Home Oral cavity What do the tests say? Decoding of the general blood test of adult men and women. What the tests say - transcript

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What do the tests say? Decoding of the general blood test of adult men and women. What the tests say - transcript

A complete blood count is a simple and informative blood test. Based on the results of a general blood test, you can obtain the necessary information for diagnosing many diseases, as well as assess the severity of some diseases and monitor the dynamics of the treatment. The general blood test includes the following indicators: hemoglobin, red blood cells, white blood cells, leukocyte formula (eosinophils, basophils, segmented and band neutrophils, monocytes and lymphocytes), erythrocyte sedimentation rate (ESR), platelets, color index and hematocrit. Although in a general blood test, if there are no direct indications, all these indicators are not always determined; sometimes they are limited to determining only ESR, leukocytes, hemoglobin and leukemia.

Hemoglobin Hb

120-160 g/l for men, 120-140 g/lfor women

Increased hemoglobin levels:

Diseases accompanied by an increase in the number of red blood cells (primary and secondary erythrocytosis)
Blood thickening (dehydration)
Congenital heart defects, pulmonary heart failure
Smoking (formation of functionally inactive HbCO)
Physiological causes (in residents of high mountains, pilots after high-altitude flights, climbers, after increased physical activity)

Decreased hemoglobin levels (anemia):

Increased hemoglobin loss during bleeding - hemorrhagic anemia
Increased destruction (hemolysis) of red blood cells - hemolytic anemia
Lack of iron necessary for the synthesis of hemoglobin, or vitamins involved in the formation of red blood cells (mainly B12, folic acid) - iron deficiency or B12 deficiency anemia
Impaired formation of blood cells in specific hematological diseases - hypoplastic anemia, sickle cell anemia, thalassemia

Hematocrit Ht

40-45% for men 36-42% for women

Shows the percentage of cells in the blood - red blood cells, leukocytes and platelets in relation to its liquid part - plasma. If the hematocrit drops, the person either suffered a hemorrhage or the formation of new blood cells is sharply inhibited. This happens with severe infections and autoimmune diseases. An increase in hematocrit indicates blood thickening, for example due to dehydration.

Increased hematocrit:

Erythremia (primary erythrocytosis)
Secondary erythrocytosis (congenital heart defects, respiratory failure, hemoglobinopathies, kidney tumors accompanied by increased formation of erythropoietin, polycystic kidney disease)
Decrease in the volume of circulating plasma (blood thickening) in case of burn disease, peritonitis, etc.
Dehydration of the body (with severe diarrhea, uncontrollable vomiting, excessive sweating, diabetes)

Decreased hematocrit:

Anemia
Increase in circulating blood volume (second half of pregnancy, hyperproteinemia)
Overhydration

Red blood cells R.B.C.

4-5*1012 per liter for men 3-4*1012 per liter for women

Cells that carry hemoglobin. Changes in the number of red blood cells are closely related to hemoglobin: few red blood cells - little hemoglobin (and vice versa).

Increased red blood cell count (erythrocytosis):

Absolute erythrocytosis (caused by increased production of red blood cells)

Erythremia, or Vaquez's disease, is one of the variants of chronic leukemia (primary erythrocytosis)
Secondary erythrocytoses:

- caused by hypoxia (chronic lung diseases, congenital heart defects, the presence of abnormal hemoglobins, increased physical activity, exposure to high altitudes)
- associated with increased production of erythropoietin, which stimulates erythropoiesis (kidney parenchyma cancer, hydronephrosis and polycystic kidney disease, liver parenchyma cancer, benign familial erythrocytosis)
- associated with excess adrenocorticosteroids or androgens (pheochromocytoma, Cushing's disease/syndrome, hyperaldosteronism, cerebellar hemangioblastoma)

Relative - with blood thickening, when plasma volume decreases while maintaining the number of red blood cells

dehydration (excessive sweating, vomiting, diarrhea, burns, increasing swelling and ascites)
emotional stress
alcoholism
smoking
systemic hypertension

Decreased levels (erythrocytopenia):

Acute blood loss
Deficiency anemia of various etiologies - as a result of deficiency of iron, protein, vitamins
Hemolysis
May occur secondary to various types of chronic non-hematological diseases
The number of red blood cells may physiologically decrease slightly after eating, between 17.00 and 7.00, and also when taking blood in a supine position.

Color index CPU

0.85-1.05V

The ratio of hemoglobin level to the number of red blood cells. The color index changes with various anemias: it increases with B12-, folate-deficiency, aplastic and autoimmune anemia and decreases with iron deficiency.

Leukocytes WBC

3-8*109 per liter

White blood cells are responsible for fighting infections. The number of leukocytes increases with infections and leukemia. It decreases due to inhibition of the formation of leukocytes in the bone marrow during severe infections, cancer and autoimmune diseases.

Increased levels (leukocytosis):

Acute infections, especially if their causative agents are cocci (staphylococcus, streptococcus, pneumococcus, gonococcus). Although a whole series acute infections(typhoid, paratyphoid, salmonellosis, etc.) can in some cases lead to leukopenia (decrease in the number of leukocytes)
Inflammatory conditions; rheumatic attack
Intoxications, including endogenous (diabetic acidosis, eclampsia, uremia, gout)
Malignant neoplasms
Injuries, burns
Acute bleeding (especially if the bleeding is internal: into the abdominal cavity, pleural space, joint or in close proximity to the dura mater)
Surgical interventions
Infarction of internal organs (myocardium, lungs, kidneys, spleen)
Myelo- and lymphocytic leukemia
The result of the action of adrenaline and steroid hormones
Reactive (physiological) leukocytosis: impact physiological factors(pain, cold or hot bath, physical activity, emotional stress, exposure sunlight and UV rays); menstruation; period of childbirth

Decreased level (leukopenia):

Some viral and bacterial infections (influenza, typhoid fever, tularemia, measles, malaria, rubella, mumps, infectious mononucleosis, miliary tuberculosis, AIDS)
Sepsis
Bone marrow hypo- and aplasia
Damage to the bone marrow by chemicals and drugs
Exposure to ionizing radiation
Splenomegaly, hypersplenism, post-splenectomy condition
Acute leukemia
Myelofibrosis
Myelodysplastic syndromes
Plasmacytoma
Metastases of neoplasms to the bone marrow
Addison–Biermer disease
Anaphylactic shock
Systemic lupus erythematosus, rheumatoid arthritis and other collagenoses
Taking sulfonamides, chloramphenicol, analgesics, non-steroidal anti-inflammatory drugs, thyreostatics, cytostatics

Neutrophils NEU

up to 70% of the total number of leukocytes

Neutrophils are cells of a nonspecific immune response; they are found in large numbers in the submucosal layer and on the mucous membranes. Their main task is to swallow foreign microorganisms. Their increase indicates a purulent inflammatory process. But you should be especially wary if there is a purulent process, but there is no increase in neutrophils in the blood test.

Increased neutrophil levels (neutrophilia, neutrophilia):

Acute bacterial infections

localized (abscesses, osteomyelitis, acute appendicitis, acute otitis, pneumonia, acute pyelonephritis, salpingitis, meningitis, tonsillitis, acute cholecystitis and etc.)
generalized (sepsis, peritonitis, pleural empyema, scarlet fever, cholera, etc.)

Inflammatory processes and tissue necrosis (myocardial infarction, extensive burns, rheumatism, rheumatoid arthritis, pancreatitis, dermatitis, peritonitis)
Condition after surgery
Endogenous intoxications (diabetes mellitus, uremia, eclampsia, hepatocyte necrosis)
Exogenous intoxications (lead, snake venom, vaccines)
Oncological diseases (tumors of various organs)
Taking some medicines eg corticosteroids, digitalis preparations, heparin, acetylcholine
Physical stress and emotional stress and stressful situations: exposure to heat, cold, pain, burns and childbirth, pregnancy, fear, anger, joy

Decreased neutrophil levels (neutropenia):

Some infections caused by bacteria (typhoid fever and paratyphoid fever, brucellosis), viruses (influenza, measles, chickenpox, viral hepatitis, rubella), protozoa (malaria), rickettsia (typhus), prolonged infections in elderly and weakened people
Diseases of the blood system (hypo- and aplastic, megaloblastic and iron deficiency anemia, paroxysmal nocturnal hemoglobinuria, acute leukemia)
Congenital neutropenia (hereditary agranulocytosis)
Anaphylactic shock
Splenomegaly of various origins
Thyrotoxicosis
Ionizing radiation
Impact of cytostatics, antitumor drugs
Drug-induced neutropenia associated with increased sensitivity of individuals to the action of certain drugs (non-steroidal anti-inflammatory drugs, anticonvulsants, antihistamines, antibiotics, antiviral agents, psychotropic drugs, drugs affecting the cardiovascular system, diuretics, antidiabetic drugs)

Eosinophils EOS

1-5% of total leukocytes

Increased levels (eosinophilia):

Decreased levels (eosinopenia):

Initial phase of the inflammatory process
Severe purulent infections
Shock, stress
Intoxication with various chemical compounds, heavy metals

LymphocytesLYM

Cells of specific immunity. If, with severe inflammation, the rate drops below 15%, it is important to evaluate the absolute number of lymphocytes per 1 microliter. It should not be lower than 1200-1500 cells.

Increased level of lymphocytes (lymphocytosis):

Infectious diseases: infectious mononucleosis, viral hepatitis, cytomegalovirus infection, whooping cough, ARVI, toxoplasmosis, herpes, rubella, HIV infection
Diseases of the blood system (chronic lymphocytic leukemia; lymphosarcoma, heavy chain disease - Franklin disease)
Poisoning with tetrachloroethane, lead, arsenic, carbon disulfide
Treatment with drugs such as levodopa, phenytoin, valproic acid, narcotic analgesics

Decreased lymphocyte levels (lymphopenia):

Severe viral diseases
Miliary tuberculosis
Lymphogranulomatosis
Aplastic anemia
Pancytopenia
Kidney failure
Circulatory failure
Terminal stage of cancer
Immunodeficiencies (with T-cell deficiency)
X-ray therapy
Taking drugs with a cytostatic effect (chlorambucil, asparaginase), glucocorticoids

PlateletsPLT

170-320* 109 per liter

Platelets are the cells responsible for stopping bleeding - hemostasis. And they, like scavengers, collect on the membrane the remnants of inflammatory wars - circulating immune complexes. A platelet count below normal may indicate an immunological disease or severe inflammation.

Increased levels (thrombocytosis):

Primary thrombocytosis (as a result of proliferation of megakaryocytes)

Essential thrombocythemia
Erythremia
Myeloproliferative disorders (myeloid leukemias)

Secondary thrombocytosis (occurring against the background of any disease)

Inflammatory processes (systemic inflammatory diseases, osteomyelitis, ulcerative colitis, tuberculosis)
Cirrhosis of the liver
Acute blood loss or hemolysis
Condition after splenectomy (for 2 months or more)
Oncological diseases (cancer, lymphoma)
Conditions after surgery (within 2 weeks)

Decreased level (thrombocytopenia):

Congenital thrombocytopenias:

Wiskott-Aldrich syndrome
Chediak-Higashi syndrome
Fanconi syndrome
May-Hegglin anomaly
Bernard-Soulier syndrome (giant platelets)

Acquired thrombocytopenia:

Idiopathic autoimmune thrombocytopenic purpura
Drug-induced thrombocytopenia
Systemic lupus erythematosus
Thrombocytopenia associated with infection (viral and bacterial infections, rickettsiosis, malaria, toxoplasmosis)
Splenomegaly
Aplastic anemia and myelophthisis (replacement of bone marrow by tumor cells or fibrous tissue)
Tumor metastases to the bone marrow
Megaloblastic anemias
Paroxysmal nocturnal hemoglobinuria (Marchiafava-Micheli disease)
Evans syndrome (autoimmune hemolytic anemia and thrombocytopenia)
DIC syndrome (disseminated intravascular coagulation)
Massive blood transfusions, extracorporeal circulation
During the neonatal period (prematurity, hemolytic disease of the newborn, neonatal autoimmune thrombocytopenic purpura)
Congestive heart failure
Renal vein thrombosis

ESR-speederythrocyte sedimentation

10 mm/h for men 15 mm/h for women

An increase in ESR signals an inflammatory or other pathological process. Increased without visible reasons ESR should not be ignored!

Increase (acceleration of ESR):

Inflammatory diseases of various etiologies
Acute and chronic infections (pneumonia, osteomyelitis, tuberculosis, syphilis)
Paraproteinemia (multiple myeloma, Waldenström's disease)
Tumor diseases (carcinoma, sarcoma, acute leukemia, lymphogranulomatosis, lymphoma)
Autoimmune diseases (collagenoses)
Kidney diseases (chronic nephritis, nephrotic syndrome)
Myocardial infarction
Hypoproteinemia
Anemia, condition after blood loss
Intoxication
Injuries, bone fractures
Condition after shock, surgical interventions
Hyperfibrinogenemia
In women during pregnancy, menstruation, and the postpartum period
Elderly age
Taking medications (estrogens, glucocorticoids)

Decrease (slowdown of ESR):

Erythremia and reactive erythrocytosis
Severe symptoms of circulatory failure
Epilepsy
Fasting, decreased muscle mass
Taking corticosteroids, salicylates, calcium and mercury preparations
Pregnancy (especially 1st and 2nd semester)
Vegetarian diet
Myodystrophies

Agranulocytosis – a sharp decrease in the number of granulocytes in the peripheral blood up to their complete disappearance, leading to a decrease in the body's resistance to infection and the development of bacterial complications. Depending on the mechanism of occurrence, a distinction is made between myelotoxic (arising as a result of the action of cytostatic factors) and immune agranulocytosis.

Monocytes- the largest cells among leukocytes, do not contain granules. They are formed in the bone marrow from monoblasts and belong to the system of phagocytic mononuclear cells. Monocytes circulate in the blood for 36 to 104 hours, and then migrate into tissues, where they differentiate into organ- and tissue-specific macrophages.

Macrophages play a critical role in the processes of phagocytosis. They are capable of absorbing up to 100 microbes, while neutrophils are only 20-30. Macrophages appear at the site of inflammation after neutrophils and exhibit maximum activity in an acidic environment, in which neutrophils lose their activity. At the site of inflammation, macrophages phagocytize microbes, dead leukocytes, and damaged cells of inflamed tissue, thereby cleaning the site of inflammation and preparing it for regeneration. For this function, monocytes are called “the body’s wipers.”

Increased levels of monocytes (monocytosis):

Infections (viral (infectious mononucleosis), fungal, protozoal (malaria, leishmaniasis) and rickettsial etiology), septic endocarditis, as well as the period of convalescence after acute infections
Granulomatosis: tuberculosis, syphilis, brucellosis, sarcoidosis, ulcerative colitis (nonspecific)
Blood diseases (acute monoblastic and myelomablastic leukemia, myeloproliferative diseases, myeloma, lymphogranulomatosis)
Systemic collagenoses (systemic lupus erythematosus), rheumatoid arthritis, periarteritis nodosa
Poisoning with phosphorus, tetrachloroethane

Decreased monocyte count (monocytopenia):

Aplastic anemia (bone marrow damage)
Hairy cell leukemia
Surgical interventions
Shock conditions
Taking glucocorticoids

Basophils- the smallest population of leukocytes. The lifespan of basophils is 8-12 days; The circulation time in peripheral blood, like all granulocytes, is short - a few hours. The main function of basophils is to participate in the immediate anaphylactic hypersensitivity reaction. They are also involved in delayed-type reactions through lymphocytes, in inflammatory and allergic reactions, and in the regulation of vascular wall permeability. Basophils contain biologically active substances such as heparin and histamine (similar to mast cells connective tissue).

Increased level of basophils (basophilia):

Allergic reactions to food, medications, introduction of foreign protein
Chronic myeloid leukemia, myelofibrosis, erythremia
Lymphogranulomatosis
Chronic ulcerative colitis
Myxedema (hypothyroidism)
Chicken pox
Nephrosis
Condition after splenectomy
Hodgkin's disease
Treatment with estrogens

Decreased basophil levels (basopenia)– difficult to assess due to the low content of basophils in normal conditions.

Update: December 2018

Total protein in blood serum is the total concentration of albumin and globulin in the liquid component of blood, expressed quantitatively. This indicator is measured in g/liter.

Protein and protein fractions are composed of complex amino acids. Blood proteins take part in various biochemical processes in our body and serve to transport nutrients (lipids, hormones, pigments, minerals, etc.) or medicinal components to various organs and systems.

They also act as catalysts and provide immune defense for the body. Total protein serves to maintain a constant pH in the circulating blood and takes an active part in the coagulation system. Due to protein, all blood components (leukocytes, erythrocytes, platelets) are present in the serum in suspension. It is the protein that determines the filling of the vascular bed.

Based on total protein, one can judge the state of hemostasis, because Due to protein, blood has such characteristics as fluidity and has a viscous structure. The functioning of the heart and the cardiovascular system as a whole depends on these qualities of blood.

The study of total blood protein refers to biochemical analysis and is one of the main indicators for diagnosing various diseases; it is also included in the mandatory list of studies during clinical examination for some groups of the population.

Norms of protein concentration in blood serum of various age categories:

Total blood protein is required to be determined during diagnosis:

kidney diseases, liver diseases
acute and chronic infectious processes of various types
burns, cancer
metabolic disorders, anemia
nutritional disorders and exhaustion, gastrointestinal diseases - to assess the degree of malnutrition
a number of specific diseases
as stage 1 in comprehensive examination patient's health status
to assess the body's reserves before surgery, medical procedures, taking medications, the effectiveness of treatment and determine the prognosis of the current disease

Readings of total blood protein make it possible to assess the patient’s condition, the function of his organs and systems in maintaining proper protein metabolism, and also determine the rationality of nutrition. In case of deviation from the normal value, the specialist will prescribe further examination to identify the cause of the disease, for example, the study of protein fractions, which can show the percentage of albumin and globulins in the blood serum.

Deviations from the norm may be:

Relative deviations associated with changes in the amount of water in the circulating blood, for example, during infusions or, conversely, with excessive sweating.
Absolute are caused by changes in the rate of protein metabolism. They can be caused by pathological processes that affect the rate of synthesis and breakdown of serum proteins or physiological processes, such as pregnancy.
Physiological abnormalities from the norm of total protein in the blood serum are not associated with the disease, but can be caused by the intake of protein foods, prolonged bed rest, pregnancy, lactation, or changes in water load and heavy physical work.

What does a decrease in the concentration of total protein in the blood serum indicate?

Reduced levels of total protein in the blood are called hypoproteinemia. This condition can be observed during pathological processes, for example, such as:

parenchymal hepatitis
chronic bleeding
anemia
loss of protein in urine in kidney disease
diets, fasting, insufficient consumption of protein foods
increased protein breakdown associated with metabolic disorders
intoxications of various types
fever.

Special mention should be made of physiological hypoproteinemia, i.e. conditions not associated with the course of pathological processes (disease). A decrease in total protein in the blood can be observed:

in the last trimester of pregnancy
during lactation
during prolonged heavy loads, for example when preparing athletes for competitions
with prolonged physical inactivity, for example, in bedridden patients

Symptomatically, a decrease in the concentration of total protein in the blood can be expressed by the appearance of tissue edema. This symptom usually appears with a significant decrease in total protein, below 50 g/l.

What does an increase in total protein in the blood serum indicate?

A significant increase in the concentration of total protein in the blood is called hyperproteninemia. This condition cannot be observed during normal physiological processes, which means it develops only in the presence of pathology, in which pathological proteins are formed.

For example, an increase in total protein in the blood may indicate the development of an infectious disease or condition in which it occurs (burns, vomiting, diarrhea, etc.).

An increase in total protein cannot be accidental; in this case, it is recommended to seek help from a doctor as soon as possible for further examination. Only a specialist can establish the cause, make a correct diagnosis and prescribe effective treatment.

Diseases in which there is a decrease and increase in total protein in the blood:

Reduced total blood protein	Elevated total blood protein
Surgical interventions Tumor processes Liver diseases (hepatitis, cirrhosis, tumors and metastases) Glomerulonephritis Gastrointestinal diseases (pancreatitis, enterocolitis) Acute and chronic bleeding Burn disease Anemia Wilson-Konovalov Bn (heredity)

From the article, the reader will learn what a general blood test shows, in what cases it is prescribed, and what indicators the general blood test includes. How to prepare for the test procedure, and what factors may influence the results. Find out normal values and how they change when various states and diseases of the body.

Blood testing is an important step in examination and diagnosis. The hematopoietic organs are susceptible to physiological and pathological influences. They change the blood picture.

As a result, the general analysis (GCA) is the most popular analysis method, which helps the doctor judge general condition body. For a detailed examination, in addition to the CBC, a biochemical analysis and a general urinalysis (UUF) are prescribed. About what it shows general Analysis of urine, a separate article has already been written. If anyone is interested, you can read it.

What does a general blood test show, detailed, main indicators

Let's find out what a general blood test shows and why it is taken. General hematological blood test is an important diagnostic criterion that reflects the answer hematopoietic system on the effect of physiological and pathological factors.

CBC is of great importance in establishing a diagnosis, especially in diseases of the hematopoietic organs. The UAC covers the study of the following indicators:

hemoglobin (Hb) level
red blood cells
leukocytes
platelets
color index
leukoformula calculation
erythrocyte sedimentation rate

If necessary, clotting time and bleeding duration are examined. In many laboratories, analysis is carried out on hematology automatic analyzers. They immediately determine up to 36 parameters.

Hemoglobin, functions and clinical significance

Hb - blood pigment, is the core component of the erythrocyte. Its role is to transport O2 from the lungs to organs, tissues and remove carbon dioxide.

The hemoglobin level performs the main function in the diagnosis of anemia of various etiologies. At the same time, his performance decreases.

An increase in Hb concentration occurs with erythremia, symptomatic erythrocytosis, congenital heart disease, and cardiopulmonary failure. An increase in Hb is combined with an increase in the number of red blood cells.
With acute blood loss, there is a significant decrease in Hb to 50 g/l. The minimum pigment content in the blood compatible with life is 10 g/l.

If you have problems with back pain, I suggest you find out what it is, it is also very useful, which is also covered in the article - follow the link.

Red blood cells, physiological role in the body

Red blood cells occupy the main share of the mass shaped elements blood, contains hemoglobin. The main function is the transfer of O 2 with the assistance of Hb. In addition, red blood cells participate in:

in the absorption of lipids, amino acids, toxins
in enzymatic processes
when regulating the acid-base balance of the body
in regulating plasma ion equilibrium

A decrease in the number of red blood cells is one of the signs of anemia. In addition to anemia, red blood cells decrease when the volume of blood in the bloodstream increases, for example during pregnancy.

An increase in the number of red blood cells (erythrocytosis) is characteristic of erythremia. CBC in newborns will show erythrocytosis during the first 3 days of life. In adults, erythrocytosis is observed during fasting, profuse sweating, and climbing to altitude.

Leukocytes: their physiological role in the body

The number of leukocytes (L) in the bloodstream is an important diagnostic criterion. They perform important functions - protective, trophic and others. An increase in the number of leukocytes more than 10 × 10 9 /l (G/l) is called leukocytosis.

Most often, leukocytosis occurs as a consequence of acute infections caused by cocci. Therefore, the CBC will definitely show inflammation, pneumonia, and blood cancer. Leukocytosis is typical for:

leukemia of various courses, malignant tumors
inflammatory, purulent, acute infectious processes
uremia
myocardial infarction
toxic poisoning, severe blood loss, shock, extensive burns

CBC in acute appendicitis will show an increase in the amount of L. Leukocytosis is characteristic of tubal pregnancy, splenic rupture, and acute gout.

A decrease in the number of leukocytes below 3.5 g/l is called leukopenia. Leukopenia tendencies occur in healthy populations and are often hereditary, but may be influenced by exposure external factors environment (solar radiation).

Sometimes it occurs during fasting, when tone decreases, or during sleep. Leukopenia is typical for:

infections caused by viruses and bacteria - typhoid fever, endocarditis, salmonellosis, measles, influenza, rubella
lupus erythematosus
hemoblastoses
and children (read more by following the link)

The appearance of leukopenia is associated with inhibition of cell maturation and the release of L from the hematopoietic organs and their redistribution into vascular bed.

The diagnostic value of calculating the leukoformula is enormous in many pathological conditions. It can be used to judge the severity of the situation and the effectiveness of the prescribed therapy.

Leukocytes include cells of the lymphocytic, monocyte, and granulocytic series. To find out their number use counting leukocyte formula – % content of different types of leukocytes:

band and segmented neutrophils
eosinophils
monocytes
basophils
lymphocytes

Neutrophils carry out bactericidal and virucidal functions. They are capable of phagocytosis in capillaries and participate in all stages of inflammation. Therefore, an increase in the number of neutrophils will show inflammation in the body. Neutrophilia (above 8×10 9 /l) is present in any suppurative process, sepsis.

Eosinophils have a detoxifying effect. They are found in large quantities in tissue fluid, intestinal mucosa, and skin.

Eosinophilia accompanies connective tissue diseases - polyarteritis, rheumatoid arthritis, tumors, especially with metastases and necrosis.

Eosinopenia (decrease) is typical for an infectious-toxic process in the postoperative period. And it indicates the severity of the condition.

Basophils have anticoagulant properties. Involved in inflammatory and allergic processes. Basophilia occurs when an allergic reaction to food, medication, or foreign protein. For oncology - chronic myeloid leukemia, myelofibrosis, erythremia, lymphogranulomatosis.

Characteristic of ulcerative colitis, treatment with estrogen. Basophilia is likely during ovulation and pregnancy, with lung cancer, anemia of unknown origin, and iron deficiency.

Monocytes have the ability to phagocytose. They actively phagocytose (absorb) cell debris, small foreign bodies, malaria plasmodia, and mycobacterium tuberculosis.

With tuberculosis, monocytosis is observed in the blood - an increase in the number of monocytes. Monocytopenia is observed with hypoplasia of hematopoiesis.

Lymphocytes important for immunity. In addition, lymphocytes take part in the fight against infection and also perform a trophic function at sites of inflammation and wounds. Lymphocytosis is possible with infectious mononucleosis, tuberculosis, and syphilis.

Platelets - physiological role, clinical significance

Formed element of blood, participates in hemostasis processes. Thrombocytosis(increase in tr number) can be observed under physiological conditions after physical activity, due to excitement nervous system. Thrombocytosis occurs when:

injuries with muscle damage
burns, asphyxia, after blood loss and removal of the spleen
leukemia – erythremia, myeloid leukemia

Thrombocytopenia(decrease in tr number) in physiological conditions occurs during menstrual blood loss in women, after histamine. In pathological conditions, thrombocytopenia occurs when:

In this case, the autoimmune factor is of great importance - the formation of antibodies to one’s platelets.

Erythrocyte sedimentation rate

An increase in ESR can occur under physiological conditions - during pregnancy, during fasting, when eating dry food, after vaccination, when taking certain medications.

Changes in ESR in pathology have diagnostic and prognostic meaning. And it serves as an indicator of the effectiveness of the treatment. ESR increases with:

infections and inflammations
purulent processes
rheumatism
kidney diseases, liver diseases ( including with)
myocardial infarction, malignant tumors, anemia

Reduced ESR levels occur during processes accompanied by blood thickening. Sometimes observed with neuroses, epilepsy, anaphylactic shock, and erythremia.

Total red blood cell volume (hematocrit)

Hematocrit (Ht) is the ratio of plasma to formed elements. An increase in Ht occurs with heart defects and is accompanied by cyanosis and erythrocytosis.

A decrease in hematocrit is typical for various anemias in the second half of pregnancy.

Color index

Color or color index is the relative amount of Hb in a red blood cell. A decrease in this value occurs with iron deficiency.

An increase in the color index is observed with anemia, deficiency of Vit B 12 (cyanocobolamine), and folic acid. Accompanies cirrhosis of the liver, thyroid disease, occurs during therapy with cytostatics, taking contraceptives, and using anticonvulsants.

Normal blood laboratory tests

An important stage in assessing the result of OAC is to establish the difference between pathology and the norm. To do this, it is necessary to define normal indicators - these are indicators found in healthy people. They may differ depending on gender.

Index	Normal values
Index	men	women
Hemoglobin, Hb	125 - 170 g/l	105 – 155 g/l
Red blood cells, Er	3.8 – 5.5 T/L	3.5 – 4.9 T/l
Leukocytes, L	3.8 – 9.5 G/L
Hematocrit	40 – 50 %	38 – 47 %
ESR	1 – 10 mm/h	2 – 12 mm/h
Platelets, tr	150 – 380×10 9 /l
Segmented neutrophils Band neutrophils Lymphocytes Monocytes Eosinophils Basophils

When assessing test results, it must be remembered that deviations outside the normal range do not necessarily indicate the presence of a disease.

When interpreting the results, it is necessary to find out whether the deviations are physiological in nature. We should not forget about the variability of the norm associated with personal characteristics.

When interpreting the results, it is necessary to take into account many factors: age, gender, concomitant diseases, medications, living conditions and much more. Therefore, a doctor should do this.

Where to take blood for testing: from a vein or from a finger

On the results laboratory research The location and technique of collecting biological material has a significant impact. In medical practice, blood from capillaries is more often used. It is usually taken from the pulp ring fingers hands, in difficult cases - from the earlobe.

The puncture is made from the side, where the capillary network is thicker. The blood should flow by gravity so that there is no admixture of tissue fluid, which will distort the result. For testing, capillary blood should be taken:

for extensive burns of the body, especially the hands
if the veins are small or inaccessible, if you are obese
in patients prone to thrombosis
in newborns

Currently, blood from the venous bed is revered the best material for general clinical analysis. This is due to the use of hematology analyzers. With their help, in our time, OAC is carried out. They are designed and standardized for the processing of venous blood.

When taking blood from a vein, you also need to follow some rules. The best place to take blood is the cubital vein. Do not apply a tourniquet for more than 2 minutes, this will lead to an increase in cellular elements in the bloodstream.

When assessing test results, it is necessary to take into account a number of factors that influence them. Let's name the most significant ones:

food intake and composition, nutritional routine
physical stress has a transient and long-term effect on results
nervous stress increases leukocytosis
medications
body position during the collection procedure
place and technique of blood collection
time and conditions for delivery of biomaterial to the laboratory

Among other factors that influence the results, the age of the patient, gender, and temperature are relevant. external environment. Harmful tendencies - smoking and alcohol - have a great influence. They lead to an increase in Hb concentration and the number of red blood cells. On the contrary, the number of leukocytes decreases.

Basic rules for preparing to take the UAC

in agreement with the doctor, stop taking medications the day before the test
do not donate blood after physiotherapy or x-ray examination
do not donate blood directly after mental and physical exertion
1 hour before the procedure, refrain from smoking
Avoid fatty and spicy foods and alcohol 48 hours before the procedure
go to bed at your usual time, get up no later than one hour before blood sampling

Repeated examinations should be carried out at the same hours, since the morphological composition of the blood is prone to daily fluctuations.
I suggest watching a video of how a general blood test is done:

Do not neglect the rules of preparation for the research procedure, and you will not be afraid of false results!

So, now the reader knows what a general blood test shows, the purpose of its purpose, what indicators the general analysis includes. How to prepare for the test procedure, and what factors influence the results. We learned about normal values and how they change under various conditions and diseases of the body.

Still have questions? Ask in the comments.

Clinical tests provide a doctor with enormous information about the patient’s health status, and their importance for medical practice can hardly be overestimated. These research methods are quite simple, require minimal equipment and can be performed in the laboratory of almost any medical institution. For this reason, clinical examinations of blood, urine and stool are routine and should be performed on all people admitted for treatment to a hospital, hospital or clinic, as well as on most patients undergoing outpatient examination for various diseases.

1.1. General clinical blood test

Blood is a liquid tissue that continuously circulates throughout vascular system and delivers oxygen and nutrients, and also removes “waste” waste products from them. The total amount of blood is 7-8% of a person's weight. Blood consists of a liquid part - plasma and formed elements: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (platelets).

How is blood obtained for clinical research?

To conduct a clinical analysis, capillary blood is used, which is obtained from the finger of the hand (usually the ring finger, less often the middle and index finger) by puncturing the lateral surface of the soft tissue of the terminal phalanx with a special disposable lancet. This procedure is usually performed by a laboratory assistant.

Before taking blood, the skin is treated with a 70% alcohol solution, the first drop of blood is blotted with a cotton ball, and the subsequent ones are used to prepare blood smears, collected in a special glass capillary to determine the erythrocyte sedimentation rate, as well as assess other indicators, which will be discussed below. .Basic rules for taking blood from a finger

To avoid mistakes when performing a clinical blood test, you need to follow some rules. A finger prick blood test should be taken in the morning after an overnight fast, i.e. 8-12 hours after the last meal. The exception is when the doctor suspects the development of a serious acute illness, for example, acute appendicitis, pancreatitis, myocardial infarction, etc. In such situations, blood is taken regardless of the time of day or meal.

Before visiting the laboratory, you are allowed moderate consumption drinking water. If you drank alcohol the day before, it is better to get your blood tested no earlier than 2-3 days later.

In addition, before taking blood for testing, it is advisable to avoid excessive physical activity (cross country, lifting weights, etc.) or other intense effects on the body (visiting a steam room, sauna, swimming in cold water, etc.). In other words, the physical activity regimen before donating blood should be as normal as possible.

You should not stretch or rub your fingers before drawing blood, as this can lead to an increase in the level of leukocytes in the blood, as well as a change in the ratio of the liquid and dense parts of the blood.

The main indicators of a clinical blood test and what their changes may indicate

The most important indicators for assessing the health status of the subject are such indicators as the ratio of the volume of liquid and cellular parts of blood, the number of cellular elements of blood and the leukocyte formula, as well as the content of hemoglobin in erythrocytes and the erythrocyte sedimentation rate.

1.1. 1. Hemoglobin

Hemoglobin is a special protein that is found in red blood cells and has the ability to attach oxygen and transfer it to various human organs and tissues. Hemoglobin is red, which determines the characteristic color of blood. The hemoglobin molecule consists of a small non-protein part called heme, which contains iron, and a protein called globin.

A decrease in hemoglobin below the lower limit of normal is called anemia and can be caused by various reasons, among which the most common are iron deficiency in the body, acute or chronic blood loss, lack of vitamin B 12 and folic acid. Anemia is often detected in patients with cancer. It should be remembered that anemia is always a serious symptom and requires an in-depth examination to determine the causes of its development.

With anemia, the oxygen supply to the body's tissues sharply decreases, and oxygen deficiency primarily affects those organs in which metabolism occurs most intensively: the brain, heart, liver and kidneys.

The more pronounced the decrease in hemoglobin, the more severe the anemia. A decrease in hemoglobin below 60 g/l is considered life-threatening for the patient and requires an urgent blood or red blood cell transfusion.

The level of hemoglobin in the blood increases with some severe blood diseases - leukemia, with “thickening” of the blood, for example due to dehydration, as well as compensatory in healthy people in high altitude conditions or in pilots after flights. high altitude.

1.1.2. Red blood cells

Red blood cells, or red blood cells, are small, flat, round cells with a diameter of about 7.5 microns. Since the red blood cell is slightly thicker at the edges than in the center, “in profile” it looks like a biconcave lens. This form is the most optimal and makes it possible for red blood cells to be maximally saturated with oxygen and carbon dioxide as they pass through the pulmonary capillaries or vessels of internal organs and tissues, respectively. Healthy men have 4.0-5.0 x 10 12 /l in their blood, and healthy women have 3.7-4.7 x 10 12 /l.

A decrease in the content of red blood cells in the blood, as well as hemoglobin, indicates the development of anemia in a person. With different forms of anemia, the number of red blood cells and the level of hemoglobin may decrease disproportionately, and the amount of hemoglobin in the red blood cell may vary. In this regard, when conducting a clinical blood test, the color indicator or the average hemoglobin content in a red blood cell must be determined (see below). In many cases, this helps the doctor quickly and correctly diagnose one or another form of anemia.

A sharp increase in the number of red blood cells (erythrocytosis), sometimes up to 8.0-12.0 x 10 12 / l or more, almost always indicates the development of one of the forms of leukemia - erythremia. Less commonly, in individuals with such changes in the blood, so-called compensatory erythrocytosis is detected, when the number of red blood cells in the blood increases in response to a person’s presence in an atmosphere thinned by oxygen (in the mountains, when flying at high altitude). But compensatory erythrocytosis occurs not only in healthy people. Thus, it was noticed that if a person has severe lung diseases with respiratory failure (pulmonary emphysema, pneumosclerosis, chronic bronchitis, etc.), as well as pathology of the heart and blood vessels that occurs with heart failure (heart defects, cardiosclerosis, etc.), the body compensatory increases the formation of red blood cells in the blood.

Finally, the so-called paraneoplastic (Greek para - near, at; neo... + Greek. plasis- formations) erythrocytosis, which develops in some forms of cancer (kidney, pancreas, etc.). It should be noted that red blood cells may have unusual sizes and shapes in various pathological processes, which has important diagnostic significance. The presence of red blood cells of various sizes in the blood is called anisocytosis and is observed in anemia. Red blood cells normal sizes(about 7.5 microns) are called normocytes, reduced ones are called microcytes, and enlarged ones are called macrocytes. Microcytosis, when small red blood cells predominate in the blood, is observed in hemolytic anemia, anemia after chronic blood loss, and often in malignant diseases. The size of red blood cells increases (macrocytosis) with B12-, folate-deficiency anemia, with malaria, with liver and lung diseases. The largest red blood cells, the size of which is more than 9.5 microns, are called megalocytes and are found in B12-, folate-deficiency anemia and, less often, in acute leukemia. The appearance of erythrocytes of irregular shape (elongated, worm-shaped, pear-shaped, etc.) is called poikilocytosis and is considered a sign of inadequate regeneration of erythrocytes in the bone marrow. Poikilocytosis is observed in various anemias, but is especially pronounced in B 12 deficiency anemia.

Some forms of congenital diseases are characterized by other specific changes in the shape of red blood cells. Thus, sickle-shaped red blood cells are observed in sickle cell anemia, and target-like red blood cells (with a colored area in the center) are detected in thalassemia and lead poisoning.

Young forms of red blood cells called reticulocytes can also be detected in the blood. Normally, they are contained in the blood at 0.2-1.2% of the total number of red blood cells.

The importance of this indicator is mainly due to the fact that it characterizes the ability of the bone marrow to quickly restore the number of red blood cells during anemia. Thus, an increase in the content of reticulocytes in the blood (reticulocytosis) in the treatment of anemia caused by a lack of vitamin Bx2 in the body is an early sign of recovery. In this case, the maximum increase in the level of reticulocytes in the blood is called a reticulocyte crisis.

On the contrary, an insufficiently high level of reticulocytes in long-term anemia indicates a decrease in the regenerative capacity of the bone marrow and is an unfavorable sign.

It should be borne in mind that reticulocytosis in the absence of anemia always requires further examination, as it can be observed with cancer metastases to the bone marrow and some forms of leukemia.

Normally, the color index is 0.86-1.05. An increase in the color index above 1.05 indicates hyperchromia (Greek hyper - above, over, on the other side; chroma - color) and is observed in people with Bxr-deficiency anemia.

A decrease in color index of less than 0.8 indicates hypochromia (Greek hypo - below, under), which is most often observed in iron deficiency anemia. In some cases, hypochromic anemia develops with malignant neoplasms, more often with stomach cancer.

If the level of red blood cells and hemoglobin is reduced, and the color index is within the normal range, then we speak of normochromic anemia, which includes hemolytic anemia - a disease in which rapid destruction of red blood cells occurs, as well as aplastic anemia - a disease in which insufficient production is produced in the bone marrow number of red blood cells.

Hematocrit number, or hematocrit- this is the ratio of the volume of red blood cells to the volume of plasma, also characterizing the degree of deficiency or excess of red blood cells in a person’s blood. In healthy men this figure is 0.40-0.48, in women - 0.36-0.42.

An increase in hematocrit occurs with erythremia - a severe oncological blood disease and compensatory erythrocytosis (see above).

Hematocrit decreases with anemia and blood dilution, when the patient receives a large amount of medicinal solutions or takes an excessive amount of liquid orally.

1.1.3. Erythrocyte sedimentation rate

Erythrocyte sedimentation rate (ESR) is perhaps the most well-known laboratory indicator, the meaning of which they know something about, or at least guess that “ high ESR is a bad sign,” most people who undergo regular medical examinations.

The erythrocyte sedimentation rate refers to the rate of separation of uncoagulated blood placed in a special capillary into 2 layers: the lower one, consisting of settled erythrocytes, and the upper one, made of transparent plasma. This indicator is measured in millimeters per hour.

Like many other laboratory parameters, the ESR value depends on the gender of the person and normally ranges from 1 to 10 mm/hour in men, and from 2 to 15 mm/hour in women.

Increasing ESR- always a warning sign and, as a rule, indicates some kind of trouble in the body.

It is assumed that one of the main reasons for the increase in ESR is an increase in the ratio of large-sized protein particles (globulins) and small-sized ones (albumin) in the blood plasma. Protective antibodies belong to the class of globulins, so their number in response to viruses, bacteria, fungi, etc., increases sharply in the body, which is accompanied by a change in the ratio of blood proteins.

For this reason, the most common cause of increased ESR is various inflammatory processes occurring in the human body. Therefore, when someone gets a sore throat, pneumonia, arthritis (inflammation of the joints) or other infectious and non-infectious diseases, the ESR always increases. The more pronounced the inflammation, the more clearly this indicator increases. Thus, in mild forms of inflammation, ESR can increase to 15-20 mm/hour, and in some severe diseases - up to 60-80 mm/hour. On the other hand, a decrease in this indicator during treatment indicates a favorable course of the disease and recovery of the patient.

At the same time, we must remember that an increase in ESR does not always indicate any kind of inflammation. The value of this laboratory indicator may be influenced by other factors: a change in the ratio of the liquid and dense parts of the blood, a decrease or increase in the number of red blood cells, loss of protein in the urine or a violation of protein synthesis in the liver and in some other cases.

The following are the groups of non-inflammatory diseases that usually lead to an increase in ESR:

Severe kidney and liver diseases;

Malignant formations;

Some severe blood diseases (myeloma, Waldenström's disease);

Myocardial infarction, pulmonary infarction, stroke;

Frequent blood transfusions, vaccine therapy.

It is necessary to take into account physiological reasons increasing ESR. Thus, an increase in this indicator is observed in women during pregnancy and can be observed during menstruation.

It should be borne in mind that a natural increase in ESR in the diseases described above does not occur if the patient has such concomitant pathology, such as chronic heart and cardiopulmonary failure; conditions and diseases in which the number of red blood cells in the blood increases (compensatory erythrocytosis, erythremia); acute viral hepatitis and obstructive jaundice; increase in protein in the blood. In addition, taking medications such as calcium chloride and aspirin can influence the ESR value in the direction of reducing this indicator.

1.1 .4. Leukocytes

Leukocytes, or white blood cells, are colorless cells of varying sizes (from 6 to 20 microns), round or irregular in shape. These cells have a nucleus and are capable of independently moving like a single-celled organism - an amoeba. The number of these cells in the blood is significantly less than erythrocytes and in a healthy person is 4.0-8.8 x 109/l. Leukocytes are the main protective factor in the human body’s fight against various diseases. These cells are “armed” with special enzymes that are capable of “digesting” microorganisms, binding and breaking down foreign protein substances and breakdown products formed in the body during vital activity. In addition, some forms of leukocytes produce antibodies - protein particles that attack any foreign microorganisms that enter the blood, mucous membranes and other organs and tissues of the human body.

There are two main types of white blood cells. In cells of one type, the cytoplasm has granularity, and they are called granular leukocytes - granulocytes. There are 3 forms of granulocytes: neutrophils, which, depending on their appearance the nuclei are divided into band and segmented, as well as basophils and eosinophils.

In the cells of other leukocytes, the cytoplasm does not contain granules, and among them there are two forms - lymphocytes and monocytes. These types of leukocytes have specific functions and change differently in various diseases (see below), so their quantitative analysis is a serious aid to the doctor in determining the causes of the development of various forms of pathology.

An increase in the number of leukocytes in the blood is called leukocytosis, and a decrease is called leukopenia.

Leukocytosis can be physiological, i.e. occurs in healthy people in some quite ordinary situations, and pathological when it indicates some kind of disease.

Physiological leukocytosis is observed in the following cases:

2-3 hours after eating - digestive leukocytosis;

After intense physical work;

After hot or cold baths;

After psycho-emotional stress;

In the second half of pregnancy and before menstruation.

For this reason, the number of leukocytes is examined in the morning on an empty stomach in a calm state of the subject, without previous physical activity, stressful situations, or water treatments.

The most common causes of pathological leukocytosis include the following:

Various infectious diseases: pneumonia, otitis media, erysipelas, meningitis, pneumonia, etc.;

Suppuration and inflammatory processes of various localization: pleura (pleurisy, empyema), abdominal cavity(pancreatitis, appendicitis, peritonitis), subcutaneous tissue(felon, abscess, phlegmon), etc.;

Quite large burns;

Infarctions of the heart, lungs, spleen, kidneys;

Conditions after severe blood loss;

Leukemia;

Chronic renal failure;

Diabetic coma.

It must be remembered that in patients with weakened immunity (senile people, exhausted people, alcoholics and drug addicts), leukocytosis may not be observed during these processes. The absence of leukocytosis during infectious and inflammatory processes indicates a weak immune system and is an unfavorable sign.

Leukopenia- a decrease in the number of leukocytes in the blood below 4.0 H 10 9 /l in most cases indicates inhibition of the formation of leukocytes in the bone marrow. More rare mechanisms for the development of leukopenia are increased destruction of leukocytes in the vascular bed and redistribution of leukocytes with their retention in depot organs, for example, during shock and collapse.

Most often, leukopenia is observed due to the following diseases and pathological conditions:

Exposure to ionizing radiation;

Taking certain medications: anti-inflammatory drugs (amidopyrine, butadione, pyra-butol, reopirin, analgin); antibacterial agents (sulfonamides, syntomycin, chloramphenicol); drugs that inhibit thyroid function (mercazolyl, propicyl, potassium perchlorate); drugs used to treat cancer - cytostatics (methotrexate, vincristine, cyclophosphamide, etc.);

Hypoplastic or aplastic diseases, in which, for unknown reasons, the formation of leukocytes or other blood cells in the bone marrow is sharply reduced;

Some forms of diseases in which the function of the spleen increases (hypersplenism), liver cirrhosis, lymphogranulomatosis, tuberculosis and syphilis, occurring with damage to the spleen;

Selected infectious diseases: malaria, brucellosis, typhoid fever, measles, rubella, influenza, viral hepatitis;

Systemic lupus erythematosus;

Anemia associated with vitamin B12 deficiency;

In case of oncopathology with metastases to the bone marrow;

In the initial stages of development of leukemia.

Leukocyte formula is the ratio of different forms of leukocytes in the blood, expressed as a percentage. Standard values of the leukocyte formula are presented in table. 1.

Table 1

Leukocyte formula of blood and the content of various types of leukocytes in healthy people

The name of the condition in which an increase in the percentage of one or another type of leukocyte is detected is formed by adding the ending “-iya”, “-oz” or “-ez” to the name of this type of leukocyte

(neutrophilia, monocytosis, eosinophilia, basophilia, lymphocytosis).

A decrease in the percentage of various types of leukocytes is indicated by adding the ending “-singing” to the name of this type of leukocyte (neutropenia, monocytopenia, eosinopenia, basopenia, lymphopenia).

To avoid diagnostic error When examining a patient, it is very important for the doctor to determine not only the percentage of different types of leukocytes, but also their absolute number in the blood. For example, if the number of lymphocytes in the leukoformula is 12%, which is significantly lower than normal, and the total number of leukocytes is 13.0 x 10 9 / l, then the absolute number of lymphocytes in the blood is 1.56 x 10 9 / l, i.e. “ fits" into the normative meaning.

For this reason, a distinction is made between absolute and relative changes in the content of one or another form of leukocytes. Cases when there is a percentage increase or decrease in various types of leukocytes with their normal absolute content in the blood are designated as absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc. In those situations where both the relative (in %) and the absolute number of certain forms of leukocytes speaks of absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc.

Different types of leukocytes “specialize” in different protective reactions of the body, and therefore analysis of changes in the leukocyte formula can tell a lot about the nature of the pathological process that has developed in the body of a sick person and help the doctor make a correct diagnosis.

Neutrophilia, as a rule, indicates an acute inflammatory process and is most pronounced when purulent diseases. Since inflammation of an organ in medical terms is indicated by adding the ending “-itis” to the Latin or Greek name of the organ, neutrophilia appears in pleurisy, meningitis, appendicitis, peritonitis, pancreatitis, cholecystitis, otitis, etc., as well as acute pneumonia, phlegmon and abscesses of various locations, erysipelas.

In addition, an increase in the number of neutrophils in the blood is detected in many infectious diseases, myocardial infarction, stroke, diabetic coma and severe renal failure, after bleeding.

It should be remembered that neutrophilia can be caused by taking glucocorticoids hormonal drugs(dexamethasone, prednisolone, triamcinolone, cortisone, etc.).

Band leukocytes react most to acute inflammation and purulent process. A condition in which the number of leukocytes of this type in the blood increases is called a band shift, or a shift of the leukocyte formula to the left. Band shift always accompanies severe acute inflammatory (especially suppurative) processes.

Neutropenia is observed in some infectious (typhoid fever, malaria) and viral diseases (influenza, polio, viral hepatitis A). A low level of neutrophils often accompanies severe inflammatory and purulent processes (for example, in acute or chronic sepsis - a serious disease when pathogenic microorganisms enter the blood and freely settle in internal organs and tissues, forming numerous purulent foci) and is a sign that worsens the prognosis of severe sick.

Neutropenia can develop when bone marrow function is suppressed (aplastic and hypoplastic processes), with B 12 deficiency anemia, exposure to ionizing radiation, as a result of a number of intoxications, including when taking drugs such as amidopyrine, analgin, butadione, reopirin, sulfadimethoxine , biseptol, chloramphenicol, cefazolin, glibenclamide, mercazolil, cytostatics, etc.

If you noticed, the factors leading to the development of leukopenia simultaneously reduce the number of neutrophils in the blood.

Lymphocytosis is characteristic of a number of infections: brucellosis, typhoid and relapsing endemic typhus, tuberculosis.

In patients with tuberculosis, lymphocytosis is a positive sign and indicates a favorable course of the disease and subsequent recovery, while lymphopenia worsens the prognosis in this category of patients.

In addition, an increase in the number of lymphocytes is often detected in patients with reduced thyroid function - hypothyroidism, subacute thyroiditis, chronic radiation sickness, bronchial asthma, B 12 deficiency anemia, and fasting. An increase in the number of lymphocytes has been described when taking certain drugs.

Lymphopenia indicates immunodeficiency and is most often detected in persons with severe and long-term infectious and inflammatory processes, the most severe forms of tuberculosis, acquired immunodeficiency syndrome, separate forms leukemia and lymphogranulomatosis, prolonged fasting, leading to the development of dystrophy, as well as in persons who chronically abuse alcohol, substance abusers and drug addicts.

Monocytosis is the most characteristic feature infectious mononucleosis, and can also occur with some viral diseases - infectious mumps, rubella. An increase in the number of monocytes in the blood is one of the laboratory signs of severe infectious processes - sepsis, tuberculosis, subacute endocarditis, some forms of leukemia (acute monocytic leukemia), as well as malignant diseases lymphatic system— lymphogranulomatosis, lymphoma.

Monocytopenia is detected with bone marrow damage - aplastic anemia and hairy cell leukemia.

Eosinopenia can be observed at the height of the development of infectious diseases, B 12 deficiency anemia and bone marrow damage with a decrease in its function (aplastic processes).

Basophilia is usually detected in chronic myeloid leukemia, decreased thyroid function (hypothyroidism), and a physiological increase in basophils in the premenstrual period in women has been described.

Basopenia develops with increased thyroid function (thyrotoxicosis), pregnancy, stress influences, Itsenko-Cushing syndrome - a disease of the pituitary gland or adrenal glands, in which the level of adrenal hormones - glucocorticoids - is increased in the blood.

1.1.5. Platelets

Platelets, or blood platelets, are the smallest among the cellular elements of blood, the size of which is 1.5-2.5 microns. Platelets perform the most important function of preventing and stopping bleeding. With a lack of platelets in the blood, the bleeding time increases sharply, and the vessels become brittle and bleed more easily.

Thrombocytopenia always alarming symptom, as it creates a threat of increased bleeding and increases the duration of bleeding. A decrease in the number of platelets in the blood accompanies the following diseases and conditions:

. autoimmune (idiopathic) thrombocytopenic purpura (Purpura is a medical symptom characteristic of the pathology of one or more parts of hemostasis) (Werlhof’s disease), in which a decrease in the number of platelets is due to their increased destruction under the influence of special antibodies, the mechanism of formation of which has not yet been established;
. acute and chronic leukemia;
. decreased platelet formation in the bone marrow in aplastic and hypoplastic conditions of unknown cause, B 12, folate deficiency anemia, as well as in cancer metastases to the bone marrow;
. conditions associated with increased activity spleen with cirrhosis of the liver, chronic and, less commonly, acute viral hepatitis;
. systemic diseases connective tissue: systemic lupus erythematosus, scleroderma, dermatomyositis;
. dysfunction of the thyroid gland (thyrotoxicosis, hypothyroidism);
. viral diseases (measles, rubella, chickenpox, influenza);
. disseminated intravascular coagulation syndrome (DIC);
. taking a number of medications that cause toxic or immune damage to the bone marrow: cytostatics (vinblastine, vincristine, mercaptopurine, etc.); chloramphenicol; sulfonamide drugs (biseptol, sulfadimethoxine), aspirin, butadione, reopirin, analgin, etc.

Because low platelet counts can be serious complications, bone marrow puncture and antiplatelet antibody testing are usually performed to determine the cause of thrombocytopenia.

Platelet count, although it does not pose a threat of bleeding, is no less a serious laboratory sign than thrombocytopenia, since it often accompanies diseases that are very serious in terms of consequences.

The most common causes of thrombocytosis are:

. malignant neoplasms: stomach cancer and kidney cancer (hypernephroma), lymphogranulomatosis;
. oncological blood diseases - leukemia (megacarytic leukemia, polycythemia, chronic myeloid leukemia, etc.).
It should be noted that in leukemia, thrombocytopenia is an early sign, and as the disease progresses, thrombocytopenia develops.

It is important to emphasize (all experienced doctors know this) that in the cases listed above, thrombocytosis may be one of the early laboratory signs and its identification requires a thorough medical examination.

Other causes of thrombocytosis that are of less practical importance include:

. condition after massive (more than 0.5 l) blood loss, including after large surgical operations;
. condition after removal of the spleen (thrombocytosis usually persists for 2 months after surgery);
. in sepsis, when the platelet count can reach 1000 x 10 9 / l.

1.2. General clinical examination of urine

Urine is produced in the kidneys. Blood plasma is filtered in the capillaries of the renal glomeruli. This glomerular filtrate is the primary urine, containing all the components of blood plasma except proteins. Then, in the renal tubules, epithelial cells carry out reabsorption into the blood (reabsorption) of up to 98% of the renal filtrate with the formation of final urine. Urine is 96% water, contains the end products of metabolism (urea, uric acid, pigments, etc.) mineral salts in dissolved form, as well as a small amount of cellular elements of the blood and epithelium of the urinary tract.

Clinical examination of urine gives an idea, first of all, about the condition and function of the genitourinary system. In addition, certain changes in urine can help diagnose some endocrine diseases(diabetes mellitus and diabetes insipidus), identify certain metabolic disorders, and in some cases suspect a number of other diseases of internal organs. Like many other tests, repeated urine testing helps to judge the effectiveness of the treatment.

Conducting a clinical analysis of urine includes an assessment of its general properties (color, transparency, odor), as well as physicochemical qualities (volume, relative density, acidity) and microscopic examination of urinary sediment.

A urine test is one of the few that is collected by the patient independently. In order for the urine analysis to be reliable, that is, to avoid artifacts and technical errors, it is necessary to follow a number of rules when collecting it.

Basic rules for collecting urine for analysis, its transportation and storage.

There are no restrictions on the diet, but you should not “lean” on mineral water - the acidity of the urine may change. If a woman is menstruating, collecting urine for analysis should be postponed until after the menstrual period. The day before and immediately before submitting your urine for analysis, you should avoid intense physical activity, as in some people this can lead to the appearance of protein in the urine. The use of medications is also undesirable, since some of them (vitamins, antipyretics and painkillers) can affect the results of biochemical studies. On the eve of the test, you need to limit yourself in eating sweets and brightly colored foods.

For general analysis, “morning” urine is usually used, which is collected in the urine during the night. bladder; this reduces the influence of natural daily fluctuations in urine parameters and characterizes the studied parameters more objectively. The required volume of urine to perform a full examination is approximately 100 ml.

Urine should be collected after thorough toileting of the external genitalia, especially in women. Failure to comply with this rule may result in the detection of an increased number of white blood cells, mucus, and other contaminants in the urine, which may complicate the test and distort the result.

Women need to use a soap solution (followed by washing boiled water) or weak solutions of potassium permanganate (0.02 - 0.1%) or furatsilin (0.02%). Antiseptic solutions should not be used when submitting urine for bacteriological analysis!

Urine is collected in a dry, clean, well-washed small jar with a volume of 100-200 ml, well washed from cleaning agents and disinfectants, or in a special disposable container.

Due to the fact that inflammatory elements may enter the urine urethra and external genitalia, you first need to release a small portion of urine and only then place a jar under the stream and fill it to the required level. The container with urine is tightly closed with a lid and transferred to the laboratory with the necessary direction, where the surname and initials of the subject, as well as the date of the analysis, must be indicated.

It must be remembered that a urine test must be performed no later than 2 hours after receiving the material. Urine that is stored longer may be contaminated with foreign bacterial flora. In this case, the urine pH will shift to the alkaline side due to ammonia released into the urine by bacteria. In addition, microorganisms feed on glucose, so negative or low urine sugar results may be obtained. Storing urine for a longer period of time also leads to the destruction of red blood cells and other cellular elements in it, and, in daylight, bile pigments.

In winter, it is necessary to avoid freezing urine when transporting it, since salts that precipitate during this process can be interpreted as a manifestation of renal pathology and complicate the research process.

1.2.1. General properties of urine

As is known, ancient doctors did not have such instruments as a microscope, a spectrophotometer, and, of course, did not have modern diagnostic strips for express analysis, but they could skillfully use their senses: vision, smell and taste.

Indeed, the presence of a sweet taste in the urine of a patient with complaints of thirst and weight loss allowed the ancient healer to very confidently diagnose diabetes mellitus, and urine the color of “meat slop” indicated severe kidney disease.

Although currently no doctor would think of tasting urine, assessing the visual properties and smell of urine still have not lost their diagnostic value.

Color. In healthy people, urine has a straw-yellow color, due to the content of urinary pigment - urochrome.

The more concentrated the urine, the darker the color. Therefore, during intense heat or intense physical activity with profuse sweating, less urine is released and it is more intensely colored.

In pathological cases, the intensity of the color of urine increases with an increase in edema associated with kidney and heart diseases, with loss of fluid associated with vomiting, diarrhea or extensive burns.

Urine becomes dark yellow (the color of dark beer), sometimes with a greenish tint, with increased excretion of bile pigments in the urine, which is observed with parenchymal (hepatitis, cirrhosis) or mechanical (clogging of the bile duct due to cholelithiasis) jaundice.

Red or reddish color of urine may be due to the consumption of large quantities of beets, strawberries, carrots, as well as some antipyretic drugs: antipyrine, amidopyrine. Large doses of aspirin can turn the urine pink.

A more serious cause of red urine is hematuria - blood in the urine, which may be associated with renal or extrarenal diseases.

Thus, the appearance of blood in the urine can be due to inflammatory diseases of the kidneys - nephritis, but in such cases the urine, as a rule, becomes cloudy, since it contains an increased amount of protein, and resembles the color of “meat slop”, i.e. the color of water, in which the meat was washed.

Hematuria may be due to damage to the urinary tract during passage kidney stone as it happens during attacks renal colic in people with urolithiasis. More rarely, blood in the urine is observed with cystitis.

Finally, the appearance of blood in the urine may be associated with the disintegration of a kidney or bladder tumor, injuries to the kidneys, bladder, ureters or urethra.

The greenish-yellow color of urine may be due to an admixture of pus, which occurs when a kidney abscess is opened, as well as with purulent urethritis and cystitis. The presence of pus in the urine during its alkaline reaction leads to the appearance of dirty brown or gray urine.

A dark, almost black color occurs when hemoglobin enters the urine due to massive destruction of red blood cells in the blood (acute hemolysis), when taking certain toxic substances - hemolytic poisons, transfusion of incompatible blood, etc. A black tint that appears when urine stands is observed in patients with alkaptonuria , in which homogentisic acid is excreted in the urine, which darkens in air.

Transparency. Healthy people have clear urine. Cloud-like turbidity of urine, which occurs during prolonged standing, has no diagnostic value. Pathological cloudiness of urine can be caused by the release of large amounts of salts (urates, phosphates, oxalates) or an admixture of pus.

Smell. Fresh urine from a healthy person does not have a strong or unpleasant odor. The appearance of a fruity smell (the smell of soaked apples) occurs in patients with diabetes mellitus who have high blood glucose levels (usually exceeding 14 mmol/l for a long time), when a large amount of special products of fat metabolism - ketone acids - are formed in the blood and urine. Urine acquires a sharp unpleasant odor when consuming large amounts of garlic, horseradish, and asparagus.

When assessing physical and chemical properties urine is examined for its daily amount, relative density, acid-base reaction, protein, glucose, and the content of bile pigments.

1.2.2. Daily amount of urine

The amount of urine that a healthy person excretes per day, or daily diuresis, can vary significantly, as it depends on the influence of a number of factors: the amount of fluid drunk, the intensity of sweating, breathing rate, and the amount of fluid excreted in feces.

Under normal conditions, the average daily diuresis is 1.5-2.0 liters and corresponds to approximately 3/4 of the volume of fluid drunk.

A decrease in urine output occurs when copious discharge sweat, for example when working in conditions high temperature, with diarrhea and vomiting. Also, low diuresis is promoted by fluid retention (increasing edema in renal and heart failure) in the body, while the patient’s body weight increases.

A decrease in urine output of less than 500 ml per day is called oliguria, and less than 100 ml/day is called anuria.

Anuria is a very serious symptom and always indicates a serious condition:

. sharp decline blood volume and drop in blood pressure associated with heavy bleeding, shock, uncontrollable vomiting, severe diarrhea;
. severe impairment of the filtration capacity of the kidneys - acute renal failure, which can be observed in acute nephritis, renal necrosis, acute massive hemolysis;
. blockage of both ureters with stones or their compression by a nearby large tumor (cancer of the uterus, bladder, metastases).

Ischuria should be distinguished from anuria - urinary retention due to a mechanical obstruction to urination, for example, with the development of a tumor or inflammation of the prostate gland, narrowing of the urethra, compression by a tumor or blockage of the outlet in the bladder, dysfunction of the bladder due to damage to the nervous system.

An increase in daily diuresis (polyuria) is observed when edema resolves in people with renal or heart failure, which is combined with a decrease in the patient’s body weight. In addition, polyuria can be observed with diabetes and diabetes insipidus, chronic pyelonephritis, with prolapsed kidneys - nephroptosis, aldosterome (Conn's syndrome) - an adrenal tumor that produces an increased amount of mineralocorticoids, in hysterical states due to excessive fluid intake.

1.2.3. Relative density of urine

Relative density ( specific gravity) urine depends on the content of dense substances in it (urea, mineral salts, etc., and in cases of pathology - glucose, protein) and is normally 1.010-1.025 (the density of water is taken as 1). An increase or decrease in this indicator can be a consequence of both physiological changes and can occur in certain diseases.

An increase in the relative density of urine leads to:

. low fluid intake;
. large loss of fluid with sweating, vomiting, diarrhea;
. diabetes;
. fluid retention in the body in the form of edema in cardiac or acute renal failure.

A decrease in the relative density of urine is caused by:

. drinking plenty of water;
. convergence of edema during therapy with diuretics;
. chronic renal failure with chronic glomerulonephritis and pyelonephritis, nephrosclerosis, etc.;
. diabetes insipidus (usually below 1.007).

A single study of relative density allows only a rough estimate of the state of the concentration function of the kidneys, therefore, to clarify the diagnosis, daily fluctuations of this indicator in the Zimnitsky test are usually assessed (see below).

1.2.4. Chemical examination of urine

Urine reaction. With a normal diet (a combination of meat and plant foods), the urine of a healthy person has a slightly acidic or acidic reaction and its pH is 5-7. The more meat a person eats, the more acidic his urine is, while plant foods help shift the pH of urine to the alkaline side.

A decrease in pH, i.e., a shift in the reaction of urine to the acidic side, occurs with heavy physical work, fasting, a sharp increase in body temperature, diabetes mellitus, and impaired renal function.

On the contrary, an increase in the pH of urine (a shift in acidity to the alkaline side) is observed when taking a large amount of mineral water, after vomiting, swelling, inflammation of the bladder, and blood getting into the urine.

Clinical significance determination of urine pH is limited by the fact that a change in the acidity of urine towards the alkaline side contributes to a more rapid destruction of formed elements in a urine sample during storage, which must be taken into account by the laboratory assistant conducting the analysis. In addition, changes in urine acidity are important to know for people with urolithiasis. So, if the stones are urates, then the patient should strive to maintain the alkaline acidity of the urine, which will facilitate the dissolution of such stones. On the other hand, if the kidney stones are tripel phosphates, then an alkaline urine reaction is undesirable, as it will promote the formation of such stones.

Protein. In a healthy person, urine contains a small amount of protein, not exceeding 0.002 g/l or 0.003 g in daily urine.

Increased protein excretion in the urine is called proteinuria and is the most common laboratory sign of kidney damage.

For patients with diabetes mellitus, a “border zone” of proteinuria was identified, which was called microalbuminuria. The fact is that microalbumin is the smallest protein in the blood and, in the case of kidney disease, enters the urine earlier than others, being an early marker of nephropathy in diabetes mellitus. The importance of this indicator lies in the fact that the appearance of microalbumin in the urine of patients with diabetes mellitus characterizes the reversible stage of kidney damage, in which, by prescribing special medications and following the patient’s certain doctor’s recommendations, it is possible to restore damaged kidneys. Therefore, for diabetic patients upper limit The norm for protein content in urine is 0.0002 g/l (20 μg/l) and 0.0003 g/day. (30 mcg/day).

The appearance of protein in the urine can be associated with both kidney disease and pathology of the urinary tract (ureters, bladder, urethra).

Proteinuria associated with urinary tract lesions is characterized by a relatively low level of protein (usually less than 1 g/l) in combination with a large number of leukocytes or red blood cells in the urine, as well as the absence of casts in the urine (see below).

Renal proteinuria can be physiological, i.e. observed in a completely healthy person, and can be pathological - as a consequence of some disease.

The causes of physiological renal proteinuria are:

. consuming large amounts of protein that has not undergone heat treatment (unboiled milk, raw eggs);
. intense muscle load;
. long stay in vertical position;
. swimming in cold water;
. strong emotional stress;
. epileptic seizure.

Pathological renal proteinuria is observed in the following cases:

. kidney diseases (acute and chronic inflammatory kidney diseases - glomerulonephritis, pyelonephritis, amyloidosis, nephrosis, tuberculosis, toxic kidney damage);
. nephropathy of pregnancy;
. increased body temperature in various diseases;
. hemorrhagic vasculitis;
. severe anemia;
. arterial hypertension;
. severe heart failure;
. hemorrhagic fevers;
. leptospirosis.

In most cases, it is true that the more pronounced the proteinuria, the stronger the kidney damage and the worse the prognosis for recovery. In order to more accurately assess the severity of proteinuria, the protein content in the urine collected by the patient per day is assessed. Based on this, the following degrees of gradation of proteinuria by severity are distinguished:

. mild proteinuria - 0.1-0.3 g/l;
. moderate proteinuria - less than 1 g/day;
. severe proteinuria - 3 g/day. and more.

Urobilin.

Fresh urine contains urobilinogen, which turns into urobilin when the urine stands. Urobilinogen bodies are substances that are formed from bilirubin, a liver pigment, during its transformation in the bile ducts and intestines.

It is urobilin that causes darkening of urine in jaundice.

In healthy people with a normally functioning liver, so little urobilin enters the urine that routine laboratory tests give a negative result.

The increase in this indicator from weak positive reaction(+) to sharply positive (+++) occurs in various diseases of the liver and biliary tract:

Determination of urobilin in urine is simple and in a fast way identify signs of liver damage and subsequently clarify the diagnosis using biochemical, immunological and other tests. On the other hand, a negative reaction to urobilin allows the doctor to exclude the diagnosis of acute hepatitis.

Bile acids. Bile acids never appear in the urine of a person without liver pathology. Detection of bile acids in urine varying degrees severity: weakly positive (+), positive (++) or strongly positive (+++) always indicates severe damage to the liver tissue, in which the bile formed in the liver cells, along with its entry into the bile ducts and intestines, directly enters the blood.

The reasons for a positive urine reaction to bile acids are acute and chronic hepatitis, liver cirrhosis, obstructive jaundice caused by blockage of the bile ducts.

At the same time, it should be said that with the most severe liver damage due to the cessation of production of bile acids, the latter may not be detected in the urine.

Unlike urobilin, bile acids do not appear in the urine of patients with hemolytic anemia, so this indicator is used as an important differential sign for distinguishing between jaundice associated with liver damage and jaundice caused by increased destruction of red blood cells.

Bile acids in urine can also be detected in persons with liver damage without external signs jaundice, so this test is important for those who suspect liver disease, but do not have jaundice of the skin.

1.2.5. Urine sediment examination

Examination of urinary sediment is the final stage carrying out a clinical analysis of urine and characterizes the composition of cellular elements (erythrocytes, leukocytes, casts, epithelial cells), as well as salts in a urine analysis. In order to conduct this study, urine is poured into a test tube and centrifuged, while dense particles settle to the bottom of the test tube: blood cells, epithelium, and salts. After this, the laboratory assistant, using a special pipette, transfers part of the sediment from the test tube onto a glass slide and prepares a preparation, which is dried, stained and examined by a doctor under a microscope.

To quantify the cellular elements found in urine, special units of measurement are used: the number of certain cells of the urinary sediment in the field of view under microscopy. For example: “1-2 red blood cells per field of view” or “single epithelial cells per field of view” and “leukocytes cover the entire field of view.”

Red blood cells. If in a healthy person red blood cells are not detected in the urine sediment or they are present in “single copies” (no more than 3 in the field of view), their appearance in the urine in larger quantities always indicates some kind of pathology in the kidneys or urinary tract.

It should be said that even the presence of 2-3 red blood cells in the urine should alert the doctor and the patient and require at least repeated urine testing or special tests (see below). Single red blood cells may appear in a healthy person after heavy physical exertion or prolonged standing.

When the admixture of blood in the urine is determined visually, i.e. the urine has a red color or tint (macrohematuria), then there is no great need to evaluate the number of red blood cells during microscopy of the urinary sediment, since the result is known in advance - red blood cells will cover the entire field of view, i.e. . their number will be many times higher than the standard values. To turn urine red, only 5 drops of blood (containing approximately 1 x 10 12 red blood cells) per 0.5 liter of urine is enough.

A smaller admixture of blood, which is invisible to the naked eye, is called microhematuria and is detected only by microscopy of urinary sediment.

The appearance of blood in the urine may be associated with any disease of the kidneys, urinary tract (ureters, bladder, urethra), prostate gland, as well as some other diseases not related to the genitourinary system:

. glomerulonephritis (acute and chronic);
. pyelonephritis (acute and chronic);
. malignant tumors kidney;
. cystitis;
. prostate adenoma;
. urolithiasis disease;
. kidney infarction;
. kidney amyloid;
. nephrosis;
. toxic kidney damage (for example, when taking analgin);
. kidney tuberculosis;
. kidney injuries;
. hemorrhagic diathesis;
. hemorrhagic fever;
. severe circulatory failure;
. hypertonic disease.

For practice, it is important to know how to roughly determine where blood gets into the urine using laboratory methods.

The main sign presumably indicating the entry of red blood cells into the urine from the kidneys is the concomitant appearance of protein and casts in the urine. In addition, the three-glass test continues to be widely used for these purposes, especially in urological practice.

This test consists of the patient, after holding urine for 4-5 hours or in the morning after sleep, collecting urine sequentially into 3 jars (containers): the first one is released into the 1st, the intermediate one into the 2nd, and the intermediate one into the 3rd. the last (final!) portion of urine. If red blood cells are found in the greatest quantity in the 1st portion, then the source of bleeding is in the urethra; in the 3rd portion, the source is more likely in the bladder. Finally, if the number of red blood cells is approximately the same in all three portions of urine, then the source of bleeding is the kidneys or ureters.

Leukocytes. Normally in urinary sediment healthy woman up to 5 are detected, and in a healthy man - up to 3 leukocytes in the field of view.

An increased content of leukocytes in the urine is called leukocyturia. Too pronounced leukocyturia, when the number of these cells exceeds 60 in the field of view, is called pyuria.

As already indicated, the main function of leukocytes is protective, therefore their appearance in the urine, as a rule, indicates some kind of inflammatory process in the kidneys or urinary tract. In this situation, the rule “the more leukocytes in the urine, the more pronounced the inflammation and the more acute the process” remains valid. However, the degree of leukocyturia does not always reflect the severity of the disease. Thus, there may be a very moderate increase in the number of leukocytes in the urinary sediment in people with severe glomerulonephritis and reach the level of pyuria in people with acute inflammation of the urethra - urethritis.

The main causes of leukocyturia are inflammatory diseases of the kidneys (acute and chronic pyelonephritis) and urinary tract (cystitis, urethritis, prostatitis). In more rare cases, an increase in the number of leukocytes in the urine can lead to kidney damage due to tuberculosis, acute and chronic glomerulonephritis, and amyloidosis.

For a doctor, and even more so for a patient, it is very important to establish the cause of leukocyturia, that is, to approximately determine the location of development of the inflammatory process of the genitourinary system. By analogy with the story about the causes of hematuria, laboratory signs indicating an inflammatory process in the kidneys as the cause of leukocyturia are the concomitant appearance of protein and casts in the urine. In addition, a three-glass test is also used for these purposes, the results of which are evaluated similarly to the results of this test when determining the source of blood in the urine. So, if leukocyturia is detected in the 1st portion, this indicates that the patient has an inflammatory process in the urethra (urethritis). If the highest number of leukocytes is in the 3rd portion, then it is most likely that the patient has inflammation of the bladder - cystitis or prostate gland - prostatitis. With approximately the same number of leukocytes in the urine of different portions, one can think of inflammatory damage to the kidneys, ureters, and bladder.

In some cases, a three-glass test is carried out more quickly - without microscopy of the urinary sediment and is guided by such signs as turbidity, as well as the presence of threads and flakes in each portion of urine, which to a certain extent are equivalent to leukocyturia.

In clinical practice, to accurately assess the number of red and white blood cells in urine, the simple and informative Nechiporenko test is widely used, which allows you to calculate how many of these cells are contained in 1 ml of urine. Normally, 1 ml of urine contains no more than 1000 red blood cells and 400 thousand leukocytes.

The cylinders are formed from protein in the kidney tubules under the influence of the acidic reaction of urine, being, in fact, their cast. In other words, if there is no protein in the urine, then there cannot be casts, and if they are, then you can be sure that the amount of protein in the urine is increased. On the other hand, since the process of formation of cylinders is affected by the acidity of urine, then with its alkaline reaction, despite proteinuria, cylinders may not be detected.

Depending on whether the cylinders contain cellular elements from urine and which ones, hyaline, epithelial, granular, waxy, erythrocyte and leukocyte, as well as cylinders are distinguished.

The reasons for the appearance of casts in the urine are the same as for the appearance of protein, with the only difference being that protein is detected more often, since the formation of casts, as already indicated, requires an acidic environment.

Most often in practice, hyaline casts are encountered, the presence of which may indicate acute and chronic kidney diseases, but they can also be found in people without pathology of the urinary system in cases of prolonged stay in an upright position, severe cooling or, conversely, overheating, heavy physical activity.

Epithelial casts always indicate involvement of renal tubules in the pathological process, which most often occurs with pyelonephritis and nephrosis.

Waxy casts usually indicate severe kidney damage, and detection of red blood cell casts in the urine strongly suggests that hematuria is due to kidney disease.

Epithelial cells line the mucous membrane of the urinary tract and enter large quantities into the urine during inflammatory processes. Depending on what type of epithelium lines a particular section of the urinary tract during various inflammatory processes, different types of epithelium appear in the urine.

Normally, in urinary sediment, squamous epithelial cells are found in very small numbers - from single ones in the preparation to single ones in the field of view. The number of these cells increases significantly with urethritis (inflammation of the urinary tract) and prostatitis (inflammation of the prostate gland).

Transitional epithelial cells appear in the urine during acute inflammation in the bladder and renal pelvis, urolithiasis, tumors of the urinary tract.

Cells of the renal epithelium (urinary tubules) enter the urine during nephritis (inflammation of the kidneys), poisoning with poisons that damage the kidneys, and heart failure.

Bacteria in urine is tested in a sample taken immediately after urination. Particular importance in this type of analysis is given to the correct treatment of the external genitalia before taking the analysis (see above). Detection of bacteria in urine is not always a sign of an inflammatory process in genitourinary system. An increased number of bacteria is of primary importance for diagnosis. Thus, in healthy people no more than 2 thousand microbes are found in 1 ml of urine, while patients with inflammation in the urinary organs are characterized by 100 thousand bacteria in 1 ml. If an infectious process in the urinary tract is suspected, doctors supplement the determination of microbial bodies in urine bacteriological examination, in which urine is inoculated under sterile conditions on special nutrient media and, based on a number of signs of the grown colony of microorganisms, the identity of the latter is determined, as well as their sensitivity to certain antibiotics in order to choose the right treatment.

In addition to the above components of urinary sediment, unorganized urine sediments or various inorganic compounds are isolated.

The loss of various inorganic sediments depends, first of all, on the acidity of the urine, which is characterized by pH. With an acidic reaction of urine (pH less than 5), salts of uric and hippuric acids, calcium phosphate, etc. are determined in the sediment. With an alkaline reaction of urine (pH more than 7), amorphous phosphates, tripel phosphates, calcium carbonate, etc. appear in the sediment.

At the same time, by the nature of a particular urine sediment, one can also tell about the possible illness of the person being examined. Yes, crystals uric acid appear in large quantities in the urine during renal failure, dehydration, and in conditions accompanied by large tissue breakdown (malignant blood diseases, massive, disintegrating tumors, resolving massive pneumonia).

Oxalates (salts of oxalic acid) appear due to the abuse of foods containing oxalic acid (tomatoes, sorrel, spinach, lingonberries, apples, etc.). If a person has not consumed these products, then the presence of oxalates in the urinary sediment indicates a metabolic disorder in the form of oxalo-acetic diathesis. In some rare cases of poisoning, the appearance of oxalates in the urine makes it possible to accurately confirm the victim’s consumption of a toxic substance - ethylene glycol.

1.2.6. Tests characterizing kidney function

The work of the kidneys as a whole consists of their performance of various functions, called partial: concentration of urine (concentration function), excretion of urine (glomerular filtration) and the ability of the kidney tubules to return substances useful to the body that have entered the urine: protein, glucose, potassium, etc. (tubular reabsorption) or, on the contrary, release some metabolic products into the urine (tubular secretion). A similar disruption of these functions can be observed in various forms of kidney diseases, so their study is necessary for the doctor not so much to make a correct diagnosis, but to determine the degree and severity of kidney disease, and also helps to assess the effectiveness of treatment and determine the prognosis of the patient’s condition.

The most widely used tests in practice are the Zimnitsky test and the Reberg-Ta-reev test.

The Zimnitsky test allows you to evaluate the ability of the kidneys to concentrate urine by measuring the density of urine collected during the day every 3 hours, i.e., a total of 8 urine samples are examined.

This test should be carried out with normal drinking regimen; it is not advisable for the patient to take diuretics. It is also necessary to take into account the volume accepted by man liquids in the form of water, drinks and liquid parts of food.

The daily urine volume is obtained by adding the volumes of the first 4 portions of urine collected from 09.00 to 21.00, and nighttime diuresis is obtained by summing the 5th to 8th portions of urine (from 21.00 to 09.00).

In healthy people, 2/3 - 4/5 (65-80%) of the liquid drunk per day is excreted during the day. In addition, daytime diuresis should be approximately 2 times higher than nighttime, and the relative density of individual portions of urine should fluctuate within fairly large limits - at least 0.012-0.016 and reach an indicator of 1.017 in at least one of the portions.

An increase in the daily amount of urine excreted compared to the liquid drunk can be observed as edema subsides, and a decrease, on the contrary, as edema (renal or cardiac) increases.

An increase in the ratio between nighttime and daytime urine output is typical for patients with heart failure.

Low relative density of urine in various portions collected per day, as well as a decrease in daily fluctuations of this indicator is called isohyposthenuria and is observed in patients with chronic diseases kidneys (chronic glomerulonephritis, pyelonephritis, hydronephrosis, polycystic disease). The concentration function of the kidneys is disrupted before other functions, so the Zimnitsky test makes it possible to identify pathological changes in the kidneys in the early stages, before signs of severe renal failure appear, which, as a rule, is irreversible.

It should be added that low relative density of urine with small fluctuations during the day (no more than 1.003-1.004) is characteristic of a disease such as diabetes insipidus, in which the production of the hormone vasopressin (antidiuretic hormone) in the human body decreases. This disease is characterized by thirst, weight loss, increased urination and an increase in the volume of urine excreted several times, sometimes up to 12-16 liters per day.

The Rehberg test helps the doctor determine the excretory function of the kidneys and the ability of the renal tubules to secrete or absorb back (reabsorb) certain substances.

The test method consists of collecting urine from a patient in the morning on an empty stomach in a supine position for 1 hour and in the middle of this period of time taking blood from a vein to determine the level of creatinine.

Using a simple formula, the value of glomerular filtration (characterizes the excretory function of the kidneys) and tubular reabsorption is calculated.

In healthy young and middle-aged men and women, the glomerular filtration rate (GFR), calculated in this way, is 130-140 ml/min.

A decrease in CF is observed in acute and chronic nephritis, kidney damage due to hypertension and diabetes mellitus - glomerulosclerosis. The development of renal failure and an increase in nitrogenous waste in the blood occurs when the EF decreases to approximately 10% of normal. In chronic pyelonephritis, the decrease in CP occurs later, and in glomerulonephritis, on the contrary, earlier than the impairment of the concentrating ability of the kidneys.

A persistent drop in EF to 40 ml/min in chronic kidney disease indicates severe renal failure, and a decrease in this indicator to 15-10-5 ml/min indicates the development of the final (terminal) stage of renal failure, which usually requires connecting the patient to a machine “ artificial kidney" or kidney transplant.

Tubular reabsorption normally ranges from 95 to 99% and may decrease to 90% or lower in people without kidney disease when drinking large amounts of fluid or taking diuretics. The most pronounced decrease in this indicator is observed in diabetes insipidus. A persistent decrease in water reabsorption below 95%, for example, is observed with a primary wrinkled kidney (against the background of chronic glomerulonephritis, pyelonephritis) or a secondary wrinkled kidney (for example, observed with hypertension or diabetic nephropathy).

It should be noted that usually, along with a decrease in reabsorption in the kidneys, there is a violation of the concentration function of the kidneys, since both functions depend on disturbances in the collecting ducts.

Each of us has had our blood tested, but not everyone knows what the results of this test indicate.

A general blood test is one of the most common diagnostic methods, allowing the doctor to diagnose inflammatory and infectious diseases and assess the effectiveness of treatment.

For the analysis, capillary blood (from a finger) or venous blood (from a vein) is used. There is no need to prepare for this examination, but it is recommended to carry it out in the morning, on an empty stomach.

Main indicators of general blood test

Hemoglobin

Hemoglobin is the main component of red blood cells, coloring the blood red and delivering oxygen to all organs and tissues.

Hemoglobin norm for men – 130-160 g/l, for women – 120-140 g/l

Increased hemoglobin may indicate polycythemia, excessive physical activity, dehydration, or blood thickening. Reduced hemoglobin may indicate anemia.

Color index

The color index is determined by the ratio of the amount of hemoglobin in red blood cells. This indicator is used to determine the type of anemia.

Color index norm for men – 0.85-1.15, for women – 0.85-1.15

An excess of the norm may indicate spherocytosis, a decrease in the norm may indicate iron deficiency anemia.

Red blood cells

Erythrocytes are red blood cells that have lost their nucleus, containing hemoglobin and transporting oxygen.

Red blood cell norm for men – 4-5.1x1012, for women – 3.7-4.7x1012

An increase in the number of red blood cells may indicate polycythemia (bone marrow disease) and dehydration, a decrease may indicate anemia due to blood loss, lack of iron, and vitamins.

Reticulocytes

Reticulocytes are young, immature red blood cells that have remnants of a nucleus. Only a small part of these red blood cells enters the blood, and the majority is contained in the bone marrow.

Normal reticulocytes for men – 0.2-1.2%, for women – 0.2-1.2%

Excessive levels of reticulocytes in the blood indicate anemia and blood loss. A decrease in the number of reticulocytes may be a sign of kidney disease, impaired erythrocyte metabolism, or aplastic anemia.

Platelets

Platelets are blood cells that are formed from bone marrow cells. Thanks to these cells, blood can clot.

Platelet rate for men – 180-320x109, for women – 180-320x109

An increase in platelets may indicate an inflammatory process, polycythemia, and can also be a consequence of surgical operations. A decrease in platelet count may indicate systemic autoimmune diseases, aplastic anemia, hemolytic anemia, hemolytic disease, isoimmunization by Rh factor and blood groups.

ESR – this abbreviation stands for erythrocyte sedimentation rate. A deviation of ESR from the norm may be a sign of an inflammatory or pathological process occurring in the body.

ESR norm for men – 1-10 mm/h, for women – 2-15 mm/h

ESR may increase during pregnancy, infectious disease, inflammation, anemia, or tumor formation.

Leukocytes

Leukocytes are white blood cells. Their main function is to protect the body from microbes and foreign substances.

Leukocyte norm for men – 4-9x109, for women – 4-9x109

An increase in the number of leukocytes may indicate leukemia, inflammatory or infectious process, allergies, blood loss, autoimmune diseases. A decrease in the number of leukocytes may indicate certain infections (influenza, rubella, measles, etc.), a genetic abnormality of the immune system, increased spleen function, and bone marrow pathology.

Norm of segmented neutrophils for men – 47-72%, for women – 47-72%

An increase in neutrophils indicates the presence of bacterial, fungal and some other infections, inflammatory processes due to tissue trauma, arthritis, arthrosis, etc. Neutrophils can also increase due to physical exertion, temperature changes, and during pregnancy.

A decrease in neutrophils may occur due to exhaustion of the body, after prolonged chronic diseases, thyroid disease.

Eosinophils

Normal eosinophil count for men – 0-5%, for women – 0-5%

Basophils

Basophils - take part in immediate allergic reactions.

Basophil norm for men – 0-1%, for women – 0-1%

The number of basophils increases in blood diseases, ulcerative colitis, chickenpox, food and drug intolerances. Decreased with hyperthyroidism, ovulation, pregnancy, stress, acute infections and increased production of adrenal hormones.

Lymphocytes

Lymphocytes - fight foreign cells and proteins, viral infections, release antibodies into the blood and block antigens.

Norm of lymphocytes for men – 18-40%, for women – 18-40%

The number of lymphocytes increases in infectious monoculosis, hepatitis, tuberculosis and syphilis, viral infections, as well as leukemia. Decreased in acute infection, autoimmune diseases, cancer, immunodeficiency.

Monocytes

Monocytes - destroy foreign proteins and cells in tissues.

Basophil norm for men – 2-9%, for women –2-9%

The number of monocytes increases after acute infections, with tuberculosis, syphilis, and rheumatic diseases. Decreased with bone marrow damage.

What do the tests say? Decoding of the general blood test of adult men and women. What the tests say - transcript

Hemoglobin Hb

Hematocrit Ht

Red blood cells R.B.C.

Color index CPU

Leukocytes WBC

Neutrophils NEU

Eosinophils EOS

LymphocytesLYM

PlateletsPLT

ESR-speederythrocyte sedimentation

Norms of protein concentration in blood serum of various age categories:

What does a decrease in the concentration of total protein in the blood serum indicate?

What does an increase in total protein in the blood serum indicate?

What does a general blood test show, detailed, main indicators

Hemoglobin, functions and clinical significance

Red blood cells, physiological role in the body

Leukocytes: their physiological role in the body

Platelets - physiological role, clinical significance

Erythrocyte sedimentation rate

Total red blood cell volume (hematocrit)

Color index

Normal blood laboratory tests

Where to take blood for testing: from a vein or from a finger

Basic rules for preparing to take the UAC

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