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Blood routine

A mind map of blood routine, sharing knowledge about red blood cells, white blood cells, platelets, and reticulocytes (the red blood cell stage after the denucleation of late immature red blood cells). If you are interested, you can take a look.

Edited at 2023-10-13 20:53:30

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Blood routine

red blood cells

Amount of red blood cells and hemoglobin

normal value

red blood cells

Male: (4.0～5.5)×10¹²/L

Female: (3.5~5.0)×10¹²/L

Newborn: (6.0～7.0)×10¹²/L

hemoglobin

Male: 120~160g/L

Women: 110~150g/L

Newborn: 170~200g/L

increase

relative increase

This is because the volume of plasma decreases, resulting in a relative increase in red blood cell volume.

Vomiting, diarrhea, profuse fluid discharge, and extensive burns.

Chronic adrenal insufficiency, diabetic ketoacidosis

hyperthyroidism crisis

absolute increase

secondary polycythemia

The main cause of increased EPO in the blood is lack of oxygen.

primary polycythemia

Myeloproliferative neoplasms.

reduce

Physiological reduction

child

elder

second and third trimester pregnancy

Pathological reduction

Decreased red blood cell production, bone marrow disease

Increased destruction of red blood cells, such as jaundice

Excessive loss of red blood cells, various anemias, or hookworm disease.

Red blood cell morphological changes

Abnormal size

microerythrocytes

Seen in hypochromic anemias such as iron deficiency anemia

large red blood cells

Seen in hemolytic anemia, acute blood loss anemia, and also in megaloblastic anemia.

giant red blood cells

Megaloblastic anemia is common due to deficiencies of folic acid and vitamin B2. Megared blood cells are oval in shape.

Uneven size of red blood cells

Seen in pathological hematopoiesis, the unequal size of red blood cells is especially obvious in megaloblastic anemia.

Abnormal coloring

Hypochromic

Indicates a decrease in the amount of hemoglobin, common in iron deficiency anemia and thalassemia

hyperpigmentation

Increased hemoglobin content, common megaloblastic anemia, and spherical cells are also hyperchromic.

pleochrophilia

Denucleated reticulocytes, most common in hemolytic anemia

Abnormal morphology

Normal red blood cells are biconcave disc-shaped, round in blood smear, and uniform in size.

spherical cells

Seen in hereditary spherocytosis

oval cells

Seen in hereditary elliptocytosis, e.g. with cellular anemia

stoma cells

Disseminated intravascular coagulation, alcoholism, hereditary stomatocytosis.

target cells

Globinogenic anemia (thalassemia)

tear drop cells

Seen in myelofibrosis, thalassemia, anemia, etc.

Spiny cells

Acanthocytosis, abnormal lipid metabolism, post-splenectomy

serrated cells

money-shaped arrangement

Seen in liver disease, uremia

Structural abnormality

Basophilic stippling

Red blood cells contain tiny blue dot-like substances, which can be seen in patients with cell anemia, lead poisoning, etc.

chromatin body

Red blood cells contain round purple-red bodies, which can be seen in hemolytic anemia, megaloblastic anemia, and other proliferative anemias.

kabo ring

A very thin purple-red line appears in mature red blood cells, in a ring or figure-8 shape. It can be seen in severe anemia, severe hemolytic anemia, megaloblastic anemia, lead poisoning and leukemia.

nucleated red blood cells

Mainly seen in various hemolytic anemias.

leukemia

Extramedullary hematopoiesis, such as myelofibrosis.

bone marrow metastasis cancer

The blood filtering and clearance function disappears after splenectomy.

leukocyte

normal value

Adult: (4.0~10.0)×10⁹/L

Newborn: (15.0~20.0)×10⁹/L

Children aged six months to two years old: (11.0~12.0)×10⁹/L

NeutrophilN 50%~70%

Classification

rod nucleus st 0%~5%

lobulated nucleus sg 50%~70%

increase

Physiological increase

newborn

Changes during the day, active eating

Movement, pain, agitation

Late pregnancy and childbirth

Pathological increase

Acute infection, especially pyogenes Note: In some extremely severe infections, too much bone marrow is consumed and white blood cells cannot be replenished in time. Instead of being high, the total number will be reduced.

Severe tissue damage and massive blood cell destruction

acute massive bleeding

acute poisoning Note: In chronic conditions, bone marrow hematopoiesis will be inhibited and the number of white blood cells will decrease.

malignant solid tumors

Leukemia, myeloproliferative neoplasms, immature granulocytes may appear

reduce

type

Granulocytopenia: absolute neutrophil count less than 1.5×10⁹/L

Agranulocytosis: the absolute number of neutrophils is less than 0.5×10⁹/L

Infections (especially Gram-negative bacilli, viral infections, protozoal infections)

Hematological diseases (three-line reduction) such as aplastic anemia, partial megaloblastic anemia, severe iron deficiency anemia, paroxysmal nocturnal hemoglobinuria

Physical and chemical factors damage X-rays, gamma rays, radionuclides, chemical drugs

Hyperfunction of monocyte-macrophage system

Autoimmune diseases, such as systemic lupus erythematosus

Nuclear image changes

Neutrophil nuclear left shift: the percentage of non-lobulated nuclear neutrophils in peripheral blood increases by more than 5%. Common in bacterial infections, acute purulent infections, acute blood loss, acute poisoning, and acute hemolytic reactions

Neutrophil nuclear shift to the right: The nuclei of cells in peripheral blood have 5 or more lobes, and their percentage exceeds 3% It is mainly seen in the decline of megaloblastic cells and hematopoietic function. If it appears suddenly during the progression of the disease, it indicates a poor prognosis.

Abnormal shape P243

eosinophils

Physiological functions: deformation movement and phagocytosis, release of histamine, inhibit the synthesis and release of active substances in mast cells, or inactivate the above substances

increase

allergic diseases

parasitic disease

skin diseases, blood diseases

Certain malignant tumors, certain infectious diseases (scarlet fever)

reduce

Commonly seen in the early stages of typhoid fever, paratyphoid fever, major surgery, burns and other stress states, or after long-term use of adrenocortical hormones

basophils

Physiological functions: No phagocytic function, combines with IgG in immune response to cause allergic reactions

increase

Allergic diseases, blood diseases, malignant tumors, etc.

reduce

no clinical significance

LymphocyteL 20%~40%

Physiological functions: Transform into plasma cells and participate in humoral immunity

increase

Infectious diseases mainly include viral infection, mature lymphocyte tumor, recovery period of acute infectious disease, transplant rejection, and diseases with relatively increased lymphocyte ratio (aplastic anemia)

reduce

Treatment with adrenocortical hormones, alkylating agents, antilymphocyte globulin, etc.

Reactive lymphocyte P245

Mainly CD 8T lymphocytes, found in infectious diseases, drug allergies, blood transfusions and hemodialysis, etc.

monocytes

Physiological functions: deformation movement and phagocytosis function, activation of T and B cells

increase

Physiological increase: infants and children

Pathological increase: certain infections, certain blood diseases

reduce

Generally of no clinical significance

platelets

Physiological functions: hemostasis, coagulation

Normal value: (100-300)×10⁹/L

increase

Primary increase

Myeloproliferative neoplasms

Increased reactivity

Acute infection, acute hemolysis, and cancer patients are mild

reduce

Disorders of platelet production, such as aplastic

Increased platelet destruction and consumption, DIC, SLE

Abnormal platelet distribution such as splenomegaly, massive blood transfusion dilution, etc.

Reticulocytes

It is the erythrocyte stage after the enucleation of late erythrocytes.

normal value

Adults and children: 0.005~0.015

Newborn: 0.03~0.06

clinical significance

increase

Indicates the vigorous proliferation of red blood cells in the bone marrow, common hemolytic anemia, acute blood loss, iron deficiency anemia, megaloblastic anemia and some anemia patients after treatment such as iron or vitamin B12 and folic acid supplementation

reduce

Indicates reduced bone marrow hematopoietic function, seen in aplastic anemia

Generate index RPI

The RPI for a normal person is 2

clinical significance

RPI>3 indicates hemolytic anemia or acute blood loss anemia

RPI <2 indicates anemia caused by bone marrow hypoplasia or red blood cell maturation disorder.