Académique Documents
Professionnel Documents
Culture Documents
Chemistry
Electrolytes
Potassium Sodium Total CO2 Chloride
Blood Bank
- blood typing and storage
CELL MORPHOLOGY
(40-70% of WBCs) Life span of about 10 days Moves from bone marrow to blood to tissues Mature more quickly under stressful conditions Primary defense for bacterial infections
The Neutrophil
Once in the peripheral blood, it can be in
the circulating pool (CP) or the marginated pool (MP) (approx. 50%) cells in MP not counted in CBC Shift from the MP to the CP can occur with stress, trauma, catecholamines, etc. This results in a transient leukocytosis Such leukocytosis can last 4 to 6 hours
The Neutrophil
Present in band and segmented forms Bands make up < 5 % of circulating
neutrophils normally Left shift is seen as an increase in the number of bands and is common with acute infection Main function is to locate, ingest, and kill bacteria and other foreign invaders
Cause of Neutrophilia
Pathologic
Bacterial infection Certain viruses and fungi Inflammatory responses to tissue death
Burns Snake bites
Drugs
steroids lithium
Pools of Neutrophils
1. Bone marrow: many banded forms are
present; neutrophilia with lots of bands suggest bone marrow was source 2. Circulating Pool: used to deal with day to day invasion of the body by organisms 3. Marginated Pool: no bands; respond to physiologic stimulation
Causes of Neutropenia
Decreased Production of WBCs
bone marrow diseases malignancies that affect the bone marrow
blood before it locates in the skin, GI tract, or respiratory tract Only 1% of mature cells are located in blood
The Eosinophil
Also function as phagocytes but appear to
be less potent than neutrophil Drawn to sites of hypersensitivity reactions by mast cell chemotactic factors Often found in sputum of asthmatics May play a role in pathogenesis of lung dz Play a role in parasitic infections
The Basophils
Mature basophil Least common of WBCs (< 2%) Nucleus does not always segment Increase in response to same conditions that cause eosinophils to respond
The Monocytes
Also not common in circulating blood
Stay in blood for
about 70 hours Become macrophages in tissue and live for several months or longer
The Monocytes
Primary role is phagocytosis
Play large role in ingesting cellular debris Become activated when direct contact
with microorganisms occurs Activated cell has greater motility, enzyme activity and killing capacity (causes fever) Also play a role in immunity
The Lymphocytes
May mature into B or T cells Main function is antigen recognition and immune response Life span quite varied (up to two years) Can pass back and forth between blood and tissues
marrow but also mature there. However, the precursors of T cells leave the bone marrow and mature in the thymus (which accounts for their designation)
Types of Lymphocytes
B lymphocytes (or B cells) are most effective against bacteria & their toxins plus a few viruses
T lymphocytes (or T cells) recognize & destroy
body cells gone awry, including virus-infected cells & cancer cells. T cells come in two types: helper cells and suppressor cells; normally the helper cells predominate.
Decreased AIDS Bone Marrow suppression Aplastic Anemia Steroids Neurologic Disorders Multiple Sclerosis Myasthenia Gravis Gullain Barre Syndrome
d.
e. f. g. h.
Tuberculosis Mumps Cytomegalovirus Infection Infectious Mononucleosis Infectious Hepatitis Viral pneumonia
the culprit? Is it the neutrophils, eosinophils, lymphocytes, basophils, or monocytes? Marked leukocytosis is usually due to neutrophils or lymphocytes.
%
40 70 06 01
Absolute
1800 7500 0 600 0 100
Lymphocytes
Monocytes
20 45
26
900 4500
90 - 1000
leukocytosis, compare the neutrophil % to total WBC. The % neutrophils indicates the severity of the infection; the total WBC reflects the quality of the immune system
Case Study # 4
20 yr old male admitted following MVA WBC 14,500 75% neutrophils 1% bands Leukocytosis due to neutrophilia History and low per cent of bands suggest pseudoneutrophilia Due to liberation of marginated neutrophils in the intravascular system
Platelet Count
Normal count is 140,000 to 440,000/mm3
Life span of about 10 days Low platelet counts (thrombocytopenia)
cause excessive bleeding Thrombycytopenia is common with the use of heparin, DIC, bone marrow disease, liver failure and sepsis
Platelet
Platelet (Activated)
2. Anemia
abnormal Decrease in RBC count - decreased production - increased destruction (hemolysis) - blood loss
Hematocrit
erythrocytes only Useful to detect laboratory error in measuring the Hb, HCT, and RBC count 3 times the RBC count should = Hb 3 times Hb should = Hct
3x3=9
3 x 9.2 = 27.6
Reticulocyte Count
Normal values:
0.5 1.5% of RBC
of Anemia Increase indicates Anemia is due to Blood loss Decrease indicates Anemia is due to Bone marrow disease
Bibliography
Steine-Martin: Clinical Hematology, 2nd
edition, Lippincott, Philadelphia, 1998. Kaplan: Clinical Chemistry, 4th edition, Mosby, St. Louis, 2003. Wilkins: Clinical Assessment in Respiratory Care, 5th edition, Mosby, St. Louis, 2005.