Lymphocytic decussation. Leukocyte blood formula: decoding in children (normal)

The structure and composition of peripheral blood are characterized by a fairly rigid constancy, eloquently characterizing the body's homeostasis. At the same time, such indicators as the leukocyte count and hemogram are most often used in the clinic. Leukocyte formula - This is the percentage of all types of peripheral blood leukocytes. He;; looks like that:

AGE CHANGES IN BLOOD In postnatal ontogenesis, almost all morphological parameters of blood change significantly. A doctor of any specialty should know the age-related features of the blood structure.

Erythrocytes. The number in newborns increased to 6-7x10.2 / l, to 2 weeks of age reaches adult levels and continues to decline to a minimum by 3-6 months of age (physiological anemia). Their content reaches the definitive amount by puberty. Neonates show anisocytosis and reticulocytosis(increase in the number of reticulocytes). With aging, the number of red blood cells may decrease.

Leukocytes. At birth, physiological leukocytosis (up to 10-300x10V) is noted. The definitive level is established by the age of 14. Take place physiological crossings, due to changes in the content of neutrophils and lymphocytes. In a newborn, the percentage of these forms of leukocytes is approximately equal to their levels in an adult. First cross noted on the 3-4th day of life. By this time, the content of cells is equalized due to a decrease in the proportion of neutrophils and an increase in lymphocytes. Further changes lead to the fact that by 1-2 years of life the content of neutrophils is 25%, and lymphocytes - 65%. In the next 2-3 years, the reverse process is observed, and at 4 years second cross. By the age of 14, the indicators correspond to those of adults. With aging, there may be a decrease in both the absolute content of leukocytes and shifts in the leukocyte formula (lack of young forms of neutrophils, a decrease and absence of eosinophils, etc.)

LYMPH

Lymph is a product interstitial (interstitial) fluid. It is formed by filtration of plasma from blood capillaries and venules, which is facilitated by high hydrostatic pressure in the interstitial space and differences in oncotic pressure. This ensures the flow of a certain amount of proteins from the blood plasma into the lymph, which are returned with the lymph back to the blood.

Lymph is made up of plasma lymph and shaped elements (Fig. 9.12). Lymph plasma is similar in composition to blood plasma. Formal * 1 elements make up no more than 1% of the volume of lymph, in percentage terms it is 95% of lymphocytes, 5% of granulocytes, 1% of monocytes. Single erythrocytes can occur, due to which, as well as the presence of fibrinogen;: and other coagulation factors, lymph coagulates.

Lymph functions. 1. Transport, metabolic and trophic functions - transport of lipids absorbed in the intestine, plastic and energy material. 2. Redistribution of fluid in the body 3. Participation in the regulation of antibody production, protective function. 4. Regulatory function: is a channel for the transmission of immune information, enzymes, hormones and other regulatory factors. 5. Return of protein from tissue to blood and maintenance of blood oncotic pressure.

The appearance of erythrocytes of abnormal sizes in the blood is called?

(A) poikilocytosis

(B) stomatocytosis

(AT) anisocytosis

(D) pyropoykylocytosis

Which of the named blood cells is the most numerous?

(A) neutrophilic leukocytes

(B) eosinophilic leukocytes

(B) monocytes

(D) basophilic leukocytes

(D) platelets

(E) erythrocytes

The lifespan of an erythrocyte

(A) 60-80 days

(B) 80-100 days

(B) 100-120 days

(D) 120-140 days

(D) 160 days

The appearance of abnormal forms of erythrocytes in the blood is called?

(BUT ) poikilocytosis

(B) stomatocytosis

(AT) anisocytosis

(D) pyropoykylocytosis

PF6. "Physiological jaundice of newborns" develops on:

(BUT) 3 -4 days

(B) 5-6 days

(B) 10 days

(D) 14 days

PF7. Physiological anemia of newborns develops on:

(A) 14 days

(B) 30 days

(B)2-5 month

(D)3-6 month

8. Leukocytes. Everything is true, except:

(A) are involved in phagocytosis

(B) synthesize collagen and elastin

(B) actively move

(D) are involved in humoral and cellular immunity

9. Neutrophils:

(A) are produced in the spleen

(B) secrete histamine

(B) synthesize immunoglobulins

(D) all of the above are true

(E) all of the above is wrong

Arrange the neutrophils in ascending order of their maturity.

(A) stab

(B) segmented

ANSWER: c, a, b

11. An increase in the number of neutrophils in the blood above the norm is most often the result of:

(A) inflammation

(B) bleeding

(B) hemolysis

(D) helminthiasis

Arrange the white blood cells in descending order of their number.

(A) monocytes

(B) basophils

(B) neutrophils

(D) lymphocytes

(E) eosinophils

ANSWER: b, d, a, d, c

13. Man 30 years old. A blood test was performed. Indicate the abnormal indicators of the leukocyte formula:

(A) eosinophils - 4%

(B) basophils - 0.5%

(B) neutrophils - 63%

(E) monocytes - 6%

(D) stab neutrophils - 15%

14. Mature neutrophil. Has a core:

(A) rod-shaped

(B) round

(B) notch core

(D) polysegmented

(D) S-shaped

(E) consists of 2 segments

15. Eosinophil. Has a core:

(A) rod-shaped

(B) round

(B) notch core

(D) polysegmented

(D) S-shaped

(E) consists of 2 segments

16. An increase in the number of eosinophils in the blood above the norm is most often the result of:

(A) inflammation

(B) an allergic reaction

(B) bleeding

(D) hemolysis

Eosinophils. Specify the correct one.

(B) when eosinophil is activated, histaminase is converted to histamine

(B) have a rounded nucleus

18. Eosinophils. Specify their content in the leukocyte formula of an adult healthy person:

(D) 2-4%

19. Basophils. Specify their content in the leukocyte formula of an adult healthy person:

(B) 0-1%

Specify the cells that secrete histamine when stimulated

(A) neutrophilic leukocytes

(B) eosinophilic leukocytes

(B) monocytes

(D) basophilic leukocytes

(D) platelets

21. Heparin and histamine are present in granules:

(A) reticulocytes

(B) eosinophils

(B) basophils

(D) neutrophils

Which of the following leukocytes are effector cells of humoral immunity?

(A) neutrophilic leukocytes

(B) plasma cells

(B) B-lymphocytes

(D) basophilic leukocytes

(E) T-lymphocytes

(E) monocytes

Which of the following leukocytes synthesize immunoglobulins?

(A) neutrophilic leukocytes

(B) eosinophilic leukocytes

(B) monocytes

(D) basophilic leukocytes

(E) T-lymphocytes

(E) plasmacytes

Killers, helpers, suppressors. What type of leukocytes do these cells belong to?

(A) monocytes

(B) T-lymphocytes

(B) neutrophils

(D) B-lymphocytes

(E) plasma cells

(E) basophils

25. Lymphocytes. Specify their content in the leukocyte formula of an adult healthy person:

(A) 25-30%

Which of the following leukocytes form effector cells of cellular immunity?

(A) neutrophilic leukocytes

(B) eosinophilic leukocytes

(B) B-lymphocytes

(D) basophilic leukocytes

(E) T-lymphocytes

(E) monocytes

27. Small lymphocyte. Has a core:

(A) rod-shaped

(B) round

(B) notch core

(D) horseshoe

(D) S-shaped

(E) consists of 2 segments

PF 28. The first physiological decussation occurs after birth:

(A) for 1 day

(B) on day 4

(B) on the 5th day

PF29. The second physiological decussation occurs after birth:

(A) at 4 months

(B) at 1 year

(B) at 3 years old

(D) at 4 years old

Which of the following cells is the largest?

(A) neutrophilic leukocytes

(B) eosinophilic leukocytes

(B) erythrocytes

(D) basophilic leukocytes

(D) platelets

(E) monocytes

31. Monocyte. Specify the possible options for the shape of the nucleus.

(A) rod-shaped

(B) round

(B) notch core

(D) horseshoe

(D) S-shaped

32. Monocytes. Specify their content in the leukocyte formula of a healthy person:

(D) 6-8%

33. Specify the cell that differentiates into a macrophage after exiting the bloodstream into the surrounding tissues:

(A) eosinophil

(B) basophil

(D) monocyte

(E) B-lymphocyte

PF34. Physiological crossover is a change in the ratio between

(A) erythrocytes and neutrophils

(B) neutrophils and eosinophils

(B) erythrocytes and lymphocytes

(D) neutrophils and lymphocytes

PF35. Platelets. Everything is true, except:

(A) thrombopoietin - a stimulator of their formation

(B) are involved in thrombus formation

(B) the precursor is large and has a large polyploid nucleus

(G ) have a segmented nucleus

What is the crossover of blood formulas?

The leukocyte formula is the percentage of all types of leukocytes (granulocytes: neutrophils, including stab and segmented, eosinophils, basophils, agranulocytes: monocytes and lymphocytes). Those. in a stained blood smear, 100 leukocytes that fell into the field of view are counted in a row and the percentage of each type is calculated.

Newborns.

At birth, children have leukocytosis up to (10 to 9 per liter). Of these, neutrophils are predominant (60-70%). In this case, the formula shifts to the left, i.e. the number of sticks is increased up to 10-15%, sometimes there are single metamyelocytes. Lymphocytes about 30%. There is a conditional rule: neutrophils + lymphocytes are equal to about 90%. Other types of leukocytes are the same as in adults (basophils 0-1%, eosinophils 0.5-5%, monocytes 3-10%).

first 5 days of life.

On average, on the 5th day, the first cross of the formula occurs, i.e. the number of neutrophils and lymphocytes levels out, becoming an average of 45%.

From 10 days to 4-5 years.

Lymphocytes about 60%, neutrophils-30%

4-5 years.

On average, at the age of 4.5-5 years, the second cross of the formula occurs, i.e. again the number of neutrophils and lymphocytes levels off at 45%.

School age.

By school age, the leukocyte formula in children corresponds to that in adults.

The lymphocyte formula - the ratio of leukocytes (stab, segmented, eosinophils, lymphocytes, basophils and monocytes) in a stained blood smear - in children differs from that in adults up to about 4-5 years. In newborns, up to a week of age, it is approximately the same as in adults, and then comes the first cross. The leukocyte formula changes: the ratio of lymphocytes to neutrophils changes from approximately 20%/60% to 60%/20%. At 4-5 years old, there is a reverse crossover and no longer changes.

Leukocyte formula in children

The leukocyte formula in children has significant differences depending on age. The leukocyte formula of a newborn (with the exception of the first days of life, when neutrophilia is noted) is characterized by persistent lymphocytosis, both relative and absolute (Table 2). In a newborn, the percentage of lymphocytes, gradually increasing, reaches 50-60 by the 5th day, and the percentage of neutrophils by the same time gradually decreases to 35-47.

The number of neutrophils and lymphocytes in different periods of childhood (in percent): a - first decussation; b - the second cross.

If you depict the changes in the number of neutrophils and lymphocytes in the form of curves (Fig.), then approximately between the 3rd-5th day there is an intersection of the curves - the so-called first crossover. By the end of the first month of life, the child's leukocyte formula is established, which is characteristic of the entire first year of life. The leukocyte formula of infants differs in some lability; it is relatively easily disturbed by strong crying and restlessness of the child, sudden changes in diet, cooling and overheating, and especially in various diseases.

In the future, at the 3-6th year of life, the number of lymphocytes significantly decreases and the number of neutrophils increases. Corresponding curves of neutrophils and lymphocytes cross again - the second cross. At the age of 14-15 years, the leukocyte formula of children almost completely approaches the leukocyte formula of adults.

The leukocyte formula in children naturally changes with age. The relative number of neutrophils at birth ranges from 51 to 72%, increases during the first hours of life, then decreases rather quickly (Table 2). The number of lymphocytes at birth ranges from 16 to 34%, reaching an average of 55% by the end of the second week of life. At the age of about 5-6 days, the curves of neutrophils and lymphocytes intersect - this is the so-called first crossing (Fig. 2), which occurs during the first week of life from 2-3 to 6-7 days. Basophilic leukocytes in newborns are often completely absent. The number of monocytes at birth ranges from 6.5 to 11%, and at the end of the neonatal period - from 8.5 to 14%. The number of plasma cells does not exceed 0.26-0.5%. In children of the first days of life, a distinct shift of neutrophils to the left according to Schilling is noted, almost leveling off by the end of the first week of life. In newborns and throughout the first year of life, an unequal size of lymphocytes is noted: the main mass is made up of medium lymphocytes, small ones are somewhat smaller and there are always 2-5% of large lymphocytes.

Table 2. Leukocyte formula of a newborn (according to A.F. Tur, in%)

Rice. 2. The first and second crosses of curves of neutrophils and lymphocytes (according to A. F. Tour). Roman numerals indicate options for crossings: 1 - according to Lippman; II - according to Zebordi; III - according to Karstanien; IV - according to N.P. Gundobin; V - according to Rabinovich.

By the end of the first month of life, the child's leukocyte formula is established, which is characteristic of the first year of life (Table 3). It is dominated by lymphocytes; there is always a moderate shift of neutrophils to the left, moderate monocytosis and an almost constant presence of plasma cells in the peripheral blood. The percentages between the individual forms of white blood cells in infants can vary over a very wide range.

Leukocyte formula of children aged from 1 month to 15 years (according to A. F. Tur, in%)

The leukocyte formula of infants differs in some lability; it is relatively easily disturbed by strong crying and restlessness of the child, sudden changes in diet, cooling and overheating, and especially in various diseases.

Sometimes by the end of the first year of life, but more often in the second year there is a certain tendency towards a relative and absolute decrease in the number of lymphocytes and an increase in the number of neutrophils; in the next years of life, this change in the ratio between lymphocytes and neutrophils comes to light more sharply, and, according to A.F. Tur, at the age of 5-7 years, their number becomes the same (“second cross” of the curve of neutrophils and lymphocytes).

During school years, the number of neutrophils continues to increase, while the number of lymphocytes decreases, the number of monocytes decreases slightly, and plasma cells almost completely disappear. At the age of 14-15 years, the leukocyte count in children is almost completely similar to that in adults (Table 3).

The correct assessment of the leukocyte formula in diseases is of great importance and is possible when taking into account its features, due to the age of the child.

24. Age features in the number of leukocytes. Double cross in the ratio of neutrophils and lymphocytes in children.

The number of leukocytes in newborns is increased and is equal to * 10 9 /l. The number of neutrophils is -60.5%, eosinophils - 2%, basophils -02%, monocytes -1.8%, lymphocytes - 24%. During the first 2 weeks, the number of leukocytes is reduced to 9 - 15 * 10 9 / l, by 4 years it decreases to 7-13 * 10 9 / l, and by 14 years it reaches the level characteristic of an adult. The ratio of neutrophils and lymphocytes changes, which causes the appearance of physiological crossovers.

First cross. In a newborn, the ratio of the content of these cells is the same as in an adult. In the subsequent sod. Nf falls, and Lmf increases, so that on the 3rd-4th day their number is equalized. In the future, the amount of NF continues to decrease and reaches 25% by the age of 1-2 years. At the same age, the amount of LMF is 65%.

Second cross. Over the next years, the number of Hf gradually increases, and Lmf decreases, so that in children at the age of 4 these indicators are equalized again and make up 35% of the total number of leukocytes. The amount of Nf continues to increase, while the amount of LMF decreases, and by the age of 14 these figures correspond to those in an adult (4-9 * 10 9 /l).

25. Genesis, structure, general and special. Properties and functions of neutophils

In the bone marrow, six successive morphological stages of neutrophil maturation can be observed: myeloblast, promyelocyte, myelocyte, metamyelocyte, stab and segmented cell:

In addition, there are also earlier, morphologically unidentifiable, committed neutrophil precursors: CFU-GM and CFU-G.

Neutrophil maturation is accompanied by a progressive decrease in nuclear size due to chromatin condensation and loss of nucleoli. As the neutrophil matures, the nucleus becomes serrated and finally acquires a characteristic segmentation. At the same time, changes occur in the cytoplasm of the neutrophil, where granules containing biological compounds accumulate, which will subsequently play such an important role in protecting the body. Primary (azurophilic) granules are blue inclusions approximately 0.3 µm in size containing elastase and myeloperoxidase. They first appear in the promyelocytic stage; when ripe, their number and intensity of staining decrease. Secondary (specific) granules, which contain lysozyme and other proteases, appear at the myelocyte stage. The coloration of these secondary granules determines the characteristic neutrophilic appearance of the cytoplasm.

Kinetics of neutrophils. According to the ability to divide, myeloblasts, promyelocytes and myelocytes belong to the mitotic group, i.e. have the ability to divide, the intensity of which falls from myeloblast to myelocyte. The subsequent stages of maturation of neutrophils are not associated with division. In the bone marrow, proliferating cells among neutrophils make up about 1/3, and the same amount is accounted for by granulocytic mitoses among all proliferating cells in the bone marrow. During the day, up to 4.0×10 9 neutrophils are produced per kilogram of body weight.

Structure. Neutrophil cytoplasm. At the stage of metamyelocyte and subsequent stages of maturation, the structures that ensure the synthesis of cytoplasmic proteins are reduced, the structure of lysosomes that provide the function of neutrophils is improved, and the ability for amoeboid mobility and deformation, which ensures the mobility and invasiveness of granulocytes, is enhanced.

neutrophil membrane. On the precursors of the granulocytic germ, CD34+CD33+ are determined, as well as receptors for G M - C S F, G - C S F, IL-1, IL-3, IL-6, IL-11, IL-12. The membrane also contains various molecules that are receptors for chemotactic signals, which include CCF, N-formyl-peptide.

Properties and functions. The function of neutrophils is to protect the body from infection. This process includes chemotaxis, phagocytosis and destruction of microorganisms. Chemotaxis involves the ability to detect and purposefully move towards microorganisms and foci of inflammation. Neutrophils have specific receptors for the C5a component of the complement system (produced in the classical or alternative pathways of complement activation) and for proteases released during tissue damage or direct bacterial exposure. In addition, neutrophils have receptors for N-formyl peptides secreted by bacteria and affected mitochondria. They also react to such products of inflammation, leukotriene LTB-4 and fibrinopeptides.

Neutrophils recognize foreign organisms using opsonin receptors. Fixation of serum IgG and complement on bacteria makes them recognizable to granulocytes. The neutrophil has receptors for the Fc fragment of the immunoglobulin molecule and the products of the complement cascade. These receptors initiate the processes of capture, absorption and adhesion of foreign objects.

Neutrophils engulf opsonized microorganisms with the help of cytoplasmic vesicles, called phagosomes. These vesicles move from the folded pseudopodia and fuse with the primary and secondary granules in an energy-dependent process during which explosive activation of glycolysis and glycogenolysis occurs in phagocytes. During cell degranulation, the contents of the granules are released into the phagosome and degradation enzymes are released: lysozyme, acid and alkaline phosphatases, elastazailactoferrin.

Finally, neutrophils destroy bacteria by metabolizing oxygen into products that are toxic to the ingested microorganisms. The oxidase complex generating these products consists of flavin- and heme-containing cytochrome b558-.

These reactions use the reducing agent NADPH and are stimulated by glucose-6-phosphate dehydrogenase and other hexose monophosphate shunt enzymes. As a result, the cell generates superoxide (O2) and hydrogen peroxide (H2O2), which are released into the phagosome to kill bacteria. Lactoferrin is involved in the formation of free hydroxyl radicals, and myeloperoxidase, using halides as cofactors, in the production of hypochloric acid (HOC1) and toxic chloramines.

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LEUKOCYTE CROSS

(RULE OF FOUR FOURS)

65% lymphocytic blood profile

4 days 1 year 4 years of age

Figure 12. Leukocyte decussation.

In a newborn, the percentage of neutrophils and lymphocytes is the same as in an adult. Subsequently, the content of neutrophils falls, and lymphocytes - increases, so that on the 3rd-4th day their number is equalized (44%). This phenomenon has been named the first physiological (leukocytic) decussation. In the future, the number of neutrophils continues to decrease and reaches 25% by the age of 1-2 years. At the same age, the number of lymphocytes is 65%, that is, at this age, a lymphocytic blood profile is observed. Over the following years, the number of neutrophils gradually increases, and the number of lymphocytes decreases, so that in 4-year-old children these figures equalize again (44%) - second physiological (leukocytic) decussation. The number of neutrophils continues to increase, and lymphocytes - to decrease, and by the age of 14 these figures correspond to those in an adult, that is, a neutrophilic blood profile is observed.

Lymph(from Greek lympha - pure moisture, spring water) - a biological fluid formed from interstitial (tissue) fluid passing through the system of lymphatic vessels through a chain of lymph nodes (in which it is cleansed and enriched with formed elements) and through the thoracic duct into the blood.

Mechanism of lymph formation associated with the filtration of plasma from the blood capillaries into the interstitial space, resulting in the formation of interstitial (tissue) fluid. In a young man weighing 70 kg, the interstitial space contains about 10.5 liters of fluid. This fluid is partly reabsorbed into the blood, partly enters the lymphatic capillaries, forming lymph. The formation of lymph is promoted by increased hydrostatic pressure in the interstitial space and differences in oncotic pressure between blood vessels and interstitial fluid (providing a daily flow of proteins from the blood into the tissue fluid). These proteins are completely returned to the blood through the lymphatic system.

Lymph volume in the human body is, on average, 1-2 liters.

· peripheral lymph(flowing from tissues);

· intermediate lymph(passed through the lymph nodes);

· central lymph(located in the thoracic duct).

1. Homeostatic - maintaining the constancy of the cell microenvironment by regulating the volume and composition of the interstitial fluid.

2. Metabolic - participation in the regulation of metabolism through the transport of metabolites, proteins, enzymes, water, minerals, molecules of biologically active substances.

3. Trophic - transport of nutrients (mainly lipids) from the digestive tract into the blood.

4. Protective - participation in immune reactions (transport of antigens, antibodies, lymphocytes, macrophages and APCs).

Lymph consists of a liquid part ( plasma) and shaped elements. The closer the lymphatic vessel to the thoracic duct, the higher the content of formed elements in its lymph. However, even in the central lymph, shaped elements make up less than 1% of its volume.

Lymph plasma in terms of concentration and composition of salts, it is close to blood plasma, has an alkaline reaction (pH 8.4-9.2), contains less proteins and differs from blood plasma in their composition.

Formed elements of lymph.

The concentration of formed elements varies within 2-20 thousand/µl (2-20´10 9 /l), changing significantly during the day or as a result of various influences.

The cellular composition of the lymph: 90% lymphocytes, 5% monocytes, 2% eosinophils, 1% segmented neutrophils, and 2% other cells. Normally, erythrocytes are absent in the lymph, getting into it only with an increase in the permeability of the blood vessels of the microvasculature. Due to the presence of platelets, fibrinogen, and other clotting factors, lymph is able to clot, forming a clot.

1. Almazov V.A. Physiology of leukocytes. - L., Nauka, 1979.

2. Bykov V.L. Cytology and general histology (functional morphology of human cells and tissues). - St. Petersburg: SOTIS, 1998.

3. Vashkinel V.K., Petrov M.N. Ultrastructure and functions of human platelets. - L., Nauka, 1982.

4. Volkova O.V., Eletsky Yu.K. and others. Histology, Cytology and Embryology: Atlas: Textbook. – M.: Medicine, 1996.

5. Histology (introduction to pathology) / Ed. E.G.Ulumbekova, Yu.A.Chelysheva. – M.: GEOTAR, 1997.

7. Protsenko V.A., Shpak S.I., Dotsenko S.M. Tissue basophils and basophilic blood granulocytes. - M., Medicine, 1987.

8. Reusch A. Fundamentals of immunology. Per. from English. - M., Mir, 1991.

9. Sapin M.R., Etingen L.E. The human immune system. - M., Medicine, 1996.

10. Semchenko V.V., Samusev R.P., Moiseev M.V., Kolosova Z.L. International histological nomenclature. - Omsk: OGMA, 1999.

11. Willoughby M. Pediatric hematology. Per. from English. - M., Medicine, 1981.

V. AGE CHARACTERISTICS OF BLOOD ……….………………23 – 24

I. Characteristics of the platelet.

Quantity in hemogram*10 9 /l

Quantity in Leukocyte formula:

Size in blood smear: 2-3 microns.

Light characteristics of the structure:

The chemical composition of the granules: Distinguish granulomer and hyalomer.

Granulometer is the sum of granules a,d,l (alpha, delta, lambda).

a-granules (diameter 0.2 microns) - contain a number of blood coagulation factors released from activated platelets (fibrinogen, fibronectin, thromboplastin).

d-granules (diameter) - contain ADP, Ca 2+, serotonin, histamine.

l-granules - contain lysosomal enzymes involved in the dissolution of a blood clot.

The granulomer also contains mitochondria and glycogen granules.

Hyalomer- a homogeneous fine-grained structure containing tubular and fibrillar systems.

II. Leukocyte formula - the percentage of different types of leukocytes, determined by counting them in a stained blood smear under a microscope.

III. Granulocytopoiesis is the process of formation of granulocytes in the body.

NEUTROPHILS (40-75%, d=10-12 microns)

EOSINOPHILES (1-5%, d=12-14 microns)

BASOPHILS (0.5 - 1%, d = 11-12 microns) There are 3 main age stages of differentiation:

1) Young (0-0.5%) - metamyelocytes - are characterized by a bean-shaped nucleus.

2) Stab (3-5%) - immature, with a horseshoe-shaped nucleus.

3) Segmented (60-65%) - mature cells with a nucleus consisting of 3-5 segments connected by thin bridges. Chromatin is highly condensed.

1. Mesoblastic stage: embryonic hemocytopoiesis occurs from the 3rd week of embryo development in the mesenchyme of the yolk sac;

2. Hepatic stage: from the 5-6th week - in the liver;

3. Medullary stage: from the 8th week - in the thymus, from the 3rd month - in the spleen, lymph nodes and red bone marrow. These stages are conditional, because. overlap each other.

2) Lymphopoiesis includes two stages: antigen-independent and antigen-dependent proliferation and differentiation of B- and T-lymphocytes. The first stage is genetically programmed for the formation of special cells capable of giving an immune response when they encounter a specific antigen (due to the appearance of special receptors on the plasmalemma of lymphocytes). B-lymphocytes are formed in the red bone marrow, T-lymphocytes - in the thymus. Antigen-dependent proliferation and differentiation of T- and B-lymphocytes occur when they encounter antigens in peripheral lymphoid organs that form effector and memory cells.

Anisocytosis - the presence in blood smears of erythrocytes that differ in size: with a predominance of small erythrocytes (microanisocytosis) and large erythrocytes (macroanisocytosis).

Poikilocytosis is one of the blood diseases, as a result of which the daily performance of red blood cells, which are responsible for transporting oxygen from the lungs to all the cells of our body, is disrupted.

A hemogram is a clinical blood test. Includes data on the amount of all blood cells, their morphological features, ESR, hemoglobin content, color index, hematocrit, the ratio of various types of leukocytes, etc.

III. Erythropoiesis. maturation stages.

Erythropoiesis is a process that occurs in the red bone marrow. The following stages are distinguished:

1)SKK; 2) PSK; 3) CFU-GNE; 4) CFU-E; 5) erythroblast; 6) proerythrocyte; 7) basophilic erythrocyte; 8) polychromatophilic erythrocyte; 9) oxyphilic erythrocyte; 10) reticulocyte; 11) erythrocyte.

By the period of the 7th stage of erythropoiesis, a certain amount of RNA and ribosomes (the structures necessary for the synthesis of hemoglobin protein) are already accumulating in the cytoplasm, so the cytoplasm of the cell acquires a basophilic color; such a cell is called a basophilic erythrocyte. After a certain period of time, the amount of synthesized hemoglobin increases and, along with basophilia, oxyphilic properties also become characteristic of the cytoplasm. Further, the amount of RNA and rabosomes decreases, and hemoglobin increases, so the cytoplasm is stained oxyphilically.

IV. Leukocyte decussation in children

Eosinophilia is a condition in which there is an absolute or relative increase in the number of eosinophils.

1. Describe the morphology and functions of erythrocytes according to the plan

The erythrocyte is a nuclear-free, highly specialized cell.

Size: d=7.2+-0.5 µm

There are 3 shapes according to size:

Microcytes - less than 6 microns

Macrocytes - more than 8.5 microns

Quantity in the hemogram: w-3.7-4.7; m-4.0-5.0

Size in blood mask: 5*/L

Agranulocytes are leukocytes whose cytoplasm, unlike granulocytes, does not contain azurophilic granules. Nongranular leukocytes are divided into lymphocytes and monocytes.

Lymphocytes-immune components of the cell, which are divided into B- and T-lymphocytes and NK-cells - natural killers, are involved in antitumor immunity. B-lymphocytes are formed in the red bone marrow, T-lymphocytes - in the thymus.

Large - d=more than 10 microns

Leukocyte formula: 20-35%

Monocytes- the largest agranular leukocytes

d in blood smear, leukocyte count: 6-8%

Morphology: whole chromatin, large, bean-shaped nucleus; have a small number of vacuoles, unsegmented, have a gray-blue rim.

1 class. pluripotent hematopoietic stem cell

2nd grade. Myelopoiesis progenitor cell

3rd grade. Thromboetin sensitive cell

4th grade. Morphologically recognizable proliferating cell - megakaryoblast-25 µm

5th grade. A maturing cell - a promegakaryocyte - 30-50 microns; megakaryocyte - 100 microns

6th grade. Platelet - 2-3 microns.

Specifications: increase: the size of the cell, nucleus; the cytoplasm is basophilic, the formation and accumulation of azurophilic granules, the formation of MCC processes, forms a system of demorcation channels (gEPS).

4. Define the concept.

Metachromasia is the property of cells and tissues to stain in a color tone that differs from the color of the dye itself, as well as the property of altered cells and tissues to stain in a different color compared to normal cells and tissues.

Metachromasia (Azur II stains the granules purple) is due to the presence of heparin - glycosaminoglycan. Specific granules contain peroxidase, histamine, heparin, ATP, neutrophil and eosinophil chemotaxis factors, etc. Part of the granules are modified lysosomes.

5. List the main types of hemoglobin in different age periods

Embryonic - present during the first 3 months of embryogenesis.

Fetal - present in the last 6 months of pregnancy and is the basis of fetal hemoglobin (90-95%)

Definitive - is 96-97% in an adult, while Hb is 0.5-1%

1) Describe the morphology and functions of lymphocytes according to the plan.

Features of the leukocyte formula in childhood

The leukocyte formula is an indicator of the state of peripheral blood, reflecting the percentage of leukocyte cells of various types. Normally, the ratio of cells of the lecopoietic series has characteristic features depending on the age of the child.

The situation with the formula in healthy children

In healthy newborns, there is a shift in the leukocyte formula with a shift index of 0.2 (at a rate of 0.06 in adults). At the birth of a child in the formula, 60-65% of the leukogram is represented by neutrophils and 30-35% by lymphocytes. By the end of the first week of life, the number of these cells is equalized

45% each and the “first crossover” of the leukocyte formula occurs, and physiological lymphocytosis is formed in the blood of the newborn by the day. The content of lymphocytes in the leukocyte formula is 55-60%. In addition, an increase in the number of monocytes up to 10% is characteristic. The second crossover in the leukocyte formula occurs at the age of 5-6, after which, by the age of 10, the blood leukogram acquires the features of an adult:

stab neutrophils - 1-6%,
segmented neutrophils 47-72%
lymphocytes 19-37%,
monocytes 6-8%,
eosinophils 0.5-5%,
basophils 0-1%.

A sharp increase in the number of lymphocytes in the blood in the first week after birth and their predominance in the "white" blood formula up to 5-6 years of age is a physiological compensatory mechanism associated with a pronounced stimulation of the child's body with antigens and the formation of the child's immune system. According to a number of authors, there is currently an earlier crossover in the leukocyte formula, a tendency to eosinophilia, relative neutropenia, and an increase in the number of lymphocytes.

Lymphocyte changes

Estimating the number of lymphocytes in a blood test in children, first of all, take into account the age characteristics of the leukocyte formula. So, in children under the age of 5-6 years, lymphocytosis is considered to be an increase in the number of lymphocytes over 60% and their absolute number over 5.5-6.0 x10 9 /l. In children over 6 years of age with lymphocytosis, the leukocyte blood count shows the content of lymphocytes is more than 35%, and their absolute number exceeds 4 thousand. in 1 µl.

Functions of lymphocytes

The number of lymphocyte cells in the blood can be influenced by various physiological processes in the body. For example, a tendency to lymphocytosis is noted in children whose diet is dominated by carbohydrate foods, among residents of the highlands, during menstruation in women. In children with constitutional anomalies in the form of lymphatic diathesis, there is also a tendency to increase the content of lymphocytes in the blood.

The main function of lymphocytes is participation in the formation of the immune response. Therefore, secondary blood lymphocytic reactions are most often encountered in pediatric practice, accompanying:

viral infections (measles, influenza, rubella, adenovirus, acute viral hepatitis);
bacterial infections (tuberculosis, whooping cough, scarlet fever, syphilis)
endocrine diseases (hyperthyroidism, panhypopituitarism, Addison's disease, ovarian hypofunction, thymus hypoplasia);
allergic pathology (bronchial asthma, serum sickness);
immunocomplex and inflammatory diseases (Crohn's disease, ulcerative colitis, vasculitis);
taking certain medications (analgesics, nicotinamide, haloperidol).

Lymphocytosis in viral infections is recorded, as a rule, in the stage of convalescence - the so-called lymphocytosis of recovery.

Only among children (adults get sick extremely rarely) there is a disease of viral etiology - infectious lymphocytosis. The disease has a flu-like benign course, may occur with no clinical symptoms. In a blood test against the background of leukocytosis, the leukocyte blood formula demonstrates lymphocytosis.

Primary lymphocytosis in childhood is diagnosed with lymphoblastic leukemia.

lipopenia

Lymphopenia is stated with a decrease in the relative number of lymphocytes in children of the first days of life - below 30%, at the age of 5-6 years - below 50%, in children older than 6 years - below 20%. A decrease in the number of lymphocytes occurs as a result of:

failure of the development of lymphoid tissue,
inhibition of lymphocytopoiesis,
accelerated destruction of lymphocytes.

Relative lymphopenia is characteristic of infectious and inflammatory diseases accompanied by significant granulocytosis due to increased granulocytopoiesis. Absolute lymphocytopenia (the number of lymphocytes in children older than 6 years is less than 1.2–1.5 × 109/l) indicates immunodeficiency. Observed in tuberculosis, syphilis. In patients with these infections, in most cases, an increase in lymphocytic agranulocytes is a favorable sign. Lymphopenic reaction accompanies AIDS, sarcoidosis, disseminated lupus erythematosus, lymphogranulomatosis. Against the background of radiation and cytostatic therapy, drug-induced lymphocytopenia develops.

Change from monocytes

Monocytes are the largest leukocyte blood cells and are representatives of the macrophage system of the body. The main function of monocytes is phagocytic. A leukocyte blood formula with a monocyte count of more than 10% indicates blood monocytosis (their absolute number is over 0.4 × 109/l). Monocytosis has diagnostic value:

during the period of convalescence after acute infections;
with granulomatosis (sarcoidosis, tuberculosis, ulcerative colitis, syphilis);
with protozoal, fungal and viral infections;
with collagenoses;
blood diseases (monoblastic leukemia).

Mention should be made of the lymphotropic viral disease (caused by the herpes-like Epstein-Barr virus) that is quite common in children (more often) - infectious mononucleosis. The main symptoms of the disease are fever, inflammatory changes in the pharynx, lymphadenopathy, enlargement of the spleen and liver, typical changes in the blood test in the form of an increased number of atypical mononuclear cells (over 10%) against the background of moderate leukocytosis and lymphocytosis.

A decrease in the number of monocytes in the blood formula below 4% indicates monocytopenia. More often this condition occurs with vitamin B12 folic deficiency anemia, aplastic anemia, leukemia, and may accompany systemic lupus erythematosus. In severe septic processes, the disappearance of monocytes is an unfavorable sign.

Changes in eosinophils

Leukocyte blood count registering eosinophilia is not uncommon in pediatric practice. It is most often caused by allergies in children, which tends to increase at the present time, and helminthic infestations. An increase in the absolute number of eosinophilic granulocytes over 0.4x10 9 /l is considered eosinophilia. Eosinophils are normal in children, as well as adults, make up 0.5-5% of the total number of leukocytes. An increase in the percentage from 5% to 15% is called "small" eosinophilia, more than 15% - "large". In the latter case, the absolute content of eosinophilic cells in the peripheral blood may exceed 1.5? 10 9 / l. Eosinophilia against the background of significant leukocytosis is regarded as a leukemoid reaction of the eosinophilic type.

Eosinophilia can accompany systemic diseases of the connective tissue, occur as a result of drug allergies. In some infectious conditions during the recovery period, the leukocyte blood formula can register an increase in the number of eosinophils, the so-called “pink dawn of recovery” (eosinophils are pink when stained with a smear).

The eosinophilic reaction of the blood may accompany oncological diseases, more often with the localization of the primary tumor process in the nasopharynx, bronchi, stomach,. May accompany various forms of leukemia, malignant neoplasms of lymphoid tissue. A characteristic feature of tumor eosinophilia is the absence of an increase in the concentration of JgE in the blood serum.

Familial benign eosinophilias that are asymptomatic and inherited in an autosomal dominant manner have been described.

Change in the number of basophils

Basophilic granulocytes are involved in the formation of the immune (often allergic) and inflammatory response in the human body. With basophilia, the leukocytic blood formula shows the content of basophilic cells over 0.5-1%. Basophilia is rare. An increase in basophilic cells up to 2-3% often occurs with chronic myelogenous leukemia, lymphogranulomatosis, hemophilia, tuberculosis of the lymph nodes, with allergic reactions.

Conclusion

The tactics of the practitioner in various cellular reactions of the blood in children primarily depend on the clinical picture of the disease. If changes in the blood are a symptom of the disease, then, first of all, its treatment is carried out. If, after the patient's clinical recovery, pathological changes persist in the blood test, then additional diagnostic measures are necessary to diagnose complications or concomitant diseases. In some cases, it may be necessary to consult a pediatric hematologist or oncologist.

Cross leukocyte formula

Cross of the leukocyte formula, cross of the blood formula ... This definition can often be heard when it comes to blood tests in children. What can "cross" in the results of the study, how do laboratory assistants determine this, and what does it all mean?

What is the leukocyte formula:

As everyone knows, blood contains three types of blood cells: red (erythrocytes), white (leukocytes) and platelets. When a person is given a blood test, the laboratory assistant writes in the results the absolute number of each of these groups of cells. For example, erythrocytes on average 4-5 × 1012 per 1 liter of blood, leukocytes 3-9 × 109 per the same volume.

Among leukocytes there are several forms. Rather, there are several dozen of them, since each form includes a number of varieties of cells of an intermediate degree of maturity. However, there are not so many main types of leukocytes. These are neutrophils, lymphocytes, monocytes, eosinophils, basophils.

Neutrophil (purple, right) and

lymphocyte (purple, left) -

main participants of the cross

Instead of counting the exact number of cells of one form or another, researchers write their content as a percentage. For example, neutrophils can be 45-70%, lymphocytes - 20-40%, monocytes 6-8%, basophils 0-1%, eosinophils 1-3% of all leukocytes. The total is 100%.

The number of leukocytes and their varieties is the leukocyte formula. In an adult, it is relatively stable and changes only in diseases, when the content of different cells changes. However, in young children, rather large changes occur in it, which are called the crossover of the formula. The cross is observed in the norm and is not a sign of pathology.

Segmented neutrophils, lymphocytes: how do they change during decussation?

The cross of the formula occurs due to the fact that in a small child, the formation and maturation of immunity takes place. Different forms of cells are formed in greater or lesser quantities, all this changes over time ... This is where regular changes in blood tests come from.

Approximately by the age of 10, the leukocyte formula ceases to change, and all values approach the norms that were described at the beginning of the article.

The biological role of the cross:

It is rather boring for a person who does not plan to connect his life with medicine to figure out which indicator and when is increased and which is lowered. If this is of interest to you, you can study and memorize the contents of the previous section in detail. However, if we are talking about your child's blood tests, and you just want to know if everything is in order with them, it is better to entrust their interpretation to a knowledgeable specialist who has been dealing with this for a long time. You just need to understand a few simple things.

The main thing that is needed while the child is growing is, if possible, to ensure that he grows up without stress: chronic and acute diseases, sudden climate change, long journeys, etc. In addition, immunity support would be very useful, with which childhood will pass without prolonged colds and frequent morbidity.

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Moscow, st. Verkhnyaya Radishchevskaya, 7 building 1 of. 205 Tel.

The situation with the formula in healthy children

Healthy newborns have shift of the leukocyte formula with a shift index of 0.2 (at a rate of 0.06 in adults). At the birth of a child in the formula, 60-65% of the leukogram is represented by neutrophils and 30-35% by lymphocytes. By the end of the first week of life, the number of these cells equalizes to ~ 45% and the “first crossover” of the leukocyte formula occurs, and by the 10-14th day, physiological lymphocytosis is formed in the blood of the newborn. The content of lymphocytes in the leukocyte formula is 55-60%. In addition, an increase in the number of monocytes up to 10% is characteristic. The second crossover in the leukocyte formula occurs at the age of 5-6, after which, by the age of 10, the blood leukogram acquires the features of an adult:

stab neutrophils - 1-6%,
segmented neutrophils 47-72%
lymphocytes 19-37%,
monocytes 6-8%,
eosinophils 0.5-5%,
basophils 0-1%.

Lymphocyte changes

Estimating the number of lymphocytes in a blood test in children, first of all, take into account the age characteristics of the leukocyte formula. So, in children under the age of 5-6 years, lymphocytosis is considered to be an increase in the number of lymphocytes over 60% and their absolute number over 5.5-6.0 x10 9 /l. In children older than 6 years with lymphocytosis leukocyte blood count demonstrates the content of lymphocytes more than 35%, and their absolute number exceeds 4 thousand. in 1 µl.

Functions of lymphocytes

The number of lymphocyte cells in the blood can be influenced by various physiological processes in the body. For example, a tendency to lymphocytosis is noted in children whose diet is dominated by carbohydrate foods, among residents of the highlands, during menstruation in women. In children with constitutional anomalies in the form of lymphatic diathesis, there is also a tendency to increase the content of lymphocytes in the blood.

viral infections (measles, influenza, rubella, adenovirus, acute viral hepatitis);
bacterial infections (tuberculosis, whooping cough, scarlet fever, syphilis)
endocrine diseases (hyperthyroidism, panhypopituitarism, Addison's disease, ovarian hypofunction, thymus hypoplasia);
allergic pathology (bronchial asthma, serum sickness);
immunocomplex and inflammatory diseases (Crohn's disease, ulcerative colitis, vasculitis);
taking certain medications (analgesics, nicotinamide, haloperidol).

Lymphocytosis in viral infections is recorded, as a rule, in the stage of convalescence - the so-called lymphocytosis of recovery.

Familial benign eosinophilias that are asymptomatic and inherited in an autosomal dominant manner have been described.

Change in the number of basophils

Basophilic granulocytes are involved in the formation of the immune (often allergic) and inflammatory response in the human body. With basophilia leukocyte formula of blood demonstrates the content of basophilic cells over 0.5-1%. Basophilia is rare. An increase in basophilic cells up to 2-3% often occurs with chronic myelogenous leukemia, lymphogranulomatosis, hemophilia, tuberculosis of the lymph nodes, with allergic reactions.

Conclusion

A child is born with the same percentage of leukocytes as an adult, in particular, about 65% of neutrophils and about 25% of lymphocytes. Immediately after birth, the number of neutrophils begins to fall, and the number of lymphocytes increases, and by 5-6 days of a child's life, their number becomes the same, about 40%, this first physiological crossover. In the future, the number of lymphocytes continues to increase, and the number of neutrophils to fall, and by 6 months of life, the number of lymphocytes will be 65%, and neutrophils 25%. This ratio is maintained for up to one year. After a year, the ratio of lymphocytes begins to slowly fall, and neutrophils increase, as a result of which, by 5-6 years, their values are leveled again - comes second physiological crossover. Finally, the leukocyte formula becomes the same as in adults only by the age of 13-14.

Lymph

Lymph is a liquid tissue formed from interstitial (tissue) fluid that forms plasma and blood cells, mainly lymphocytes. It passes through the system of lymphatic vessels through a chain of lymph nodes (in which it is cleansed and enriched with formed elements) and enters the venous blood through the thoracic duct. The volume of lymph in the human body is 1-2 liters.

Formed elements form no more than 1% of its volume. The cellular composition of the lymph: 90% lymphocytes, 5% monocytes, 2% eosinophils, 1% segmented neutrophils. Erythrocytes are normally absent in the lymph. Lymph is able to coagulate, forming a clot.

Control questions on the topic:

1. List the components of blood as tissues.

2. Erythrocytes, their shape, structure, functions, life expectancy.

5. Granular leukocytes, varieties, features of their structure and function.

6. Non-granular leukocytes, varieties, features of their structure and function.

7. Leukocyte formula, its indicators in a healthy person (child, adult).

8. Platelets, their formation, structure, functions.

9. Blood plasma, chemical composition.

10. Hemogram, its indicators in a healthy person, features.

11. Describe the morphological features of the lymph.

Lecture topic: OWN CONNECTIVE TISSUES, CONNECTIVE TISSUES WITH SPECIAL PROPERTIES

Lecture plan:

Functions of connective tissues proper (CCT)

Classification of connective tissues proper

Morphology of CCT on the example of loose fibrous unformed connective tissue (RVNCT)