Absolute and relative number of leukocytes. Leukocyte formula

The leukogram, or leukocyte formula, shows the ratio in which there are different types of white cells in the blood. These indicators are expressed as a percentage. A leukogram is obtained during a general blood test. The percentage of one or another type of leukocytes changes with an increase or decrease in the level of other types. When a leukogram is deciphered, the absolute number of white blood cells must be taken into account.

Types of leukocytes

The leukocyte formula reflects the ratio of five main varieties: lymphocytes, monocytes, neutrophils, basophils, eosinophils. Different types of white blood cells are not the same in structure and purpose. Depending on whether they contain granules that are able to perceive color, leukocytes are of two types: granulocytes, agranulocytes.

The granulocytes are:

• basophils - can perceive alkaline coloring;
• eosinophils - acid;
• neutrophils are both types of dyes.

Agranulocytes include:

• two types of lymphocytes (B- and T-lymphocytes);
• monocytes.

Functions of white cells

Lymphocytes. T-lymphocytes destroy foreign microorganisms and cancer cells. B-lymphocytes are responsible for the production of antibodies.

Monocytes. They participate in phagocytosis, directly neutralizing foreign bodies, as well as in the immune response and tissue regeneration.

Eosinophils. Capable of active movement and phagocytosis. Actively participate in the formation of inflammatory-allergic reactions, capturing and releasing histamine.

Basophils. They ensure the migration of other types of leukocytes in tissues to the focus of inflammation, take part in allergic reactions.

Neutrophils. The main purpose is phagocytic protection, that is, the absorption of foreign bodies. In addition, they secrete substances of bactericidal action.

Normal white blood counts

The leukocyte formula of the blood of adult healthy people is as follows:

Changes in the leukogram are usually denoted by terms with certain endings. With an increase in the level, endings such as “oz” (“ez”) or “ia” are added to the name of a particular type of leukocyte. For example: lymphocytosis, eosinophilia, monocytosis, etc. With a decrease in the level of leukocytes, it is customary to add the ending “singing” to the name: lymphopenia, neutropenia, eosinopenia, etc.

A distinction is made between relative and absolute change. In the first case, we are talking about a deviation from the norm of the content of leukocytes as a percentage. In the second, they speak of a deviation from the norm both in percentage terms and in absolute terms, which is understood as a change in the total number of cells per unit volume of blood.

Leukocytes differ in their structure and purpose

It should be said that the leukocyte formula depends on age. This must be taken into account when assessing it during the examination and diagnosis of diseases in children.

How to determine

The calculation of the leukocyte formula is carried out by a laboratory assistant by viewing the blood under a microscope (leukogram count per hundred cells).

In addition, a hematological automatic analyzer is used. In case of deviations from the norm, an additional microscopic examination of the smear is carried out, while describing the morphology of the cells and clarifying the leukogram.

The use of automatic equipment allows you to get the most accurate result: you can analyze more than 2000 cells, while under a microscope - a maximum of 200. When examining with an analyzer, the result is more objective.

Automatic counting also has a drawback: the inability to divide neutrophils into segmented and stab. But in the case of a large number of young forms, the equipment detects a shift to the left.

The purpose of counting the leukocyte formula

Causes of changes in the leukogram

An increase in the level of lymphocytes (lymphocytosis) is observed with such pathologies:

• acute viral infections: chickenpox, measles, mononucleosis, rubella;
• chronic bacterial infections: syphilis, brucellosis, tuberculosis;
• lymphomas, lymphosarcoma, lymphocytic leukemia;
• hyperthyroidism (thyrotoxicosis);
• insufficiency of the adrenal cortex;
• aplastic and hypoplastic anemias.

Lymphocytopenia can develop for the following reasons:

• acute infections;
• lymphogranulomatosis;
• systemic lupus erythematosus;
• kidney failure;
• immunodeficiency;
• radiation sickness (acute form);
• taking corticosteroids.

An increase in the level of neutrophils in the blood (neutrophilia) is observed in such conditions:

• acute bleeding;
• intoxication;
• bacterial diseases in acute forms;
• taking corticosteroids;
• tissue necrosis.

• bacterial infections: typhoid fever, brucellosis, tularemia;
• viral infections: measles, hepatitis, rubella;
• toxic effects to which the bone marrow is exposed: drugs, ionizing radiation;
• autoimmune diseases;
• hypersensitivity to medicines;
• benign chronic neutropenia is hereditary.

Monocytosis, in which the level of monocytes in the blood is increased, may indicate the following disorders:

A low level of monocytes is assessed in combination with lymphocytic indicators, which is important in the diagnosis of pulmonary tuberculosis.

Basophilia (increased levels of basophils in the blood) is observed in chronic myeloid leukemia, erythremia.

An elevated level of eosinophils is noted in the following conditions:

Causes of low eosinophil levels (eosinopenia) may include:

• typhoid fever;
• increased adrenocorticosteroid activity.

Leukogram shift

Modern automatic blood analyzers quickly and accurately calculate the complete leukocyte count, which greatly facilitates the diagnosis.

When a leukogram is deciphered, nuclear shifts are taken into account. These are changes in the ratio of mature and immature neutrophils. In the blood formula, different forms of neutrophils are listed in order from young to mature (from left to right).

There are three types of shifts: left, left with rejuvenation, and right.

With a left shift, myelocytes and metamyelocytes are present in the blood. This change occurs in the following processes:

• acute inflammation: pyelonephritis, prostatitis, orchitis;
• purulent infections;
• acidosis;
• acute bleeding;
• poisoning with toxins;
• high physical activity.

With a left shift with rejuvenation, such forms as myelocytes, metamyelocytes, promyelocytes, myeloblasts, erythroblasts can be detected in the blood. This is seen in conditions such as:

• leukemia (chronic, acute);
• erythroleukemia;
• metastases;
• myelofibrosis;
• coma.

Video about the types and functions of leukocytes:

With a decrease in the number of stab (immature) neutrophils and an increase in the level of segmented (mature forms containing 5-6 segments), they speak of a right shift. With such a change in the leukogram, we can talk about the following pathologies and conditions:

• diseases of the liver and kidneys;
• megaloblastic anemia;
• consequences of blood transfusion;
• radiation sickness;
• vitamin B12 deficiency, folate deficiency anemia.

The degree of shift is estimated using a special index, which is determined by the ratio of the total number of all young neutrophils (myelocytes, metamyelocytes, promyelocytes, stab) to mature segmented. The norms for healthy adults are in the range of 0.05-0.1.

Conclusion

The leukocyte formula in medical practice is of great importance. According to the leukogram obtained during a general blood test, one can judge the development of pathological processes in the body, the severity of the disease, the effectiveness of therapy, and the prognosis.

The number of blood leukocytes can be counted in a Burker counting chamber with a Goryaev grid or in electronic automatic analyzers (Celloscope, Kulter, Technikan).

Counting technique in Burker's chamber with Goryaev's grid

Method principle: similar to such a count of erythrocytes, its essence lies in the exact measurement of blood and its dilution in a certain volume of liquid, followed by counting of cellular elements in a counting chamber and converting the result to 1 blood.

Equipment and reagents:

mixers or test tubes for counting leukocytes;

3% solution of acetic acid, to which a few drops of methyl violet or methylene blue are added;

counting chamber;

microscope.

The mixer for leukocytes differs from that for erythrocytes in that it has a wider capillary lumen and a smaller reservoir. Three marks are applied to the mixer: 0.5, 1.0 and 11. This allows you to dilute the blood 10 or 20 times (more often it is diluted 20 times).

Research progress: when taking blood for counting leukocytes, the remnants of blood are first removed from the skin with a cotton swab and, by slightly squeezing the finger, a fresh drop of blood is released. When working with mixers, blood is drawn up to the 0.5 mark, then diluted with a 3% solution of acetic acid to the mark 11. Shake vigorously for 3 minutes, then drain 1-2 drops and fill the counting chamber. When working with test tubes for counting leukocytes, pour 0.4 ml of a 3% solution of acetic acid and release 0.02 ml of blood into it, measured with a pipette from a Saly hemometer. Shake the test tubes thoroughly, then lower the pipette into the liquid and, having collected the contents, fill the counting chamber. Since there are much fewer leukocytes than erythrocytes, in order to obtain a reliable and accurate result, the calculation is carried out in 100 large (unmarked) squares. Usually there are 1-2 leukocytes in one large square. The number of leukocytes in 1 µl of blood is calculated similarly to the calculation of the number of erythrocytes using the formula

X \u003d (A x 4000 x C) / B,

where X is the number of leukocytes in 1 µl of blood; A - the number of leukocytes counted in 1600 small squares; B - the number of small squares counted (1600); 4000 is the value, multiplying by which we get the number of cells in 1 µl.

Interpretation of the received data. Normal white blood cell count: 4.0 - 9.0 x 10 9 /l. A decrease in their number in the blood is called leukopenia, an increase is called leukocytosis.

Leukocytosis can be absolute (true) and relative (redistributive).

Absolute leukocytosis - observed in acute inflammatory processes, tissue necrosis, acute bacterial infections (with the exception of typhoid fever, brucellosis, tularemia, etc.), allergic conditions, malignant tumors (with tissue destruction), closed skull injuries and cerebral hemorrhages, diabetic and uremic coma, shock, acute blood loss, as a primary reaction - with radiation sickness. A significant increase in the number of leukocytes occurs in leukemia.

Relative (redistributive) is a consequence of the entry of leukocytes into the blood stream from the organs that serve as a depot for it. This occurs after meals (food leukocytosis), hot and cold baths, strong emotions (vegetovascular leukocytosis), intensive muscular work (myogenic leukocytosis), etc.

Leukopenia. Leukopenia is considered as an indicator of inhibition of the functional ability of the bone marrow as a result of exposure to toxic substances (arsenic, benzene, etc.), certain medications (sulfonamides, levomycetin, butadione, immuran, cyclophosphamide, etc.), viruses (influenza, viral hepatitis , measles, etc.), microbes (typhoid fever, brucellosis, etc.), ionizing radiation, x-rays and hypersplenism (increased spleen function).

Leukocytosis and leukopenia are rarely characterized by a proportional increase (decrease) in the total number of leukocytes of all types (for example, leukocytosis with thickening of the blood); in most cases there is an increase (decrease) in the number of any one cell type, therefore, the terms "neutrophilia", "neutropenia", "lymphocytosis", "lymphopenia", "eosinophilia", "eosinopenia", "monocytosis", "monocytopenia" are used , "basophilia".

In the clinical assessment of changes in the number of leukocytes, great importance is attached to the percentage of individual forms of leukocytes, that is, the leukocyte formula.

The leukocyte formula of the blood of a healthy person:

Relative quantity Absolute quantity

Basophils……………………….0-1% 0-0.0650 x 10 9 /l

Eosinophils…………………….0.5-5% 0.02-0.30 x 10 9 /l

Neutrophils: - myelocytes…………0% absent

Metamyelocytes……0% absent

Stab ...... 1-6% 0.040-0.300 x 10 9 / l

Segmented ... .47-72% 2.0-5.5 x 10 9 / l

Lymphocytes……………………….19-37% 1.2-3.0 x 10 9 / l

Monocytes………………………….3-11% 0.09-0.6 x 10 9 /l

The count of the leukocyte formula is made in stained smears of peripheral blood. For the correct interpretation of the results of the study of the leukocyte formula, it is recommended to count in absolute quantities, and not in relative ones. The most common methods of staining smears according to Romanovsky-Giemsa, according to Pappenheim. Under immersion, at least 200 cells are considered, and then the percentage of individual types of leukocytes is derived. Analysis of the leukogram, taking into account other blood parameters and the clinical picture, is a valuable method of examination, it helps in making a diagnosis and determining the prognosis of the disease.

The main causes of neutrophilia.

Acute bacterial infections - localized and generalized.

Inflammation or tissue necrosis.

Myeloproliferative diseases.

Intoxication.

Medicinal effects (corticosteroids).

Acute bleeding.

The main causes of neutropenia.

Infections - bacterial (typhoid fever, brucellosis, tularemia, paratyphoid) and viral (infectious hepatitis, measles, influenza, rubella and others).

Myelotoxic effects and suppression of granulocytopoiesis (ionizing radiation; chemical agents - benzene, aniline, DDT; medicinal effects - cytostatics and immunosuppressants; vitamin B 12 - folic deficiency anemia, acute aleukemic leukemia, aplastic anemia).

The impact of antibodies (immune forms) - hypersensitivity to drugs, autoimmune diseases (SLE, rheumatoid arthritis, chronic lymphocytic leukemia), isoimmune manifestations (hemolytic disease of the newborn).

Redistribution and deposition in organs - shock conditions, diseases with splenomegaly and hypersplenism.

Hereditary forms (familial benign chronic neutropenia).

The main causes of eosinophilia.

Allergic diseases.

Chronic skin lesions - psoriasis, pemphigus, eczema.

Tumors (eosinophilic variants of leukemia).

Other diseases - Leffler's fibroplastic endocarditis, scarlet fever.

In the convalescent phase of infections and inflammatory diseases (good prognostic sign).

Causes of eosinopenia (aneosinophilia).

Increased adrenocorticosteroid activity in the body.

Typhoid fever.

The main causes of basophilia:

Chronic myeloid leukemia and erythremia.

The main causes of monocytosis.

Subacute and chronic bacterial infections.

Hemoblastoses - monocytic leukemia, lymphogranulomatosis, lymphomas.

Other conditions - SLE, sarcoidosis, rheumatoid arthritis, infectious monocytosis; during the period of recovery from infections, at the exit from agranulocytosis, after splenectomy.

The decrease in the number of monocytes is important mainly in assessing the lymphocyte-monocytic ratio in pulmonary tuberculosis.

The main causes of lymphocytosis.

Infections - acute viral (infectious mononucleosis, measles, rubella, chicken pox), chronic bacterial (tuberculosis, syphilis, brucellosis), protozoal (toxoplasmosis).

Hemoblastoses (lymphocytic leukemia, lymphomas).

Other diseases - hyperthyroidism, Addison's disease, vitamin B 12 - folic deficiency anemia, hypo- and aplastic anemia.

Lymphocytopenia observed in SLE, lymphogranulomatosis, widespread tuberculosis of the lymph nodes, in the terminal stage of renal failure, acute radiation sickness, immunodeficiency states, taking glucocorticoids.

An increase or decrease in the number of certain types of leukocytes in the blood can be relative or absolute. If only the percentage of one or another type of leukocyte changes, then relative neutrophilia, relative eosinopenia, etc. take place. An increase or decrease in the absolute content of any type of leukocyte, that is, the number of these cells per unit volume of blood, is called absolute neutrophilia, absolute eosinopenia, etc.

The shift of the formula to the left (an increase in the number of young forms of neutrophils) is a sign of inflammation or a necrotic process in the body.

A shift of the leukocyte formula to the right is characteristic of radiation sickness and vitamin B 12 - folic acid deficiency anemia.

The absence or significant decrease in the number of all types of granular leukocytes - granulocytes (neutrophils, eosinophils, basophils) is referred to as agranulocytosis. Depending on the mechanism of occurrence, myelotoxic (exposure to ionizing radiation, taking cytostatics) and immune (hapten and autoimmune agranulocytosis) are distinguished.

Absolute values are the results of statistical observations. In statistics, unlike mathematics, all absolute values ​​have a dimension (a unit of measurement), and can also be positive and negative.

Units absolute values ​​reflect the properties of units of the statistical population and can be simple, reflecting 1 property (for example, the mass of cargo is measured in tons) or complex, reflecting several interrelated properties (for example, ton-kilometer or kilowatt-hour).

Units absolute values ​​can be 3 types:

1. natural- are used to calculate quantities with homogeneous properties (for example, pieces, tons, meters, etc.). Their disadvantage is that they do not allow summing dissimilar quantities.
2. Conditionally natural- apply to absolute values ​​with homogeneous properties, but exhibiting them in different ways. For example, the total mass of energy carriers (firewood, peat, coal, oil products, natural gas) is measured in toe. - tons of reference fuel, since each of its types has a different calorific value, and 29.3 mJ / kg is taken as the standard. Similarly, the total number of school notebooks is measured in US dollars. - conditional school notebooks with a size of 12 sheets. Similarly, canning products are measured in a.c.b. - conditional cans with a capacity of 1/3 liter. Similarly, the production of detergents is reduced to a conditional fat content of 40%.
3. Cost units of measurement are expressed in rubles or in another currency, representing a measure of the value of an absolute value. They make it possible to summarize even heterogeneous values, but their disadvantage is that it is necessary to take into account the inflation factor, so statistics always recalculates cost values ​​in comparable prices.

Absolute values ​​can be momentary or interval. Momentary absolute values ​​show the level of the studied phenomenon or process at a certain point in time or date (for example, the amount of money in your pocket or the value of fixed assets on the first day of the month). Interval absolute values ​​are the final accumulated result for a certain period (interval) of time (for example, salary for a month, quarter or year). Interval absolute values, unlike moment ones, allow subsequent summation.

The absolute statistic is denoted X, and their total number in the statistical population is N.

The number of quantities with the same feature value is denoted f and called frequency(recurrence, occurrence).

By themselves, absolute statistical values ​​do not give a complete picture of the phenomenon under study, since they do not show its dynamics, structure, or relationship between parts. For these purposes, relative statistical values ​​are used.

The concept and types of relative values

Relative statistic is the result of the ratio of two absolute statistical values.

If absolute values ​​with the same dimension are related, then the resulting relative value will be dimensionless (the dimension will be reduced) and is called coefficient.

Often applied artificial dimension of coefficients. It is obtained by multiplying them:

• for 100 - receive interest (%);
• per 1000 - receive ppm (‰);
• per 10000 - receive decimille(‰O).

The artificial dimension of coefficients is used, as a rule, in colloquial speech and in formulating results, but it is not used in the calculations themselves. Most often, percentages are used, in which it is customary to express the obtained values ​​of relative values.

More often instead of the name relative statistic a shorter synonym is used - index(from lat. index- indicator, coefficient).

Depending on the types of correlated absolute values, when calculating relative values, different types of indices: dynamics, plan task, plan fulfillment, structure, coordination, comparison, intensity.

Dynamic index

Dynamic index(growth factor, growth rate) shows how many times the studied phenomenon or process has changed over time. It is calculated as the ratio of the value of the absolute value in the reporting (analyzed) period or point in time to the base (previous):

The criterion value of the index of dynamics is "1", that is: if iД>1 - there is an increase in the phenomenon in time; if iД =1 - stability; if iD

If we subtract its criterion value "1" from the dynamics index and express the resulting value as a percentage, then we get with the criterion value "1":

If T>0, then the growth of the phenomenon takes place; T=0 - stability, T In some textbooks, the dynamics index is called growth factor or growth rategrowth rate, regardless of the result obtained, which can show not only growth, but also stability or decline. Therefore, the more logical and more commonly used names are precisely and .

For example, a car dealership sold 100 cars in January and 110 cars in February. Then the dynamics index will be iD = 110/100 = 1.1, which means an increase in car sales by a car dealership by 1.1 times or 10%

Scheduled Job Index

Scheduled Job Index is the ratio of the planned value of the absolute value to the base value:

For example, a car dealership sold 100 cars in January and planned to sell 120 cars in February. Then the target target index will be ipz = 120/100 = 1.2, which means planning for sales growth of 1.2 times or 20%

Plan execution index

Plan execution index- this is the ratio of the actually obtained value of the absolute value in the reporting period to the planned one:

For example, a car dealership sold 110 cars in February when it was scheduled to sell 120 cars in February. Then the plan execution index will be ivp = 110/120 = 0.917, which means the plan is fulfilled by 91.7%, that is, the plan is underfulfilled by (100% -91.7%) = 8.3%.

Multiplying the indices of the planned task and the execution of the plan, we obtain the dynamics index:

In the previously discussed example about a car dealership, if we multiply the obtained values ​​of the indices of the planned task and the execution of the plan, we will obtain the value of the dynamics index: 1.2 * 0.917 = 1.1.

Structure index

Structure index(share, share) is the ratio of any part of the statistical population to the sum of all its parts:

The structure index shows what proportion is a separate part of the population from the entire population.

For example, if there are 20 girls and 10 young people in the group of students under consideration, then the structure index (share) of girls will be 20/(20+10) = 0.667, that is, the share of girls in the group is 66.7%.

Coordination index

Coordination index- this is the ratio of one part of the statistical population to its other part, taken as the basis for comparison:

The coordination index shows how many times more or how many percent is one part of the statistical population compared to the other part, taken as the basis for comparison.

For example, if in a group of students of 20 girls and 10 young people, we take the number of girls as a comparison base, then the coordination index of the number of young people will be 10/20 = 0.5, that is, the number of young people is 50% of the number of girls in the group.

Comparison Index

Comparison Index- this is the ratio of the values ​​of the same absolute value in the same period or point in time, but for different objects or territories:

Where A, B - signs of compared objects or territories.

For example, in January 2009, the number of inhabitants in Nizhny Novgorod was approximately 1280 thousand people, and in Moscow - 10527 thousand people. Let us take Moscow as object A (since it is customary to put a larger number in the numerator when calculating the comparison index), and Nizhny Novgorod as object B, then the index for comparing the number of residents of these cities will be 10527/1280 = 8.22 times, that is, in Moscow the number there are 8.22 times more residents than in Nizhny Novgorod.

Intensity index

Intensity index- this is the ratio of the values ​​of two interconnected absolute quantities with different dimensions, related to the same object or phenomenon.

For example, a bakery shop sold 500 loaves of bread and earned 10,000 rubles from it, then the intensity index would be 10,000/500 = 20 [rubles/loaf of bread], that is, the selling price of bread was 20 rubles. for a loaf

Most fractional quantities are intensity indices.

There are four types of relative values: intensive, extensive, ratio indicators, visibility indicators.

Intensive indicators - show frequency phenomena in the environment. The medium is usually a certain set of objects (population, patients, cases), some of which have some kind of phenomenon. Calculated using the following formula:

I.p. = phenomenon/environment*coefficient.

The coefficient is used for the convenience of presenting the indicator, it represents various powers of the number 10 and usually takes values ​​of 100, 1000, 10,000, 100,000. Its value depends on the frequency of occurrence of the phenomenon: the less common, the greater the coefficient. Thus, the birth rate, mortality, general morbidity of the population are usually calculated per 1000 people. A factor of 100,000 is used to calculate maternal death as a much rarer event. Conversely, the frequency of such a common event as temporary disability is calculated per 100 workers.

An example of calculating an intensive indicator:

During the year, 360 surgical operations were performed at the N. hospital. In 54 cases, various complications were observed in the postoperative period. Find the frequency of postoperative complications per 100 operations.

Decision: The frequency of postoperative complications is an intensive indicator that can be calculated as the ratio of the phenomenon to the environment. The environment is a set of operations performed (360), of which in 54 cases, as follows from the condition of the problem, a phenomenon occurred - postoperative complications were noted. Thus:

Postoperative Complication Rate = (Number of Postoperative Complications) / (Number of Operations Performed) * 100 = (54 / 360) * 100 = 15.

The value of the coefficient is taken equal to 100, since the condition of the problem asks for the frequency calculated for 100 performed operations.

Answer: The frequency of postoperative complications in the N. hospital for the year was 15 cases per 100 operations performed.

Extensive indicators - characterize structure phenomena are measured as a percentage, less often - in ppm or fractions of a unit. Extensive values ​​show what part is a separate group of units in the structure of the entire population. Calculated according to the formula:

E.p. = part/whole*100%.

An example of calculating an extensive indicator:

In a study of the effectiveness of the treatment of pneumonia using a new antibiotic, 200 patients took part, of which 90 were men. It is necessary to determine the proportion of men among the subjects, the result is expressed in%.

Decision: Male patients represent a part of the total population of the study. Therefore, we must use the formula for calculating extensive indicators:

The proportion of male patients among all studied = (number of men) / (number of all patients) * 100% = (90 / 200) * 100% = 45%.

Answer: The proportion of patients in the structure of the study is 45%.

Ratio indicators - characterize the ratio of two unrelated sets. These aggregates can be measured in the same quantities, the main condition is that their changes must occur independently of each other. Usually, various indices, coefficients, indicators are presented in this form. security population. Calculated using the following formula:

P.s. = (first population) / (second population)*coefficient

The coefficient usually takes the values ​​1 (for indexes) or 10,000 (for indicators of the provision of the population).

An example of calculating the ratio indicator:

In one of the districts of the Republic of Tatarstan, 40,000 people live. 384 inpatient beds have been deployed in the medical and preventive institutions of this district. What is the provision of the population with beds in the district?

Decision: We have two populations: population and inpatient beds. Changes in the population number do not depend on changes in the number of inpatient beds and vice versa, and therefore we conclude that the populations presented are not related. Calculate the indicator of provision of the population with inpatient beds:

Provision of the population with beds = (number of beds) / (population) * 10,000 = (384 / 40,000) * 10,000 = 96.

Answer: The provision of the population with inpatient beds is 96 per 10,000 population.

It should be remembered that absolute indicators of the content of blood cells (leukocytes of various types, reticulocytes and other blood cells) are not just more informative than relative indicators, but the only ones that allow obtaining information about the state (oppression or irritation) of a hematopoietic germ. Relative indicators do not have independent significance,

but are intermediate, "technological" indicators necessary to obtain absolute indicators.

Features of assessing the state of neutrophils

The assessment of the state of neutrophils, in comparison with other leukocytes, has two features:

1. In quantitative terms, the content of neutrophils is estimated as the sum of subpopulations of neutrophils, regardless of their degree of maturity. At the same time, the limit of the relative norm of neutrophils is 50–70%. For example, in a patient Ivanov I.I. leukocytes 10.00x109/l, myelocytes 2%, metamyelocytes 4%, stab neutrophils 6%, segmented neutrophils 57%.

A) the relative number of neutrophils in total is equal to

2% + 4% + 9% + 67% = 82% (relative neutrophilia).

B) the absolute number of neutrophils is 82% of 10.00x109/l, i.e. (82% x 10.00x109/l) / 100 = 8.20x109/l (absolute neutrophilia).

2. In addition to quantitative assessment, neutrophils are evaluated qualitatively according to their degree of maturity.

Assessment of the qualitative state of neutrophils is carried out using the calculation nuclear shift index(INS) or the Solovyov-Bobrov index.

NAI is calculated as the ratio of the sum of the relative number of all immature forms of neutrophils present in a given patient to the relative number of mature neutrophils. Mature neutrophils are segmented neutrophils. Under immature neutrophils are meant stab neutrophils, metamyelocytes, myelocytes, promyelocytes and myeloblasts. For example, in a patient Ivanov I.I. myelocytes 2%, metamyelocytes 4%, stab neutrophils 9%, segmented neutrophils 67%. RSI = (2% + 4% + 9%) / 67% = 0.22.

Normally, IAS fluctuates within 0,04–0,08 .

Decrease in IAS less than 0.04 called shift of the neutrophil formula to the right (hyporegenerative nuclear shift). A hyporegenerative nuclear shift is noted with inhibition of neutrophil production in the bone marrow and the predominance of mature forms of neutrophils in the peripheral blood.

Increase in IAS above 0.08 called shift of the neutrophilic formula to the left. This indicates the rejuvenation of peripheral blood neutrophils as a result of increased myelopoiesis in the bone marrow.

There are three types of shift of the neutrophilic formula to the left. If the IAS increases within 0,08–0,50 , the nuclear shift is called regenerative. The regenerative nuclear shift indicates, on the one hand, the presence and sufficient severity of the pathological process in the body (usually of an inflammatory nature), on the other hand, the adequate protective and adaptive response of the body to this pathological process.

If the IAS increases within 0,50–1,00, the shift is called hyper-regenerative. The presence of such a shift indicates, on the one hand, the high severity of the pathological process, on the other hand, an inadequate reaction of the body. With a nuclear shift of this type, the bone marrow is re-irritated, as a result of which most of the neutrophils are released from it into the blood in immature functionally inactive forms. The protective potential of neutrophils does not increase, but decreases.

If the IAS increases over 1.00, a shift in the neutrophil formula is called degenerate. The appearance of a degenerative nuclear shift indicates a primary violation of the processes of differentiation and maturation of neutrophils. This form of shift of the neutrophil formula to the left is observed most often in leukemia (myeloid leukemia).

Erythrocyte sedimentation rate assessment

In addition to the actual number of blood cells, the standard indicators of the general blood test include erythrocyte sedimentation rate (ESR). Normally, ESR fluctuates within 2–10 mm/hour for men and 5–15 mm/hour for women. In pathogenetic terms, ESR mainly depends on the ratio of gamma globulins and other protein fractions of blood plasma. ESR increases with an increase in the amount of gamma globulins in the blood plasma due to their hyperproduction against the background of inflammatory, infectious or other processes.

When evaluating a complete blood count (and other laboratory data), it should be remembered that its clinical and diagnostic interpretation is impossible without taking into account the totality of clinical and laboratory data. Therefore, interpreting the results of a separate blood test, we can not talk about the diagnosis as a whole, but only about the presence in a particular analysis of typical hematological symptoms characteristic of a particular pathology. Identification of these symptoms is important for making a preliminary diagnosis and developing a plan for further examination of the patient.

Examples of reading a blood test and interpreting the data obtained

Blood test #1