pool, the leukocyte suspension should be vigorously and rapidly shaken for 30 seconds to fully mix it, but do not generate too many bubbles. 3. Complete the filling of the pool at one time. Avoid insufficient filling, liquid overflow, intermittent filling, and moving the cover glass after filling. 4. Cells should be evenly distributed in the counting cell. Generally, when the total number of white blood cells is within the normal range, the number of cells between each large square should not differ by more than 8, and the error of two repeated counts should not exceed 10%. If the difference is too large, the pool count should be recharged. 5. For line-pressing cells, still follow the principle of counting up, not down, and counting left, not right. 6. Like red blood cell counting, the dilution factor can be adjusted by yourself: (1) When the number of white blood cells is too high (>15×109/L), the dilution factor can be increased. Such as 20ul blood 0.78ml diluent, or 10ul blood 0.39ml diluent. (2) When the number of white blood cells is too low (<3×109/L), the dilution factor can be reduced, such as 40ul of blood 0.36ml diluent; or expand the counting range, such as counting 8 or 9 large squares. 7. White blood cell diluent cannot destroy nucleated red blood cells. It can increase the white blood cell count. In this case, accrued Calculate the white blood cell correction value: White blood cell count after correction/L= × White blood cell count before correction
★Hematology analyzer method: electrical impedance method.
Detection principle: According to the non-conductive nature of blood cells, the resistance changes caused by the blood cells suspended in the conductive electrolyte solution passing through the counting holes, thereby producing Generate a voltage pulse signal. The number of pulses represents the number of cells, and the amplitude of the pulses represents the volume of cells.
Microscopic counting method: Advantages: The traditional method does not require special instruments, the equipment is simple, and the cost is low. It is suitable for primary medical units. Under strict and standardized conditions, it can be used to calibrate blood analyzers and review abnormal results. Disadvantages: The operation is time-consuming, accuracy and repeatability depend to a large extent on the operator's technical level and the accuracy of the instrument used. At the same time, there are inherent errors, which can be reduced by averaging multiple counts of the same specimen.
Methodological evaluation
Hematology analyzer method: Advantages: The conventional screening method is simple to operate, fast in detection, and can obtain multiple test results at the same time. It is highly efficient, has good repeatability, is easy to standardize, and is suitable for centralized testing of large batches of specimens. Disadvantages: The cost of instrument reagents is high, and quality control must be done tomorrow, otherwise it is easy to cause system errors.
quality assurance
1. Avoid counting errors 1) Technical errors: Operate strictly in accordance with standard operating procedures to avoid or eliminate technical errors. (1) Specimens should be measured as soon as possible, generally not more than 4 hours. It is best to control the room temperature at 18~22 C, mix the blood specimen thoroughly, and there should be no hemolysis or small clots in the specimen. (2) The equipment used must be clean and dry. (3) The leukocyte diluent should be filtered to avoid interference from impurities and particles. All reagents used should meet standard requirements to avoid bacterial growth and turbidity. (4) Operation process ① Blood collection: Blood collection is smooth and fast. The peripheral blood collection should have sufficient depth (2~3 mm). Do not squeeze hard around the needle to avoid mixing with tissue fluid. ② Anticoagulant: Use EDTA-K2 as anticoagulant, with a concentration of 3.7~5.4umol/mL blood (1.5~2.2mg/mL blood) ③Adding a cover glass: WHO recommends the "push" method to ensure that the height of the liquid filled into the counting cell is 0.10mm. ④ Release and mixing: The dilution ratio should be accurate, and the blood and leukocyte diluent should be fully mixed, but not with excessive force to avoid the generation of bubbles. When the red blood cells are completely dissolved and destroyed, the cell suspension can be filled with liquid when it becomes brown and transparent. ⑤Filling: Mix the leukocyte suspension thoroughly again before filling. The filling should be done at once to avoid too much, too little or intermittent filling. Avoid the generation of bubbles and the movement of the coverslip after filling. ⑥Counting: When filling, try to make the cells evenly distributed in the counting chamber. When the total number of white blood cells is within the reference range, the number of white blood cells in each large square must not differ by more than 8. The error of two repeated countings must not exceed 10%. Otherwise, the number of white blood cells in each large square should not exceed 10%. Otherwise, the number of white blood cells should be re-calculated. Charge pool count. Counting cells at the pressure line should follow the principle of counting up, not down, and counting left, not right. ⑦Clean counting board: After counting, clean the counting board as required to prepare for the next counting. (5) Correcting the influence of nucleated red blood cells When there are more nucleated red blood cells in the blood, it must be corrected according to the following formula. The correction formula is as follows: 100 corrected white blood cell count/L = X* (100/100 Y) where X: uncorrected white blood cell count; Y: When performing differential counting of white blood cells, the number of nucleated red blood cells is counted when counting 100 white blood cells. 2) Instrument error Equipment such as graduated pipettes, micropipettes, and modified Neubauer blood cell counting boards used for leukocyte microscopic counting must be calibrated. 3) Counting field error (field error) is a random error caused by the fact that the distribution of blood cells in the counting pool cannot be exactly the same after each filling. It is inversely proportional to the number of cells counted. The greater the number of cells counted, the wider the counting range. , the smaller the error, on the contrary, the larger the error. If the number of white blood cells is too low (generally <3 × 109/L), the dilution factor can be appropriately increased. .⒉Experiential control Use the number of white blood cells seen in the blood smear to roughly estimate whether there is a large error in the white blood cell count result. The blood smear needs to be of appropriate thickness. The approximate relationship between the number of white blood cells seen in the blood smear and the total number of white blood cells is as shown in the table below. If it does not match, the count results need to be reviewed. 3. Influence of physiological state Transient increases in white blood cells often occur due to general physical and mental work, cold, extreme heat, hot and cold baths, exercise, severe pain, and emotional excitement; the highest and lowest leukocyte counts within a day can differ by a factor of 1. In addition, the total number of white blood cells in smokers is on average 30% higher than that in non-smokers. Therefore, for patients who need to dynamically observe changes in the number of white blood cells, it is best to collect blood in a quiet and stable state at a fixed time.
reference interval
1. Blood cell analyzer method for adults: (3.5~9.5)x109/L. microscopic counting Adult: (4~10)x10°/L (5~12)x109/L Children: (5-12)*109/L 6 months to 2 years old: (11-12)*109/L Newborn: (15-20)*109/L
clinical significance
Traditionally, when the total number of white blood cells is higher than the upper limit of the reference interval (10 x10°/L), it is called leukocytosis; when the total number of white blood cells is lower than the lower limit of the reference interval (4 x10°/L), it is called leukopenia. Changes in the number of white blood cells in peripheral blood are affected by physiological and pathological factors. Generally, when neutrophils increase, the total number of white blood cells increases; when neutrophils decrease, the total number of white blood cells also decreases. The quantitative correlation between the two is also reflected in the consistency in clinical significance. For details of its clinical significance, see the clinical significance of neutrophil changes. However, there are also inconsistencies in the changes in the two quantities, which need to be analyzed on a case-by-case basis.
eosinophil count
Detection principle
★Microscopic counting method: After using eosinophil diluent (such as eosin-acetone) to dilute the blood to a certain multiple, red blood cells and most other white blood cells are destroyed, and eosinophils are stained. Fill the diluted blood into the modified cow's blood cell counting board, count the eosinophils in 10 large squares in two counting chambers under a low-magnification microscope, and calculate the number of eosinophils per liter of blood after conversion.
★Hematology analyzer method: Comprehensive use of electrical, optical, and chemical principles
Methodological evaluation
microscopy Advantages: The traditional method does not require special equipment, is simple and low-cost, and is suitable for primary medical units. Disadvantages: The operation is time-consuming, and the accuracy and repeatability are not as good as the blood analyzer method. It largely depends on the technical level of the operator and the accuracy of the equipment used.
blood analyzer method Advantages: simple operation, fast detection speed, high efficiency, repeated signals can provide eosinophil percentage, absolute value, histogram or scatter plot. Disadvantages: The cost of the instrument is high and it is necessary to make a good accusation. When an abnormal increase in eosinophils occurs and an alarm semi-histogram or scatter plot is abnormal, the microscopic counting method should be used for review.
There are many types of diluents used in the direct eosinophil counting method, and their functions are similar. They mainly include: protecting eosinophils, destroying red blood cells and neutrophils, and coloring eosinophil granules.
quality assurance
1. Various factors that cause white blood cell counting errors must also be strictly controlled in direct eosinophil counting. 2. After blood dilution, counting should be completed within 30 minutes to 1 hour, otherwise the eosinophils will gradually dissolve and destroy, making the counting results low and difficult to identify. 3. Because eosinophils are easy to aggregate and break, it is not advisable to shake vigorously and the mixing time can be appropriately extended. 4. Observe changes in eosinophils at the same time to reduce the impact of physiological changes during the day. 5. Pay attention to the difference from residual neutrophils to avoid misunderstanding and causing the result to be higher. Neutrophils are generally uncolored or lightly colored, but their particles are small. 6. If the eosinophils are destroyed, the amount of protective agents such as ethanol and acetone can be appropriately increased in the diluent. If the neutrophils are not completely destroyed, the amount of protective agents can be appropriately reduced, and blood collection and counting can be repeated after adjustment.
reference interval
(0.05-0.50)*109/L
clinical significance
1. Physiological changes (1) Daytime changes: Eosinophils in healthy people are lower in the morning and higher at night; they fluctuate greatly in the morning, up to 40%, and are more constant in the afternoon. (2) Exercise and stimulation: Labor, exercise, hunger, heat and cold, and mental stimulation can all cause sympathetic nerve excitement and reduce eosinophils in the blood.
2. Increased eosinophils Eosinophilia refers to the absolute value of eosinophils in the peripheral blood of adults greater than 0.5 × 10°L. ① Mild increase: (0.5～1.5)*109 L. ② Moderate increase: (1.5～5.0)x10°/L. ③Severe increase: greater than 5.0*10 L. The causes and possible mechanisms of eosinophilia are shown in the table below
3. eosinophilia Eosinophilia refers to the absolute value of eosinophils in the peripheral blood of adults being less than 0.05×109/L. Its clinical significance mainly includes: (1) Used to observe the condition and prognosis of acute infectious diseases. In the acute phase of infectious diseases, the body is in a state of stress, the secretion of adrenocortical hormones increases, and eosinophils decrease. During the recovery phase, eosinophils gradually increase. If the clinical symptoms are severe and eosinophils are not reduced, it indicates adrenal cortical failure; if eosinophils The neutrophils continue to decrease or even disappear, indicating a serious condition. 2) As an indicator of prognosis. In severe tissue damage, such as 4 hours after surgery, eosinophils often decrease significantly and gradually increase after 24 to 48 hours; in patients with extensive burns, eosinophils completely disappear after a few hours and last for a long time. If the number of eosinophils does not decrease or the decrease is not obvious after major surgery or extensive burns, it indicates poor prognosis. 3) Determine pituitary or adrenal cortex function. When the pituitary gland or adrenal cortex is hyperactive, eosinophils decrease. Therefore, the pituitary or adrenal cortex stimulation test can be used to observe changes in the number of eosinophils to determine the function of the pituitary gland or adrenal cortex.
White blood cell morphological examination
⒈Neutrophils (N)
Round, diameter 10-15um Cytoplasm: pink, containing many small and uniform purple-red neutral granules Nucleus: unevenly stained, divided into N rod-shaped nucleus (Nst) and N lobulated nucleus (Nsg)
⒉Eosinophils (E)
Shape: Slightly larger than neutrophils Cytoplasm: The cells are filled with thick, neat, uniform, tightly arranged, and three-dimensional orange-red eosinophilic granules. Nucleus: Great Wall lobed, mostly with two lobes, lens-shaped, occasionally 3-4, chromatin stained dark purple.
⒊Basophils (B)
The cell body is round and slightly smaller than neutrophils Cytoplasm: Contains thick, unevenly distributed purple-black alkaline particles, which cover the nucleus, making the outline and structure of the nucleus unclear. Nucleus: Nucleus is not clearly divided and irregular in shape
⒋Lymphocytes (L)
Shape: diameter 6-15um, divided into large L and small L Cytoplasm: Small lymph nodes rarely contain granules, while large lymph nodes are rich in slurry and appear transparent blue. There are often a small amount of thick, unevenly sized purple-red particles called azure granules. Nucleus: round or dark purple-red chromatin, rough and evenly arranged. Large lymphocytes often deviate to one side.
⒌Monocytes (m)
Shape: The largest cell in peripheral blood, with a diameter of 15*25um and a round or irregular cell body. Cytoplasm: richly stained light blue or gray blue, translucent and encapsulated like ground glass, containing a large number of dust-like cells dispersedly distributed, lavender red with azure particles, and vacuoles visible. Nucleus: The nucleus is large, irregularly round, kidney-shaped, horseshoe-shaped or irregularly paged, sometimes folded and twisted, and the chromatin is fine and loose, such as reticular staining in lavender red.
★Abnormal cell morphology
Abnormal neutrophil morphology
1. Toxic changes in neutrophils
1) Uneven size The size of neutrophils varies greatly, and the heterogeneity increases. It is common in some purulent infections with a long course. Factors such as endotoxin and endotoxin act on early neutrophils in the bone marrow, causing them to develop abnormally. Rules related to division and proliferation. 2) toxic granulation In severe infections and extensive burns, purple-black or dark purple-brown particles that are larger than normal neutrophils, unevenly sized, and randomly distributed appear in the cytoplasm of neutrophils, called toxic particles. 3) Vacuolar denaturation One or several vacuoles appear in the cytoplasm of neutrophils and may also appear on the nucleus. Vacuoles are the result of fatty degeneration of cells and are common in severe infections such as sepsis. 4) Dürer body The local basophilic area retained in the cytoplasm of neutrophils due to toxic changes is round, pear-shaped or cloud-shaped, sky blue or gray blue, 1-2 μm in diameter, and is bounded by the normal staining area. Blurring is a manifestation of local immaturity of the cytoplasm, that is, imbalance of nucleoplasmic development. Common in serious infections such as pneumonia, measles, sepsis, and burns. (Can also occur in monocytes) 5) Degeneration and nuclear degeneration Degeneration is the phenomenon of cell body swelling, blurred structure, unclear edges, nuclear pyknosis, nuclear swelling, and nuclear dissolution (blurred and loose chromatin). It is common in aging and diseased cells. Nuclear degeneration is fine The nuclei undergo pyknosis, dissolution and fragmentation. Pyknosis means that the cell nucleus condenses into a uniform dark purple mass; karyolysis means that the cell nucleus swells, becomes lighter in color, and the nuclear outline is unclear; karyorrhexis means that the cell nucleus breaks into several small pieces.
⒉rod-shaped body
Purple-red thin rod-shaped substances in the cytoplasm of white blood cells, one or several, about 1 to 6 μm in length, are called rod-shaped bodies. Rod-shaped bodies are of great value in identifying the type of acute leukemia. Acute myelogenous leukemia (common), acute monocytic leukemia (rare), acute lymphoblastic leukemia not.
3. Changes in the nuclear image of neutrophils
Under normal circumstances, the lobulated nuclei of neutrophils are more common with 2-3 lobes, and the ratio of lobed nuclei to rod nuclei is about 13:1. Under pathological conditions, the nuclear image of neutrophils may shift to the left. Or nuclear shift to the right.
1) Left shift of nucleus, increase of neutrophils in peripheral blood (>5%) or (and) the appearance of late granulocytes and intermediate granulocytes Even the phenomenon of promyelocytes is called nuclear left shift, which is a reactive change in the body. Common in purulent infections, acute lytic Blood, etc., are often accompanied by toxic changes such as toxic particles, vacuole formation, and degeneration. Nuclear shifts to the left are often accompanied by an increase in the total number of white blood cells. But it can also be normal or even reduced.
1) Regenerative nuclear left shift: The left shift of the nucleus and the increase of the total number of white blood cells indicate that the bone marrow has strong hematopoietic function and release ability, and the body has strong resistance. It is more common in acute purulent infection, acute poisoning, acute hemolysis and acute blood loss. 2) Degenerative left nuclear shift: left nuclear shift accompanied by normal or reduced white blood cell count, indicating that the bone marrow release function is inhibited and the body's resistance is poor. Such as aplastic anemia and agranulocytosis. Nuclear left shift is divided into three grades: mild, moderate and severe, which are closely related to the severity of infection and the body's resistance.
Rightward shift of the nucleus, increased neutrophils with lobulated nuclei in peripheral blood, and neutrophils with more than 5 lobed nuclei When the number of cells exceeds 3%, it is called a right shift of the nucleus (see the figure below). Severe right-shifted nuclei are often accompanied by a decrease in the total number of white blood cells. It is a manifestation of hematopoietic function decline. It is related to the lack of hematopoietic substances, DNA synthesis disorders and decreased bone marrow hematopoietic function. Right shift of the nucleus is common in megaloblastic anemia, pernicious anemia caused by intrinsic factor deficiency, infection, uremia, MDS, etc., and anti-metabolite drugs are used Rightward nuclear shift can also occur when tumors are treated.
⒋Abnormal morphology of neutrophils
Abnormal neutrophil nuclear morphology includes multi-lobed neutrophils, giant rod-shaped neutrophils, giant multi-lobed neutrophils, binucleated granulocytes, ring-shaped rod-shaped granulocytes, and drumstick bodies. wait.
Abnormal lymphocyte morphology
⒈Atypical lymphocytes Type I (vacuolar type): also known as foam type or plasma cell type, its cell body is slightly larger than normal lymphocytes, mostly round; the nucleus is round, oval, kidney-shaped or irregular, and the chromatin is thick Reticular or irregular aggregation into rough lumps; cells The quality is relatively rich, dark blue, without particles, containing vacuoles of varying sizes or in the form of foam. Type II (irregular type): also known as monocytic type. The cell body is significantly larger than that of type I cells, with an irregular appearance, like a monocyte; the nucleus is round or irregular, and the chromatin is more delicate than type I cells; the cytoplasm is rich, light blue or blue, transparent, and unevenly colored. Uniform, darker blue at the edge, skirt-like, may have a few azurophilic particles, generally no vacuoles Type III (naïve type): also known as immature cell type or prolymphocyte-like type. The cell body is larger, the nucleus is large, round or oval, the chromatin is finely meshed, and there may be 1 to 2 nucleoli; the cytoplasm is small, dark blue, mostly without granules, and occasionally There are small vacuoles ⒈Atypical lymphocytes are occasionally found in the peripheral blood of normal people. Viral and microbial infections, such as Epstein-Barr virus, cytomegalovirus, hepatitis virus, HIV, beta-streptococcus, Treponema pallidum, Toxoplasma gondii and vaccination can cause an increase in peripheral blood atypical lymphocytes Clinically, atypical lymphocytosis is mainly seen in infectious mononucleosis, viral hepatitis, epidemic hemorrhagic fever, eczema and other viral diseases and allergic diseases. 2. Lymphocytes with satellite nuclei Next to the main nucleus of lymphocytes there is a small free nucleus called a satellite lymphocyte. Commonly seen after receiving a large dose of ionizing radiation, nuclear radiation or other physical and chemical factors, anti-cancer When drugs, etc. cause damage to cells, they are often used as one of the objective indicators of teratogenesis and mutagenesis.
White blood cell differential count
concept
Differential white blood cell counting: DLC is a classification technology that observes the morphology of various white blood cells on stained blood smears under a microscope to obtain the relative and absolute values of various white blood cells.
Purpose
① Observe changes in white blood cells in leukocytosis, leukopenia, infection, poisoning, malignant tumors, leukemia or other hematological diseases. ②Assess red blood cell and platelet morphology
Detection method
★Microscope classification and counting: The blood smear is stained with Wright or Wright-Giemsa and then observed under an oil microscope. Classification and counting are performed based on the morphological characteristics and staining differences of the leukocytes. Usually 100 to 200 leukocytes are classified and counted to obtain the phase of various leukocytes. Contrast value or percentage. Based on the results of the white blood cell count, the absolute values of each type of white blood cell per liter of blood are calculated.
★Hematology analyzer method: Comprehensive use of electrical, optical, and chemical principles
Methodological evaluation
Microscopic classification and counting method: Advantages: Classic method, simple equipment, low cost, and can more accurately comprehensively analyze morphological characteristics such as cell staining, size, nucleoplasm, and cytoplasm characteristics. Disadvantages: The operation is time-consuming, the accuracy of the results depends on the operator's ability to identify cell morphology, requires the operator to have a certain technical level, and is not suitable for screening a large number of healthy people.
Hematology analyzer method: Advantages: The preferred method of screening reduction has good repeatability, is easy to standardize, has abnormal results, alarm prompts and reports in various forms, and can be connected to a fully automatic film pushing and dyeing machine. Disadvantages: It cannot replace the microscopic classification and counting method for screening subtraction. To confirm the pathological changes of white blood cells, a smear must be performed for microscopic review.
clinical significance
1. Total white blood cells and neutrophils
In peripheral blood, the clinical significance of changes in the total number of white blood cells is basically consistent with that of changes in the number of neutrophils. ①Leukocytosis: The total number of white blood cells in peripheral blood exceeds the upper limit of the reference interval (10*10*9/L for adults) ②Leukopenia: The total number of white blood cells in peripheral blood is lower than the lower limit of the reference interval (4.0*10*9/L for adults) ③ Neutrophilia: The absolute value of peripheral blood neutrophils exceeds the upper limit of the reference interval (7.0*10*9/L for adults) ④Granulocytopenia: The absolute value of peripheral blood neutrophils is less than 1.5×10*9/L ⑤Agranulocytosis: The absolute value of peripheral blood neutrophils is less than 0.5×10*9/L
★Physiological changes in white blood cells or neutrophils Fluctuations in the number of white blood cells within 30% are meaningless, and diagnostic value can only be achieved through regular and repeated observation.
①Age: The total number of white blood cells in newborns is generally (15~20)*109/L. It reaches (21~28)x109/L 6~12 hours after birth, and then gradually decreases. The average number is 12x109/L in one week. In infancy Maintain around 10 x109/L, Then gradually reduce to adult levels. The white blood cells in the peripheral blood of newborns are mainly neutrophils, which gradually decrease to approximately equal to lymphocytes on the 6th to 9th day, and then lymphocytes gradually increase throughout infancy. The number of lymphocytes is relatively high, reaching about 70%. After 2 to 3 years old, lymphocytes gradually decrease and neutrophils gradually increase. By 4 to 5 years old, the two are basically equal, forming a change curve of neutrophils and lymphocytes. The two crossovers are basically the same as adults by adolescence ②Diurnal changes: The number of autologous cells is lower when quiet and relaxed, and can increase after activity and eating; it is lower in the morning and higher in the afternoon; the highest value and the lowest value between a day can be doubled. But some individuals have smaller changes Pain and emotions General physical and mental work, ③Exercise pain and emotion: General physical and mental work, hot and cold baths, etc. can increase the number of white blood cells; severe cold and severe heat can increase the number of white blood cells to 15 x109/L or higher: strenuous exercise, severe pain and emotional excitement It can increase white blood cells up to 35 Due to increased distribution and bone marrow release. ④ Pregnancy and childbirth: The number of white blood cells may increase slightly during menstruation and ovulation; the number of white blood cells often increases slightly during pregnancy, especially after 5 months of pregnancy, the number of white blood cells can reach about 15 x109/L, and even higher during childbirth, up to 35 x109/L. Return to normal within 2 weeks. If it rises again after that, there is a possibility of postpartum infection. ⑤Smoking: Smokers 2) Pathological increase in white blood cells (neutrophils), divided into reactive increase and abnormal proliferative increase The average total number of white blood cells is 30% higher than that of non-smokers, reaching 12 x109/L, and that of heavy smokers can reach 15 x109/L
★2) Pathological increase of white blood cells (neutrophils), divided into reactive increase and abnormal proliferative increase
① Increased reactivity
①Acute infection Acute purulent inflammation, especially acute infections caused by various pyogenic cocci, the most significant increase in the total number of white blood cells and neutrophils; in addition, it is seen in certain bacteria, fungi, viruses, rickettsiae, spirochetes, parasitic infections, etc. ②Acute poisoning When poisoned by chemical drugs such as sleeping pills, dichlorvos, lead, benzene, mercury, etc., the white blood cells may even increase to more than 20 x109/L; metabolic poisoning such as diabetic ketoacidosis and chronic nephritis and uremia, etc. ③Acute massive bleeding Especially after internal bleeding such as spleen rupture or ectopic pregnancy fallopian tube rupture, white blood cells increase rapidly, often reaching more than 20 x109/L. The significant increase in the total number of white blood cells can be used as an important basis for early diagnosis of internal bleeding - ④Tissue damage 12 to 36 hours after major surgery, white blood cells often reach more than 10 Can be distinguished from angina pectoris ⑤Destruction of blood cells Severe intravascular hemolysis. ⑥Leukemia Leukocytosis is common in acute and chronic myelogenous leukemia. ⑦Malignant tumors In the late stages of malignant tumors, especially malignant tumors of the digestive tract, the white blood cell count often increases. This is because the digested malignant tumor cells can produce granulopoietin, a bad magnetic product of malignant tumors, which promotes the release of granulocytes from the bone marrow storage pool.
Acute infection is the most common cause of neutrophilia
Mild infection: white blood cells may be normal and neutrophils may be slightly increased Moderate infection: white blood cells increase, neutrophils increase mildly and shift to the left, and toxic changes occur. The body responds well and bone marrow cells are released into the blood. Severe infection: White blood cells increase significantly, neutrophils increase significantly and shift to the left, and toxic changes occur. The body responds well and bone marrow cells are released into the blood. Very severe infection: leukopenia, neutropenia, marked cooperation and toxic changes. The body's response is poor and it is at or close to acute suppuration. Sexual infection causes a state of severe toxic shock, and a large number of white blood cells accumulate in visceral blood vessels and severe local areas.
① Some patients with severe acute infection may develop leukemia-like reactions, which need to be differentiated from leukemia (see table below). Leukemia-like reaction is a blood reaction similar to leukemia produced by the body to certain stimuli. When the stimulus is removed Later, the leukemia-like reaction also gradually disappeared. ②Eosinophilic leukemia-like reaction Neutrophilic leukemia-like reaction According to the total number of leukocytes in peripheral blood, it can be divided into leukocytosis and non-leukocytosis, with the former being more common. Leukocytosis can be further divided into neutrophilic and eosinophilic types
② Abnormal increase
It is a clonal disease of hematopoietic stem cells. The increased granulocytes are mainly pathological granulocytes or immature granulocytes, often accompanied by other cell changes.
(1) Leukemia is a malignant tumor of the hematopoietic system. Common in acute myeloid leukemia (acute myeloid) and chronic myeloid leukemia (chronic myeloid) ( 2) Myeloproliferative diseases are a group of diseases caused by pluripotent stem cell lesions ①Polycythemia vera: white blood cells can reach 20 x10°/L, accompanied by mild left nuclear shift, and characteristic increase in red blood cells and platelets. ② Essential thrombocythemia: white blood cells (10~30) × 10°/L, abnormal increase in platelets, often >1000 x 10°, accompanied by abnormal morphology. ③Myelofibrosis: white blood cells can reach 50*10°L, accompanied by an increase in "young red-granules". 3) What are the mechanisms of pathological neutropenia and neutropenia? When the neutrophil count is <1.0×10°/L, infection is very likely to occur; when the neutrophil count is <0.5×10°/L (acute agranulocytosis), the risk of severe infection and disease recurrence increases. Among injuries caused by physical and chemical factors, drug-induced neutropenia is the most common, accounting for about 10% of children and young patients, and about 50% of elderly patients. Textbook page 54
⒉Eosinophils
See eosinophil count
⒊Basophils
The number of basophils is small, accounting for only 1/300-1/200 of white blood cells. Moore first reported his counting method in 1953. In recent years, it has been found to be of great significance in the diagnosis and differential diagnosis of allergies, chronic myelogenous leukemia and other related diseases. The most prominent feature among all physiological functions is its involvement in hypersensitivity reactions.
Basophilia: ⒈Allergic and inflammatory diseases: Food, drugs, inhaled allergic reactions, ulcerative colitis, urticaria, rheumatoid arthritis, etc., may be accompanied by an increase in white blood cells or neutrophils. ⒉Basophilic leukemia: In rare types of acute leukemia, the number of white blood cells is normal or increased, and the number of erythrocytes can be abnormally increased, up to 30%-80%, and most of them are naive. ⒊Myeloproliferative diseases: ① Chronic myeloid leukemia, polycythemia vera, essential thrombocythemia, primary myelofibrosis, etc. are mildly elevated alkaline granulocyte counts, which can be an early symptom of myeloproliferative diseases. Because the percentage of basophils in basophilia is very low, most of the decreases have no clinical significance. Anaphylactic shock, excessive application of adrenocorticotropic hormone or glucocorticoids, and stress reactions can reduce basophils. ② The percentage of alkaline granulocytes in peripheral blood is 10% to 20%, which is one of the characteristics of chronic myelogenous leukemia. If the percentage of alkaline granulocytes suddenly exceeds 20%, it indicates a worsening of the condition. ⒋Endocrine diseases: Diabetes, hypothyroidism, estrogen therapy, etc. ⒌Others: Heavy metal poisoning, radiation exposure, reflecting certain infectious diseases, etc.
basophilia Since the percentage of basophils is very low, its decrease is mostly without clinical significance.
⒋Lymphocytes
① Physiological increase: For example, it is higher in the afternoon and evening than in the morning; infant lymphocytes can reach more than 50% one week after birth, can last until 6 to 7 years old, and then gradually drop to adult levels.
②Pathological increase Infectious diseases: Infectious diseases caused by certain viruses during the recovery period of typical acute bacterial infections. Some chronic infections are expected to be combined into a recovery phase or a chronic phase. Tumor diseases: Mainly primitive and immature lymphocytes, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Mainly mature lymphocytosis, chronic lymphocytic leukemia, lymphocytic lymphosarcoma, etc. After tissue transplantation: The absolute value of lymphocytes increases in the early stage of rejection, which can be used as one of the indicators for detecting rejection of tissue or organ transplantation. Certain hematological diseases: aplastic anemia, granulocytopenia and agranulocytosis, etc., have a significant decrease in neutrophils, resulting in a relative increase in the percentage of lymphocytes. Drugs: aspirin, haloperidol, lead, levodopa, etc.
③Pathological reduction Influenza: Influenza recovery period HIV infection: selectively destroys CD tetrapositive cells, resulting in a significant decrease in CD 4 cells and an inversion of CD 4/CD 8 positive values. Tuberculosis: Lymphocytes are reduced in the early stage. If treatment is effective, lymphocytes can become normal. Drug treatment: Chemical agents can significantly reduce white blood cells and significantly reduce lymphocytes. Lymphocyte reduction can last for several years after stopping treatment. Some drugs can also reduce lymphocytes. Radiation therapy: Long-term exposure to radioactivity can destroy lymphocytes, leading to lymphopenia. Immune diseases: Systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, etc. produce lymphocyte antibodies due to gas, and the destruction of lymphocytes increases. The conflict with the decrease is slightly related to the antibodies. Congenital immunodeficiency diseases: Various types of severe immunodeficiency diseases, ataxia telangiectasia, malnutrition or cardiac deficiency can reduce lymphocytes to varying degrees.
monocytes
① Physiological increase: The number of peripheral blood mononuclear cells in children can be slightly higher than that in adults, with an average of 9%; in infants within 2 weeks, it can reach 15% or more; it can also increase in the second and third trimesters of pregnancy and delivery.
②Pathological increase Infections: convalescent acute infection, chronic infection, subacute infective endocarditis malaria, active tuberculosis such as severe infiltrative tuberculosis and miliary tuberculosis Connective tissue diseases: systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, etc. Blood diseases: The total number of white blood cells increases in monocytic leukemia. Malignant histiocytosis can also increase when a large number of mature monocytes appear. It is also common in malignant lymphoma. And most of them are in the recovery period of mature agranulocytosis, and a transient increase in monocytes is common. Malignant diseases: stomach cancer, lung cancer, colon cancer, pancreatic cancer, etc. Gastrointestinal diseases: alcoholic cirrhosis, Crohn's disease, ulcerative colitis, sprue. Others: bone marrow recovery after chemotherapy, granulocytes after bone marrow transplantation, monocyte colony-stimulating factor treatment drug response completer poisoning.
clinical significance
neutrophils
Physiological changes
Pathological increase
Increased reactivity
Increased abnormal proliferation
Pathological reduction
basophils
Pathological increase
Pathological reduction
Lymphocytes
Physiological increase
Pathological increase
Pathological reduction
monocytes
Physiological increase
Pathological increase