Interpretation of a general blood test for adult men and women. Blood analysis

NINE BLOOD VALUES THAT WILL TELL EVERYTHING ABOUT YOU

What you can read about your health from the most informative analysis

Whatever your illness, the first test that a competent doctor will send you for will be a general (general clinical) blood test, says our expert - cardiologist, doctor of the highest category Tamara Ogieva.

Blood for general analysis is taken venous or capillary, that is, from a vein or from a finger. The primary general analysis can be taken without an empty stomach. A detailed blood test is given only on an empty stomach.

For biochemical analysis, blood will have to be donated only from a vein and always on an empty stomach. After all, if you drink, say, coffee with sugar in the morning, the glucose level in your blood will certainly change and the analysis will be incorrect.

A competent doctor will definitely take into account your gender and physiological state. For example, in women during “critical days,” the ESR increases and the platelet count decreases.

A general analysis provides more information about inflammation and the state of the blood (propensity for blood clots, the presence of infections), and biochemical analysis is responsible for the functional and organic state internal organs- liver, kidneys, pancreas.

General analysis indicators:

1. HEMOGLOBIN (Hb) is a blood pigment found in erythrocytes (red blood cells), its main function is the transfer of oxygen from the lungs to the tissues and the removal of carbon dioxide from the body.

Normal values ​​for men are 130-160 g/l, women - 120-140 g/l.

Reduced hemoglobin occurs with anemia, blood loss, hidden internal bleeding, damage to internal organs, for example, kidneys, etc.

It can increase with dehydration, blood diseases and some types of heart failure.

2. ERYTHROCYTES - blood cells that contain hemoglobin.

Normal values ​​are (4.0-5.1) * 10 to the 12th power/l and (3.7-4.7) * 10 to the 12th power/l, for men and women, respectively.

An increase in red blood cells occurs, for example, in healthy people on high altitude in the mountains, as well as for congenital or acquired heart defects, diseases of the bronchi, lungs, kidneys and liver. The increase may be due to an excess of steroid hormones in the body. For example, with Cushing's disease and syndrome, or during treatment with hormonal drugs.

Decrease - with anemia, acute blood loss, with chronic inflammatory processes in the body, as well as in late pregnancy.

3. LEUCOCYTES - white blood cells, they are formed in the bone marrow and lymph nodes. Their main function is to protect the body from adverse effects. Norm - (4.0-9.0) x 10 to the 9th degree / l. Excess indicates the presence of infection and inflammation.

There are five types of leukocytes (lymphocytes, neutrophils, monocytes, eosinophils, basophils), each of them performs a specific function. If necessary, a detailed blood test is done, which shows the ratio of all five types of leukocytes. For example, if the level of leukocytes in the blood is increased, a detailed analysis will show which type has increased their total number. If due to lymphocytes, then there is an inflammatory process in the body; if there are more eosinophils than normal, then an allergic reaction can be suspected.

WHY ARE THERE MUCH LEUKOCYTES?

There are many conditions in which changes in white blood cell levels are observed. This does not necessarily indicate illness. Leukocytes, as well as all indicators of general analysis, react to various changes in the body. For example, during stress, pregnancy, or after physical exertion, their number increases.

An increased number of leukocytes in the blood (also known as leukocytosis) also occurs with:

Infections (bacterial),

Inflammatory processes

Allergic reactions,

Malignant neoplasms and leukemia,

Reception hormonal drugs, some heart drugs (eg digoxin).

But a low number of white blood cells in the blood (or leukopenia): this condition often occurs with a viral infection (for example, the flu) or taking certain medications, for example, analgesics, anticonvulsants.

4. PLATELETS - blood cells, an indicator of normal blood clotting, are involved in the formation of blood clots.

Normal amount - (180-320) * 10 to the 9th power/l

An increased amount occurs when:

Chronic inflammatory diseases (tuberculosis, ulcerative colitis, cirrhosis of the liver), after operations, treatment with hormonal drugs.

Reduced when:

The effects of alcohol, heavy metal poisoning, blood diseases, kidney failure, liver diseases, spleen diseases, hormonal disorders. And also under the influence of certain medications: antibiotics, diuretics, digoxin, nitroglycerin, hormones.

5. ESR or ROE - erythrocyte sedimentation rate (erythrocyte sedimentation reaction) - this is the same thing, an indicator of the course of the disease. Typically, ESR increases on days 2-4 of the disease, sometimes reaching a maximum during the recovery period. The norm for men is 2-10 mm/h, for women - 2-15 mm/h.

Increased with:

Infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation.

Downgraded:

In case of circulatory failure, anaphylactic shock.

Biochemical analysis indicators:

6. GLUCOSE - it should be 3.5-6.5 mmol/liter. Decreased - with insufficient and irregular nutrition, hormonal diseases. Increased in diabetes mellitus.

7. TOTAL PROTEIN - norm - 60-80 grams / liter. Decreases with deterioration of the liver, kidneys, malnutrition (a sharp decrease in total protein is a frequent symptom that a strict restrictive diet clearly did not benefit you).

8. TOTAL BILIRUBIN - normal - no higher than 20.5 mmol/liter shows how the liver is working. Increase - with hepatitis, cholelithiasis, destruction of red blood cells.

9. CREATININE - should not be more than 0.18 mmol/liter. The substance is responsible for the functioning of the kidneys. Exceeding the norm is a sign of kidney failure; if it falls short of the norm, it means you need to increase your immunity.

Each of us at least once in our lives has had our blood tested and received a piece of paper with letters, numbers and units of measurement. Then the doctor, looking at the results, announced: “You are healthy,” or “You are sick.” But no matter how much you looked at the incomprehensible icons, you still didn’t understand anything. In fact, everything is not that difficult. Let's try to learn the language of our blood.

What does a human blood test say?

General analysis indicators:

1. HEMOGLOBIN (Hb) is a blood pigment found in erythrocytes (red blood cells), its main function is the transfer of oxygen from the lungs to the tissues and the removal of carbon dioxide from the body.

Normal values ​​for men are 130-160 g/l, women - 120-140 g/l.

Reduced hemoglobin occurs with anemia, blood loss, hidden internal bleeding, damage to internal organs, for example, kidneys, etc.

It can increase with dehydration, blood diseases and some types of heart failure.

2. ERYTHROCYTES - blood cells that contain hemoglobin.

Normal values ​​are (4.0-5.1) * 10 to the 12th power/l and (3.7-4.7) * 10 to the 12th power/l, for men and women, respectively.

An increase in red blood cells occurs, for example, in healthy people at high altitudes in the mountains, as well as in congenital or acquired heart defects, diseases of the bronchi, lungs, kidneys and liver. The increase may be due to an excess of steroid hormones in the body. For example, with Cushing's disease and syndrome, or during treatment with hormonal drugs.

Decreased - with anemia, acute blood loss, with chronic inflammatory processes in the body, as well as in late pregnancy.

3. LEUCOCYTES - white blood cells, they are formed in the bone marrow and lymph nodes. Their main function is to protect the body from adverse effects. The norm is (4.0-9.0) x 10 to the 9th power /l. Excess indicates the presence of infection and inflammation.

There are five types of leukocytes (lymphocytes, neutrophils, monocytes, eosinophils, basophils), each of them performs a specific function. If necessary, a detailed blood test is done, which shows the ratio of all five types of leukocytes. For example, if the level of leukocytes in the blood is increased, a detailed analysis will show which type has increased their total number. If due to lymphocytes, then there is an inflammatory process in the body; if there are more eosinophils than normal, then an allergic reaction can be suspected.

WHY ARE THERE MUCH LEUKOCYTES?

There are many conditions in which changes in white blood cell levels are observed. This does not necessarily indicate illness. Leukocytes, as well as all indicators of general analysis, react to various changes in the body. For example, during stress, pregnancy, or after physical exertion, their number increases.

An increased number of leukocytes in the blood (also known as leukocytosis) also occurs with:
+ infections (bacterial),

Inflammatory processes

Allergic reactions,

Malignant neoplasms and leukemia,

Taking hormonal medications, some heart medications (for example, digoxin).

But a low number of white blood cells in the blood (or leukopenia): this condition often occurs with a viral infection (for example, the flu) or taking certain medications, for example, analgesics, anticonvulsants.

4. PLATELETS - blood cells, an indicator of normal blood clotting, are involved in the formation of blood clots.

Normal amount - (180-320) * 10 to the 9th power / l

An increased amount occurs when:
chronic inflammatory diseases (tuberculosis, ulcerative colitis, cirrhosis of the liver), after operations, treatment with hormonal drugs.

Reduced when:
the effects of alcohol, heavy metal poisoning, blood diseases, kidney failure, liver diseases, spleen diseases, hormonal disorders. And also under the influence of certain medications: antibiotics, diuretics, digoxin, nitroglycerin, hormones.

5. ESR or ROE - erythrocyte sedimentation rate (erythrocyte sedimentation reaction) - this is the same thing, an indicator of the course of the disease. Typically, ESR increases on days 2-4 of the disease, sometimes reaching a maximum during the recovery period. The norm for men is 2-10 mm/h, for women - 2-15 mm/h.

Increased with:
infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation.

Downgraded:
with circulatory failure, anaphylactic shock.

This is an attempt to decipher the results of some blood tests that are done in modern laboratories.

There are no generally accepted standards - each laboratory has its own. Find out the standards in the laboratory where you took the tests.

Of course, not all reasons for changes in test results are indicated - only the most common ones. It is impossible to interpret the tests using this “tutorial” - only the attending physician can do this. Not only the results of an individual analysis are important, but also the relationship between different results. Therefore, you should not diagnose yourself and self-medicate - the description is given for guidance only - so that you do not give yourself unnecessary diagnoses, interpreting the analysis too poorly when you see that it goes beyond the norm.

BIOCHEMISTRY

Glucose

A universal source of energy for cells is the main substance from which any cell of the human body receives energy for life. The body's need for energy, and therefore glucose, increases in parallel with physical and psychological stress under the influence of the stress hormone - adrenaline, during growth, development, recovery (growth hormones, thyroid gland, adrenal glands). For glucose uptake by cells it is necessary normal content insulin - a hormone of the pancreas. With its deficiency (diabetes mellitus), glucose cannot enter the cells, its level in the blood is increased, and the cells starve.

Increased (hyperglycemia):

Total protein

“Life is a way of existence of protein bodies.” Proteins are the main biochemical criterion of life. They are included in all anatomical structures(muscles, cell membranes), transport substances through the blood and into cells, accelerate the course of biochemical reactions in the body, recognize substances - their own or others and protect them from others, regulate metabolism, retain fluid in blood vessels and do not allow it to go into the tissue.

Proteins are synthesized in the liver from food amino acids. Total protein blood consists of two fractions: albumin and globulin.

Promotion (hyperproteinemia):

Decrease:

Protein fasting

Excess protein intake (pregnancy, acromegaly)

Malabsorption

Creatinine

Myeloma

Toxicosis of pregnant women

Foods rich in nucleic acids (liver, kidneys)

Hard physical work

Decreased (hypouricemia):

Wilson-Konovalov disease

Fanconi syndrome

Diet low in nucleic acids

Alanine aminotransferase (ALAT)

An enzyme produced by cells of the liver, skeletal muscles and heart.

Promotion:

Destruction of liver cells (necrosis, cirrhosis, jaundice, tumors, alcohol)

Destruction muscle tissue(trauma, myositis, muscular dystrophy)

Toxic effect on the liver of drugs (antibiotics, etc.)

Aspartate aminotransferase (AST)

An enzyme produced by cells of the heart, liver, skeletal muscles and red blood cells.

Promotion:

Damage to liver cells (hepatitis, toxic damage from drugs, alcohol, liver metastases)

Heart failure, myocardial infarction

Burns, heatstroke

Hyperthyroidism (overactive thyroid gland)

Prostate cancer

Excess vitamin D

Dehydration

Decreased (hypocalcemia):

Decreased thyroid function

Magnesium deficiency

Excess vitamin D

Healing of fractures

Decreased function of the parathyroid glands.

Decrease:

Growth hormone deficiency

Vitamin D deficiency

Malabsorption, severe diarrhea, vomiting

Hypercalcemia

Magnesium

Calcium antagonist. Promotes muscle relaxation. Participates in protein synthesis.

Increased (hypermagnesemia):

Dehydration

Kidney failure

Adrenal insufficiency

Multiple myeloma

Decreased (hypomagnesemia):

Impaired intake and/or absorption of magnesium

Acute pancreatitis

Decreased parathyroid function

Lactate

Lactic acid. It is formed in cells during the breathing process, especially in muscles. With a full supply of oxygen, it does not accumulate, but is destroyed to neutral products and excreted. Under conditions of hypoxia (lack of oxygen), it accumulates, causes a feeling of muscle fatigue, and disrupts the process of tissue respiration.

Promotion:

Eating

Aspirin intoxication

Insulin administration

Hypoxia (insufficient oxygen supply to tissues: bleeding, heart failure, respiratory failure, anemia)

Third trimester of pregnancy

Chronic alcoholism

Creatine kinase

Muscle damage (myopathy, muscular dystrophy, trauma, surgery, heart attack)

Pregnancy

Delirium tremens (delirium tremens)

Decrease:

Low muscle mass

Sedentary lifestyle

Lactate dehydrogenase (LDH)

An intracellular enzyme produced in all tissues of the body.

Promotion:

Destruction of blood cells (sickle cell, megaloblastic, hemolytic anemia)

Liver diseases (hepatitis, cirrhosis, obstructive jaundice)

Tumors, leukemia

Damage to internal organs (kidney infarction, acute pancreatitis)

Phosphatase alkaline

An enzyme produced in bone tissue, liver, intestines, placenta, and lungs.

Promotion:

Pregnancy

Increased turnover in bone tissue ( fast growth, healing of fractures, rickets, hyperparathyroidism)

Bone diseases (osteogenic sarcoma, cancer metastases to bone, myeloma)

Decrease:

Hypothyroidism (underfunction of the thyroid gland)

Decrease:

Organophosphate poisoning

Liver pathology (hepatitis, cirrhosis, liver metastases)

Dermatomyositis

Condition after surgery

Lipase

An enzyme that breaks down food fats. Secreted by the pancreas. With pancreatitis, it is more sensitive and specific than amylase; with simple mumps, unlike amylase, it does not change.

Promotion:

Pancreatitis, tumors, pancreatic cysts

Biliary colic

Perforation of a hollow organ, intestinal obstruction, peritonitis

Pancreatic amylase

An enzyme produced by the pancreas.

Promotion:

Acute and chronic pancreatitis

Decrease:

Pancreatic necrosis

Glycosylated hemoglobin

Formed from hemoglobin with long-term elevated glucose levels - for at least 120 days (the lifespan of an erythrocyte), it is used to assess the compensation of diabetes mellitus and long-term monitoring of the effectiveness of treatment.

Promotion:

Long-term hyperglycemia (more than 120 days)

Fructosamine

Formed from blood albumin during a short-term increase in glucose levels - glycated albumin. It is used, in contrast to glycated hemoglobin, for short-term monitoring of the condition of patients with diabetes (especially newborns) and the effectiveness of treatment.

C-peptide

Insulin metabolic product. Used to assess insulin levels when its direct determination in the blood is difficult: the presence of antibodies, the introduction of an insulin drug from the outside.

LIPIDS

Lipids (fats) are substances necessary for a living organism. The main lipid that a person receives from food, and from which their own lipids are then formed, is cholesterol. It is part of cell membranes and maintains their strength. From it the so-called steroid hormones: hormones of the adrenal cortex, regulating water-salt and carbohydrate metabolism, adapting the body to new conditions; sex hormones. Bile acids are formed from cholesterol, which are involved in the absorption of fats in the intestines. Vitamin D, which is necessary for the absorption of calcium, is synthesized from cholesterol in the skin under the influence of sunlight. When the integrity of the vascular wall is damaged and/or there is excess cholesterol in the blood, it is deposited on the wall and forms a cholesterol plaque. This condition is called vascular atherosclerosis: plaques narrow the lumen, interfere with blood flow, disrupt the smooth flow of blood, increase blood clotting, and promote the formation of blood clots. In the liver, various complexes of lipids with proteins are formed that circulate in the blood: high, low and very low density lipoproteins (HDL, LDL, VLDL); total cholesterol is divided between them. Low and very low density lipoproteins are deposited in plaques and contribute to the progression of atherosclerosis. High-density lipoproteins, due to the presence of a special protein in them - apoprotein A1 - help to “pull out” cholesterol from plaques and play a protective role, stopping atherosclerosis. To assess the risk of a condition, it is not the total level of total cholesterol that is important, but the ratio of its fractions.

Total cholesterol

Promotion:

Genetic features (familial hyperlipoproteinemia)

Liver diseases

Hypothyroidism (underfunction of the thyroid gland)

LDL cholesterol

Promotion:

Hypothyroidism

Liver diseases

Pregnancy

Taking sex hormones

Apoprotein A1

Protective factor against atherosclerosis.

Normal serum levels vary by age and gender. g/l.

Promotion:

Weight loss

Decrease:

Genetic features of lipid metabolism

Early atherosclerosis of coronary vessels

Smoking

Foods rich in carbohydrates and fats

Apoprotein B

Risk factor for atherosclerosis

Normal serum levels vary by gender and age. g/l.

Promotion:

Alcohol abuse

Taking steroid hormones (anabolics, glucocorticoids)

Early atherosclerosis of coronary vessels

Liver diseases

Pregnancy

Diabetes

Hypothyroidism

Decrease:

Low cholesterol diet

Hyperthyroidism

Genetic features of lipid metabolism

Weight loss

Acute stress (severe illness, burns)

B\A1

This ratio is a more specific marker of atherosclerosis and coronary disease heart than the ratio of LDL/HDL fractions. The higher, the greater the risk.

Triglycerides

Another class of lipids that is not derived from cholesterol. Promotion:

Genetic features of lipid metabolism

Impaired glucose tolerance

Liver diseases (hepatitis, cirrhosis)

Alcoholism

Cardiac ischemia

Hypothyroidism

Pregnancy

Diabetes

Taking sex hormones

Decrease:

Hyperthyroidism

Lack of nutrition, absorption

CARDIO MARKERS

Myoglobin

A protein in muscle tissue responsible for its respiration.

Uremia (kidney failure)

Muscle strain (sports, electropulse therapy, cramps)

Injuries, burns

Decrease:

Autoimmune conditions (autoantibodies against myoglobin): polymyositis, rheumatoid arthritis, myasthenia gravis.

Creatine kinase MV

One of the fractions of total creatine kinase.

Promotion:

Acute myocardial infarction

Acute skeletal muscle injury

Troponin I

Specific contractile protein of the cardiac muscle.

Promotion:

DIAGNOSIS OF ANEMIA (BIOCHEMISTRY)

The main function of blood is to transport oxygen to the cells of the body. This function is performed by red blood cells - erythrocytes. These cells are formed in the red bone marrow, leaving it, they lose their nucleus - a depression is formed in its place, and the cells take the shape of a biconcave disk - this shape ensures the maximum surface area for the addition of oxygen. The entire interior of the red blood cell is filled with the protein hemoglobin, the red blood pigment. At the center of the hemoglobin molecule is an iron ion, and it is to this ion that oxygen molecules attach. Anemia is a condition in which oxygen delivery does not meet the tissue needs for it. Appears as oxygen starvation(hypoxia) of organs and tissues, deterioration of their functioning. Possible reasons anemia is divided into 3 groups: insufficient oxygen consumption (lack of it in the atmospheric air, pathology of the respiratory system), disruption of its transport into tissues (blood pathology - lack or destruction of red blood cells, iron deficiency, hemoglobin pathology, diseases of the cardiovascular system) and increased consumption oxygen (bleeding, tumors, growth, pregnancy, serious illnesses). The following tests are performed to diagnose the cause of anemia.

Iron

Normal serum levels vary by gender

Promotion:

Hemolytic anemia (destruction of red blood cells and release of their contents into the cytoplasm)

Sickle cell anemia (hemoglobin pathology, red blood cells have an irregular shape and are also destroyed)

Aplastic anemia (bone marrow pathology, red blood cells are not produced, and iron is not used)

Acute leukemia

Excessive treatment with iron supplements

Decrease:

Iron-deficiency anemia

Hypothyroidism

Malignant tumors

Hidden bleeding (gastrointestinal, gynecological)

Ferritin

Protein, which contains iron, is stored in the depot, storing it for the future. By its level one can judge the sufficiency of iron reserves in the body.

Promotion:

Excess iron (some liver diseases)

Acute leukemia

Inflammatory process

Decrease:

Iron deficiency

Total iron binding capacity of serum

Shows the presence of iron in the blood serum - in transport form (in connection with a special protein - transferrin). Iron binding capacity increases with iron deficiency and decreases with iron excess.

Promotion:

Iron-deficiency anemia

Late pregnancy

Decrease:

Anemia (not iron deficiency)

Chronic infections

Cirrhosis of the liver

Folates

Promotion:

Vegetarian diet (excess folic acid in food)

Decrease:

Folate deficiency

Vitamin B12 deficiency

Alcoholism

Malnutrition

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 to all parts of the human body, and also removes “waste” waste products from them. The total amount of blood makes up 7-8% of a person's weight. Blood consists of a liquid part - plasma and shaped elements: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (platelets).

How is blood obtained for clinical research?

For clinical analysis capillary blood is used, which is obtained from the hand finger (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 cases when the doctor suspects the development of a serious acute disease, 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 and 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

Most important to assess the health status of the subject, they have such indicators as the ratio of the volume of liquid and cellular parts of blood, the number of cellular elements of blood and 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 for 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 serious symptom and requires an in-depth examination to determine the reasons for 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 flying at 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, it is necessary to determine color index or the average hemoglobin content in a red blood cell (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(emphysema, pneumosclerosis, Chronical 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.

For some forms congenital diseases other specific changes in the shape of red blood cells are characteristic. 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 indicator 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 - severe cancer blood and compensatory erythrocytosis (see above).

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

1.1.3. Erythrocyte sedimentation rate

Erythrocyte sedimentation rate (ESR) is perhaps the most well-known laboratory indicator, the meaning of which is known something, or at least guessed that “a high ESR is a bad sign”, most people who regularly undergo 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 believed that one of the main reasons increasing ESR- this 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-communicable diseases, 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 also necessary to take into account the physiological reasons for the increase in 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 the appearance of the nucleus, 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 procedures.

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 (persons old age, exhausted people, alcoholics and drug addicts) with these processes, leukocytosis may not be observed. 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 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 some medicines: anti-inflammatory (amidopyrine, butadione, pyra-butol, reopirin, analgin); antibacterial agents(sulfonamides, synthomycin, 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 initial stages 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 errors when examining a patient, it is very important for the doctor to determine not only the percentage different types 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 total leukocytes 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” within the normative value.

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 glucocorticoid 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 sign of infectious mononucleosis, and can also occur in 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 of the lymphatic system - lymphogranulomatosis, lymphoma.

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

Eosinopenia may occur at developmental heights infectious diseases, In 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 to prevent and stop bleeding. With a lack of platelets in the blood, the bleeding time increases sharply, and the vessels become brittle and bleed more easily.

Thrombocytopenia is always an 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 states:

. 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, chicken pox, flu);
. 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 (everyone knows this experienced doctors), 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 major 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 study 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 the end of the 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. It is also undesirable to use medicinal substances, because some of them (vitamins, antipyretic 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 giving urine to 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 elements of inflammation in the urethra and external genital organs can get into the urine, you must first 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, in extreme heat or intense physical activity with profuse sweating Less urine is produced 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 when the excretion of bile pigments in the urine increases, which is observed with parenchymal (hepatitis, cirrhosis) or mechanical (clogging of the bile duct with 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 sharp 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 the physical and chemical properties of urine, its daily amount, relative density, acid-base reaction, protein, glucose, and bile pigment content are examined.

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.

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

A decrease in urine output occurs when there is excessive sweating, for example when working in high temperatures, with diarrhea and vomiting. Also, low diuresis is facilitated 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:

. a sharp decrease in blood volume and a fall 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;
. obstruction of both ureters by stones or compression by a nearby tumor large sizes(uterine cancer, bladder cancer, 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 in diabetes mellitus 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

The relative density (specific gravity) of urine depends on the content in it dense substances(urea, mineral salts, etc., and in cases of pathology - glucose, protein) and normally is 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 urine pH (a shift in acidity to the alkaline side) is observed when taking a large amount mineral water, after vomiting, swelling, inflammation of the bladder, blood in the urine.

The clinical significance of determining the pH of urine is limited by the fact that a change in the acidity of urine towards the alkaline side contributes to a more rapid destruction of the formed elements in the urine sample during its 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 secretion protein 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, the upper limit of normal 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 relatively low level protein content (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;
. severe emotional stress;
. epileptic seizure.

Pathological renal proteinuria is observed in the following cases:

. kidney diseases (acute and chronic inflammatory diseases kidneys - 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 side, negative reaction 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. The detection of bile acids of varying degrees of severity in the urine: 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 biliary tract and the intestines directly enter 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 severe physical activity, with 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, so 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 roughly establish the place of development inflammatory process 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). The detection of bacteria in the urine is not always a sign of an inflammatory process in the 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 for patients with inflammation in urinary organs typically 100 thousand bacteria in 1 ml. If you suspect infectious process in the urinary tract, doctors supplement the determination of microbial bodies in the urine with a bacteriological study, in which they inoculate urine under sterile conditions on special nutrient media and, based on a number of signs of the grown colony of microorganisms, determine the identity of the latter, 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. Thus, uric acid crystals 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 with various forms renal 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 detect 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, calculate the value glomerular filtration(characterizes the excretory function of the kidneys) and tubular reabsorption.

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. At chronic pyelonephritis the decrease in CF occurs later, and with glomerulonephritis, on the contrary, earlier than the impairment of the concentrating ability of the kidneys.

Persistent drop in EF to 40 ml/min at chronic disease kidney 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 an “artificial kidney” apparatus or a 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.