Segmented neutrophils dropped, increased. What is it in a blood test, the rate of the child, adult, women during pregnancy. The causes of variances, and what to do

Immunity (protection from foreign particles and pollutants of the environment) is provided cells and extracellular substances that circulate in the blood. Blood cells of the immune system - is leukocytes (or white blood cells).

Among them, the most quantitative presence in the bloodstream shows one type of neutrophils (granulocytes) - segmented cells. Raising or lowering their number per unit volume of blood, tissue or bone marrow - significant diagnostic feature.

Segmented neutrophils: definition and function

Segmented neutrophils - mature neutrophils subtype with high granularity cytoplasm, functional ability which discloses possible. In the analysis of healthy human blood, these cells make up 40 to 70% of all white blood cells, indicating their importance for immunity.

Name segmented bull got in appearance its core, divided by constrictions into individual parts (segments), which is up to 5 pieces of normal. Unlike band neutrophils - immature, but also present in blood in an amount up to 7%, - segmented cells are able to fulfill all the spectrum peculiar neutrophil functions.

For example:

• The penetration through the blood vessel wall - the normal concentration of neutrophils - the hearth invading infectious agent, the site of inflammation or damage to the integrity of the organism.
• Rapid advancement in the intercellular space of tissues.
• Chemotaxis - sensitivity to certain chemical compounds that cause neutrophil stimulation and activation of them. Chemoattractants are: substances which are part of the bacteria or other pathogens; decay products of the body's cells, including neutrophils, who died in the interaction with the pathogen; inducers of inflammation; specific blood proteins that interacted with the pathogen; blood clotting products.
• Phagocytosis - absorption caught in the body of foreign particles (small size) and intracellular combating them.
• Attraction to a place other lesions neutrophils in contact with the agent.
• Stimulation of the synthesis of new cells, "white" blood.
• Induction of inflammation and fever.
• Activation systems lymphocyte immunoglobulin (another type of white blood cells) to generate specific immunity.
• Providing patrol hunting systems in the intercellular space of tissues due to the network of their own DNA.

Thus, the segmented neutrophil responsible for the initial response of the immune system to a security violation from outside the body.

It can manifest itself:

• invasion from the environment of microorganisms - bacteria and fungi, to a lesser extent - virus and helminths;
• penetration of foreign bodies;
• physical damage to the integument or internal organs;
• physiological disorders stable state - stress, stress, menstruation and other similar processes;
  
• relatively weak neutrophils respond to malignant tissue growth.

Segmented neutrophils lowered or raised by the analysis of all patients who have had a similar condition. And if an overabundance of these granulosa cells - rather a good sign, when failure occurs, segmented fraction of blood immune responses begin to weaken the body up to heavy immunodeficiencies.

wbc

WBC (otherwise - leukogram) - is the proportion of types of white blood cells in a blood sample. It shows the proportion of each type of cell and the numerical value on a certain volume of blood taken.

Since different pathologies ratio of different types of "white" blood cells varies, it is deployed leukogram able to demonstrate an overall picture of the state of blood disorders and promptly forward the search for the causes of deviations in the right direction.

If there are violations WBC reveals the so-called shifts on the scale of maturity (and typology) various granulocytes, which are located on it according to the degree of functional and morphological maturity of the left right.

Example:

• myeloblasts (penetrate into the peripheral channel only under particularly severe conditions);
• young (promyelocytes, myelocytes, metamyelocytes) - in a healthy person's blood found in the amount of 0 - 3%;
• stab neutrophils (normally 1-7% in adults);
• segmented neutrophils (normal adult 40-80%).

Neutropenia (neutrophils reduced value) and neutrophils (exceeded their normal) wbc will show what type of neutrophils gone beyond the reference range.

Reasons for study

The content of segmented neutrophils and other types of shows CBC, which is recommended 2 times a year. This is a simple and extremely demonstrative research is able to identify a wide variety of variations in health in the early stages that have not yet manifested clinically.

The reasons for concern practitioner results routine blood count may be a fluctuation ratio leukocytes not related to recent infection (white blood cells must be leveled prior to the 2 weeks).

In addition to laboratory tests, the violation status in leukocyte counts may indicate certain symptoms.

Signs of lowering the number of blood neutrophils (neutropenia, agranulocytosis neutrophil)

• In mild neutropenia: Frequent (more than 8-10 times per year) recurrences of acute respiratory diseases; secondary bacterial infection in acute respiratory infections; generally all infections respond well to standard therapy.
• When the average severity of neutropenia: Frequency of seasonal respiratory disease incidence than 12 times a year; ARI become protracted; there are chronic recurrent fungal local lesions and bacterial origin; among the targeted areas appear: the mouth; genitals; nasopharynx; skin and mucous membranes. In the history of recorded: stomatitis, gingivitis; sore throat and tonsillitis; sinusitis in different locations; abrasions and pustular skin lesions with fever; long-term healing and festering wounds, cuts and scrapes.
  
• If severe neutropenia: Heavy prolonged inflammation in the internal organs: the lungs; in the gastrointestinal tract organs; frequent or first appear: pneumonia; lung abscess; purulent pleurisy; intestinal ulcers; necrotic enteritis and colitis; peritonitis; there is a high fever and general intoxication; severe sepsis.

Segmented neutrophils dropped - then the body will use up the reserve of young forms and showed similar clinical signs of disease. Whenever possible to prevent the depletion of non-specific immune system, doctors recommend not ignore the planned survey.

Increase in the number of neutrophils is the response to infection, injury, tumor or other dangerous for the body state. Therefore, any neutrophilia accompanied by symptoms provoking factor.

Common symptoms of neutrophilia with the appearance of clinical signs of disease:

• fever;
• general weakness;
• redness, tenderness and swelling of the skin and mucous membranes;
• festering sores, plaque on the tonsils, sinusitis, otitis, and other local manifestations;
• headache.

The norm in adults and children

Adults and children's content standards and other segmented neutrophils in the blood vary because human immunity develops slowly and gradually to Over 12-14 years, and in addition, at an early age is two natural sharp jump (overlap) the relationship of segmented and band neutrophils and lymphocytes.

Sex differences in the standards are minimal and in most cases are insignificant. Analyzing the data of the blood sample, it is necessary to take into account the age and current health of the individual, not to make unnecessary conclusions about nonexistent disease.

Segmented neutrophils can be normally reduced in the blood samples taken from the patient to the terminating stage of acute infectious process that culminates in recovery. This result means that the body has exhausted the reserve of mature neutrophilic blood cells, spent to fight the pathogen.

In this situation, as a result of analysis reduced proportion segmented neutrophils will coexist with the further features:

• increased value of stab cells;
• lack of young neutrophils (the proportion should not exceed 3%);
• significant lymphocytosis (lymphocytes exceeded the norm).

If the external signs of the disease is not diagnosed, then this combination is indicative of acute asymptomatic viral infection.

Neutropenia accompanied by lymphocytosis is normal condition in children under 1 year if there are no other symptoms.

Normal contents of the most important of leukocytes by age:

Age	Total absolute neutrophil count	band neutrophils	segmented neutrophils	lymphocytes
in cell number 10 *9 per liter of blood	The relative amount (in% of total leukocytes)
The first 24 hours of life	6,0-26,0	1-5	50-70	30
1-5 days	5,0-21,0	1-5	35-55	40
5-15 days	1,5-10,0	1-4	25-45	50
15 days - 1 month	1,0-9,5	1-5	15-30	55
1 - 12 months	1,0-9,0	1-5	20-35	60
16 years	1,5-8,5	1-4	35-55	40
7-10 years	1,5-8,0	1-4	40-60	38
11-15 years	1,8-8,0	1-4	40-75	35
After 15 years	1,8-7,7	1-4 (7)	48-75 (80)	34

Norma neutrophils in pregnancy

At the beginning and at the end of pregnancy (I and III trimesters) a slight increase in granulocytes of band and segmented is the norm. The mother perceives the resulting fruit and its metabolites as a foreign body and reacts increased non-specific neutrophil pool (and at the same time decrease in the number of certain types of lymphocytes).

Subsequently neutrophilia should be normalized to a level characterized as moderate:

In neutrophils pregnant	indicators neutrophil
segmented	stab
Moderate	10-12 * 109/ L (75-80%)	Until 6%
Average	12-20*109/ L (above 100%)
Tall	20-60*109/ l

neutrophilia pregnant

Increased content of mature (segmented) and young (stab) beyond a moderate level of neutrophils as well as detection of young forms may indicate one of the following states.

For example:

• inflammation or infection after a period of recovery;
• intoxication (food, including because of preservatives and food additives in foods, medicines and other etiology);
• excessive physical activity (intense sport, very long walks, heavy physical labor);
• excessive emotional burden and stress;
• necrosis (thermal damage, gangrene, heart attack);
• brain microstroke;
• decay cancer;
• autoimmune neutrocytosis - an ongoing process of struggle with the fruit, which can lead to premature termination of pregnancy or the birth of a child with congenital immunodeficiency, autoimmune.

In the absence of these diseases, as well as increase the ESR, and the number of monocytes in the blood at high degrees neutrophilia Maternity risk of developing complications of pregnancy and spontaneous abortion, especially in the last trimester.

Leukocyte changes in pregnancy

Sometimes leukogram found unequal change in the content of different types of granulocytes:

• left shift - increase in the number of stab neutrophil cells. This phenomenon is observed in infectious lesions may be hidden. If the inflammation is long and heavy, in the formula appear as young forms of neutrophils. Left shift - an alarming phenomenon in pregnancy.
  
• right shift - increasing the number of segmented forms. Occurs when the depletion of bone marrow stem cell reserve white germ. Strong right shift is observed for prolonged infections, and bone marrow lesions.

Neutropenia in pregnant women

Segmented neutrophils lowered (neutropenia below 1.5 * 10⁹/ L) in pregnant women in the same cases as in the normal state.

But it occurs most often when:

• malnutrition, exhaustion; vitamin deficiency;
• blood loss;
• viral and bacterial infections, severe;
• inhibition of blood - as a result of irradiation; due receiving suppressant drugs granulocytopoiesis; as a consequence of other aplastic anemia.

Features of treatment

Treatment of neutropenia and neutrophil counts in pregnancy is complicated by the toxicity of most medications for the fetus, especially in the first trimester, so the appointment of an expert always means assesses possible risks and appoints the teratogenicity of drugs only if there is the threat of the mother's life.

As in other cases, the treatment of deviations in the number of certain white blood cells is impossible without finding out the root cause.

Gentle treatment of pregnant women can include:

• Intravenous detoxification.
  
• Immunostimulatory and antibiotic therapy.
• Diet. From food exclude meat products, snacks, foods with nutritional supplements. Diet saturated with dishes that are rich in nutrients (cereals, bread flour coarse, vegetables, fruits). Observe drinking regimen (to 2 liters of water per day in the absence of renal failure).
• Status of vitamin and mineral preparations.
• Reduced physical activity.
• Preventive measures: avoiding crowded places, observe the temperature in the room and for a walk, with the exception of reception means official and folk medicine with high allergenic ability.

Reasons for increasing (neutrophilia, neutrophil granulocytic leukocytosis; leukemoid reaction - to the exclusion of Oncology)

In normal immune system reaction to any irritation in the blood increases the pool of segmented and band neutrophils. Therefore neutrophilia - normal and desirable phenomenon for any infectious disease or injury.

It shows the willingness of the organism to an adequate response, and provides favorable treatment.

Increased neutrophils in blood test results - an important indicator of a deviation and a witness of the fight against him, but did not rise to artificially decrease, except in very rare cases of extremely severe neutrophils.

A two-fold excess of the norm is accompanied by inflammatory processes, jump to 10 or more from the norm is observed in extensive blood infection. If the increase in the number of sticks, segments, and especially the young forms of the granulocyte is due to any dangerous phenomena, the symptoms of the primary factors are observed.

Segmented neutrophils increased when:

• Natural reactions that cause physiological redistribution of neutrophil reserve in the body (a slight increase, not serious): emotional stress; chronic stress; physical exercise; overcooling or overheating; meal; smoking.
  
• Infections: infectious diseases, lung flow or in the initial stage - to two fold excess of the norm; in severe inflammatory infections (otitis media, cellulitis, angina, organ abscesses, pneumonia, appendicitis and other suppurative processes) - 2-fold increase; generalized septicemia - an increase from the norm 10 or more times.
• Leukemia, osteomyelofibrosis and other cancers of blood and bone marrow.
• Anemia benign.
• Decay of malignant tumors.
• Metastasis to the bone marrow from other organs.
• The growth of benign tumors, including those in the hematopoietic system.
• Some chromosomal abnormalities (eg Down syndrome) in neonates and adults (eg, Job's syndrome).
• Poisoning toxins, food toxins, chemicals, bites of poisonous animals.
• Internal intoxications (diabetic acidosis, toxemia during pregnancy, uremia, thyrotoxicosis, acute liver failure and others).
• Gangrene and trophic ulcers.
• Infarction (necrosis) of brain, heart, lungs, kidneys.
• Burns (thermal tissue necrosis).
• Helminth infection.
• Skin diseases (dermatitis, eczema, psoriasis).
• Allergies and intolerance of any means.
• Severe nephropathy.
• Autoimmune diseases (rheumatoid arthritis, rheumatoid arthritis and others).
• Common inflammatory conditions or noninfectious inflammation tissues (diabetes, arthritis, gout, pancreatitis, myositis, systemic vasculitis and others).
• Receiving certain medications (ACTH and glucocorticosteroid hormones, NSAIDs, ephedrine, histamine, epinephrine, sodium heparin, digitalis antidote).
• Blood loss and transfusions.
• In the period after vaccination.
• In the postoperative period.
• During the period of ovulation and menstruation.
• Second week - a month after giving birth.
• Teething.

Neutrophilia in a particularly strong manifestation (200 * 10⁹/ L) is rare and can cause a reduction in vascular permeability, local congestion, priapism, cerebrovascular disease.

diagnosing neutrophilia

When neutrophilia doctor tries to eliminate the cause of the oncological process indicating malignant blood disorders (leukemia and other myeloproliferative pathologies).

This may require:

• repeated several general blood tests;
• bakposev;
  
• Urine and stool analysis;
• Analysis secretions (sputum, vaginal smear);
• blood chemistry;
• bone marrow biopsy;
• Cytogenetic study of the bone marrow biopsy (to detect chromosomal abnormalities).

For leukemoid reactions (benign neutrophilia) characterized by several attributes:

• Total severe state (weight loss, pain, fever). Initial stages of hematological cancer show no visible symptoms; the only sign of disease in this case is considerable left shift leukocytes.
• Tromobitopeniya (higher values ​​tromotsitov in a blood test).
• Absence or minor amount (up to 5%) of young forms of neutrophils in the KLA.
• Spleen palpation is not detectable or slightly increased, and soft in consistency.
• Degenerative changes in neutrophils (toxic (increased) granulation of the cytoplasm, the presence of vacuoles in the nucleus and cytoplasm in sepsis - decay of the nucleus in live neutrophils).
• No change in alkaline phosphatase of neutrophils in the blood chemistry.
• The absence of significant fluctuations in the number of basophils and eosinophils in the blood leukogram.
• The results of the analysis of bone marrow biopsy (Myelogram): no hyperplasia (growths) white sprouts hematopoiesis; normal (not large) number of cells in a biopsy sample; unaltered number of megakaryocytes (predecessors of platelets).

Leukocytosis metastasis to the bone marrow from other organs are not expressed, usually does not exceed 10-20 * 10⁹/ L, followed by thrombocytosis and erythrocytosis in a blood test.

Reasons for the decline (neutropenia, agranulocytosis or neutrophilic granulocytopenia)

Segmented neutrophils are often dropped from the analysis of those patients in whom there prolonged severe infection, especially viral, but there are many more rare factors neutropenia.

This disease is diagnosed by reducing the number of neutrophils to 1.5 * 10⁹/ Liter blood and below (in African ethnic groups - up to 1,2 * 10⁹/л). Granulocyte deficiency may be caused by external factors (secondary neutropenia) and, rarely, impaired hematopoiesis mechanism (primary form).

Causes of primary (congenital) neutropenia:

• hereditary immune deficiency;
• chromosome mutations in the genes responsible for granulocytopoiesis (synthesis granulocytes);
• congenital chondrodysplasia;
• congenital dyskeratosis;
• other genetic abnormalities.

The causes of acquired neutropenia:

• Vitamin deficiency or mineral deficiency: Vitamin B12 (cyanocobalamin); vitamin B9 (folic acid); vitamin B1 (thiamine); copper; gland.
• Exposure to certain medicines the type of allergens or toxins. These tools include: non-steroidal anti-inflammatory drugs; some antimicrobials (penicillin antibiotics; cephalosporins; sulfonamides, chloramphenicol); immunosuppressants and interferon - with uncontrolled admission; diuretics; anelgetiki; antidiabetics; worming drugs; anti thyrotoxicosis; a number of antipsychotics and anticonvulsants.

Sensitivity neutrophil pool of drug does not occur in all patients, and presumably as a consequence of the exchange of chromosomal abnormalities.

Drug-induced neutropenia often resolves on its own in 1-2 weeks after the start of reception.

Sometimes the toxic effects of the drug may lead to a marked allergic response, extensive inflammation of internal organs, and sepsis and requires the removal of the provoking drug. Reappointment allergenic agents dangerously destructive effects on the immune properties of the organism.

Just a few reasons:

• Acute viral infections (ARI, intestinal rotavirus, rubella, varicella, polio, measles, hepatitis, etc.). Neutrophils weakly active against viral agents and migrate into the tissue when the invasion or accumulate in the wall space of the blood vessels. Neutropenia this kind often seen in children is short and lasts for 1-2 weeks after the onset of the disease.
• HIV infection and other severe chronic viral infection. This long-lasting neutropenia, tends to be severe and require external medical support.
• Sepsis - a common blood infection by pathogenic bacterial microorganisms. Observed with prolonged duration of infectious diseases (e.g. tuberculosis, brucellosis, typhoid fever) and is a consequence of depletion of the blood and bone marrow reserve neutrophils. Septicemia - a dangerous condition that requires the active intervention of a qualified.
• Long-term heavy fungal.
• Heavy protozoal infections (Malaria, toxoplasmosis and others). With infectious lesions of any etiology in leucocyte count were also observed increased lymphocytes and monocytes.
  
• Prolonged exposure to radiation and radiation therapy - destructive to the hematopoietic bone marrow, and the potential risk of dangerous infectious lesions.
• Chemotherapy. The toxic effect of cytostatics in white germ hematopoiesis seen immediately after the initiation of therapy and continues until months after its completion. Patients undergoing chemotherapy require increased hygienic and sanitary conditions to avoid contamination.
• Autoimmune destruction of granulocytes - observed only in respect of the effect of neutrophils or other autoimmune diseases (e.g. systemic lupus erythematosus). The pathology manifests with symptoms of the underlying disease, sometimes - immediately after birth (in the case of congenital immunodeficiency). It requires treatment.
• aplastic anemia - benign failure synthesis of neutrophils in the bone marrow. It may be toxic, and other genetic etiology and severe course, but on prolonged adequate treatment shows a favorable outcome.
• metastases malignant tumors in the bone from other organs - violate krovetvoryaschuyu bone marrow function.
• immaturityred bone marrow in children - one of the hypothetical causes of benign neutropenia of childhood.

types of neutropenia

There are several kinds on the rate of development of neutropenia:

• chronic - expenditure of neutrophils in tissues, blood and bone marrow occurs gradually over months or years.
• acute - neutrophilic reserve decreases rapidly within a few days.
• febrile neutropenia (Neutropenic fever) - clinically significant, life-threatening condition with low standing neutrophils (less than 0.5 * 10⁹/л). Occurs when penetration of opportunistic infections, immediately passing in severe form. Febrile neutropenia is first detected suddenly, often in the treatment with cytostatics. It calls for the immediate provision of skilled care. Symptoms: sharp (within hours or minutes) increase in body temperature above 38 ° C; shivering and tremor; pouring sweat; severe weakness, asthenic syndrome; a sharp drop in blood pressure; rapid pulse.

Etiology of neutropenia are divided into primary (congenital immunodeficiency) and acquired:

• infectious Diseases;
• dosage;
• autoimmune;
• Benign chronic (child and adult).

The dangerous neutropenia

With the lack of readiness of the organism to the response to foreign invasion observed pathology of varying severity, which manifest themselves in increase the frequency and severity of infectious diseases, reducing quality of life and enhancing the danger of death from infection and wounds.

In especially severe immunodeficiency, when the immune response is completely absent, patients can exist only in special sterile boxes.
severity

The severity of neutropenia is dependent on the absolute number of neutrophils in the blood unit:

1. easy - from 1.5 to 1 * 10⁹/л. Manifested by frequent SARS.
2. moderate - from 1 to 0.5 * 10⁹/л. Seasonal respiratory infections tend to be chronic and additional bacterial infections (sinusitis, otitis, pneumonia). Frequent angina. Frequent skin and mucous - stomatitis, gingivitis, abrasions.
3. Weight - lower than 0.5 * 10⁹/л. Severe inflammation of internal organs (lungs, intestines), fever, sepsis. skin lesions and mucous membranes become purulent and can not be cured.

treatment regimen

The treatment regimen and dosing regimen depend on the type and cause of the disease:

• Neutrophils. The high number of segmented neutrophils and other species does not bear the devastating effects of the blood, except in rare cases with indicators 200 * 10⁹/л. In this case, treatment may consist of:
• cytostatic therapy;
• leykotsitoferez (removal of leukocytes from blood transfusion);
  
• anticoagulation.

In other cases, treatment is aimed at eliminating the causes of neutrophilia:

• Antibacterial or other aseptic therapy for a specific pathogen.
• Introduction immunostimulants.
• Introduction antihistamines.
• The impact of anti-inflammatory drugs (including corticosteroids).
• Bone marrow transplantation (with aplastic anemias and hematologic diseases).
• In malignant hematologic diseases and cytostatic assigned hormone therapy, radiation, blood transfusion, sometimes it requires bone marrow transplantation.
• Neutropenia. Patients are maintained on combined or monotherapeutic schemes adjusted based on the results of treatment of therapy (e.g., febrile neutropenia requires adjusting every 72 hours).
• Mild to moderate deficiency of neutrophil removed periodic courses of vitamin and mineral supplements and probiotics.
• The introduction of interferon and immunostimulants in viral infections (especially heavy).
• Antibiotic antimycotic therapy in the presence of the infection.
• Immunoglobulin therapy (autoimmune neutropenia, febrile neutropenia on the background of staphylococcal or streptococcal infection).
  
• Moderate treatment of febrile syndrome in critically ill patients zharoponimayuschimi and glucocorticosteroids.
• Infusions of blood.
• bone marrow transplantation.
• Introduction colony stimulating factors - a new and quite effective but expensive method of treatment of severe neutropenia.

An increase or decrease in the normal number of segmented neutrophils always indicative of the body's response to any stimulus. In order to timely detect it and notice the dangerous deviations in health status, should be periodically undergo routine screening of blood - fast, indicative, safe and fairly painless diagnostics.

Registration of the article: Lozinski Oleg

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