Blood test
Together with cardiologist Yaroslav Ashikhmin, we tell you what elements blood consists of and how to understand its analysis. Do not forget that the norms of almost all blood parameters are very dependent on age and gender.
Hemoglobin and red blood cells
Hemoglobin is a protein that carries oxygen. It is located inside red blood cells. The more hemoglobin, the more oxygen the blood can carry. A drop in the level of hemoglobin or red blood cells below a certain value is called anemia. The hemoglobin norm for men is 130.0–160.0 g/l, and for women – 120.0–140.0 g/l. Red blood cells are red blood cells, which are biconcave discs. They carry oxygen due to the presence of hemoglobin in them. Erythrocytes are devoid of nuclei, that is, from a scientific point of view, they are not cells, but so-called post-cellular elements. The life span of an erythrocyte is about 3-4 months. An increase in the number of red blood cells is noted in people who live in the mountains, as well as in those who suffer from a special type of blood disease, the so-called erythrocytosis, and in those who take doping in the form of the hormone erythropoietin, which accelerates the formation of red blood cells. The norm of erythrocytes in men is 4.0–5.0× 10 12 / l, and in women – 3.9–4.7×10 12/ l.
Color index and average hemoglobin content
The hemoglobin content inside the erythrocyte, the color index and the average concentration reflect how much of the key oxygen-carrying protein is inside the erythrocyte. It should be understood that the key point at which the hemoglobin content decreases or the color index drops is iron deficiency. The color index is calculated according to the formula [3×Hb in g/l / the three highest digits of the number of red blood cells (in millions)]. Iron is part of the key part of hemoglobin, which carries oxygen inside the so-called heme. With a slight lack of iron, red blood cells are produced at the same rate as before, but they contain less hemoglobin. At first, with a small iron deficiency, it is the volume of red blood cells and the concentration of hemoglobin inside them that begins to decrease. And only with an increase in iron deficiency, when it becomes critical, the number of red blood cells already begins to decrease. In other types of anemia, when a person lacks folic acid or vitamin B12, the volume of red blood cells, on the contrary, increases. The norm of the color index is 0.85–1.05, and the average hemoglobin content in one erythrocyte is 30-35 pg.
Hematocrit
Hematocrit is the total content of cellular elements per unit volume of blood. Basically, hematocrit forms the most red blood cells in the blood. As a percentage, there are very few other cells compared to erythrocytes. And since hematocrit is interconnected with the number of red blood cells, it decreases with anemia and iron deficiency. The norm of hematocrit: men – 40-48%, women – 36-42%.
Reticulocytes
Reticulocytes are an immature form of red blood cells. They are not included in the usual analysis. They are usually considered in the event that a person has anemia and needs to find out what it is associated with. That is, with anemia associated with iron deficiency, the level of reticulocytes may even be slightly increased. The same happens with blood loss, when it is necessary to activate the formation of red blood cells. And with anemia associated with vitamin B12 and folic acid deficiency, the number of reticulocytes decreases, since due to the lack of these vitamins, the progenitor cells of red blood cells cannot divide effectively. The norm of reticulocytes is 5-12%.
Platelets
Platelets are nucleoless post–cellular elements that are involved in blood clotting. These are very, very small plates that seal the vessels when they are damaged. A decrease in platelets is observed in various severe diseases, including cancer. Their fall below 100 × 109 is fraught with severe bleeding. In addition, with improper blood collection, platelets form clots, their aggregation occurs. Therefore, there can often be conditions such as pseudothrombocytopenia, when an automatic blood analyzer shows a reduced number of platelets at their normal number. And in healthy people with a lack of platelets, it is necessary to recalculate the number of platelets "manually". An increase in the number of platelets is also a companion of a variety of pathological conditions, and it should be interpreted only taking into account the general clinical picture. The norm of platelets is 180,0–320,0×10 9/l.
White blood cells
Leukocytes are white blood cells, our main protectors from infectious diseases caused by bacteria, as well as from the cells of our own body that have embarked on the path of cancer degeneration. The number of white blood cells increases with a variety of infections and inflammatory diseases, and decreases with exhaustion. The norm is 4-9×10 9/l.
Leukocytes are divided into neutrophils, eosinophils, basophils, lymphocytes, depending on the color. Neutrophils are the most numerous part of white blood cells, cells that fight primarily bacterial infections. We can say that this is a kind of regular army. These include several groups of elements. Myelocytes are a form that is usually found in the bone marrow. The presence of them, as well as even less mature blast cells in the blood test may indicate a very serious blood disease – leukemia. Metamyelocytes are "young" forms that appear in the case of severe infections, and then extremely rarely when the release of immature forms is necessary. Immature forms enter the bloodstream when there are not enough large protectors, segmented neutrophils.
There is a division of neutrophils according to the degree of maturity: the shape of the neutrophil nucleus depends on age, and by evaluating the shape of the nucleus, we estimate the age of the neutrophil. Rod-shaped neutrophils are normally present in healthy people. This form is inherent in younger cells. The norm of rod–core is 1-6%. Segmentonuclear – mature segmentonuclear neutrophils usually predominate in the blood test. The norm is 47-72%.
Eosinophils are cells that are involved in various allergic reactions. In addition, they help us fight parasites, for example, roundworms, worms. An increase in the number of eosinophils is observed with various allergies. A marked increase in the number of eosinophils, that is, above 20%, may indicate a very severe rheumatological (inflammatory) disease. In the complete absence of eosinophils and basophils, the presence of a severe blood disease can be suspected. With an increase in the number of other forms of leukocytes, leukemia can be suspected. For them, the norm is 0.5–5%. Basophils are also involved in allergic reactions. An increase in their number is noted for various allergies and a number of rare diseases. The norm of basophils is 0-1%.
Lymphocytes are cells of the immune system. There are a lot of subspecies of lymphocytes, each of which performs its own special function. These cells help to recognize antigens, that is, determine which specific type of pathogen causes inflammation in order to develop a weapon against this particular pathogen. The weapons are antibodies – large molecules that bind specific areas on the surface of the pathogen of infection. They are produced by B-lymphocytes. And T-lymphocytes help to recognize a foreign agent and are involved in various immune processes. In addition, T-cells protect us from cancer. A decrease in the number of lymphocytes is observed with exhaustion, and an increase – with various infections. A slight increase in the number of lymphocytes is observed after a recent infection. A marked increase in the number of lymphocytes, especially T-lymphocytes, may indicate lymphoma, that is, hemoblastosis, which is often incorrectly called blood cancer. The normal number of lymphocytes is 19-37%.
Monocytes are another subspecies of leukocytes. Unlike lymphocytes, which act pointwise and are configured to destroy specific pathogens of infection, monocytes are able to fight immediately against a very wide range of different pathogens. They pass into the tissues and turn into larger cells (macrophages) with a large number of processes. Macrophages carry out phagocytosis, that is, they eat pathogenic bacteria and other microorganisms. Then they destroy and dissolve them with the help of various intracellular enzymatic systems. In addition, they also divide microorganisms into separate types and present them to lymphocytes so that they recognize areas of microorganisms against which antibodies can be synthesized. An increase in the number of monocytes is most often observed in infections, including tuberculosis. But a small increase in their number is often associated with a method error: not all automatic analyzers correctly determine their number. The norm of monocytes is 3-11%.
Plasma cells are one of the subspecies of lymphocytes, which is formed in the presence of bacterial infection. Most of these cells are engaged in the synthesis of antibodies, so they can be observed in people with bacterial infections when the number of cells synthesizing antibodies increases dramatically. While there are no infections, these cells are not needed, so they are not.
The rate (reaction) of erythrocyte sedimentation is estimated as follows: a thin capillary is selected and the rate at which erythrocytes settle is estimated. The rate of erythrocyte sedimentation depends on the protein composition of blood plasma. An increase in ESR is observed in various inflammatory, as well as oncological diseases. In women, a high speed is allowed – apparently, this is due to the peculiarities of the protein composition of blood plasma and red blood cells. Norm: men – 2-10 mm/hour, women – 2-15 mm / hour.
The morphology of red blood cells, that is, their shape, changes with a large number of different anemia. The morphology of leukocytes changes in the presence of severe infections. It is important to evaluate the morphology of leukocytes manually. Not all analyzers successfully assess the presence of atypical pathological granularity of leukocytes.
About the author: Yaroslav Ashikhmin – Candidate of Medical Sciences, practicing cardiologist, MD, PhD, Deputy General Director for Medicine of the Yusupov Hospital.
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02.11.2016