01. White blood cell count
Reference range
Clinical significance. Physiologically elevated:
1.In the evening, after meals, high temperature and cold, strenuous exercise, emotional agitation, the white blood cell count will increase physiologically, and the white blood cell count will fall after rest;
2.It is also elevated during menstruation, pregnancy, childbirth, and lactation;
3.White blood cells in neonates and infants are significantly higher than in adults.
4.Long-term smoking.
Pathologic elevation:
1.Bacterial infections: especially gram-positive coccal infections, abscesses, meningitis, pneumonia, appendicitis and tonsillitis.
2.Viral infections: infectious mononucleosis, Japanese encephalitis, hantavirus, enterovirus 71, rabies, etc.
3.Tissue damage: acute hemorrhage, major surgery, extensive burns, severe trauma and acute myocardial infarction.
4.Leukemia: acute myeloid leukemia, acute promyelocytic leukemia, chronic myeloid leukemia, etc.
5.Myelofibrosis.
6.Malignant tumors: liver cancer, gastric cancer, etc.
7.Metabolic poisoning: diabetic ketoacidosis, uremia, etc.
8.Metals, drugs, biotoxins: lead, mercury, sleeping pills, insects, and snake toxins.
Pathologic reduction:
1.Bacterial infections: especially gram-negative bacterial infections such as typhoid fever, paratyphoid, etc.
2.Protozoan infections: kala-azar, malaria, etc.
3.Viral infections: viral hepatitis, influenza, etc.
4.Blood diseases: aplastic anemia, megaloblastic anemia, etc.
5.Autoimmune diseases: systemic lupus erythematosus, AIDS, etc.
6.Hypersplenism: portal cirrhosis, etc.
7.Radiation and chemotherapy for tumors.
8.Medications: antibiotics, biologics, etc
Influencing factors. 1.Blood should be well mixed with the anticoagulant to avoid clots, and the specimen should be well mixed before testing.
2.When blood is collected for local ** chilblains, cyanosis, edema, infection, etc., the test results are not representative.
2.EDTA anticoagulants can cause neutrophil aggregation in lobulated nuclei, which can lead to a falsely low white blood cell count, which can also occur in blood specimens anticoagulated with sodium citrate and heparin.
Rare) 3Lymphocyte aggregation: burns, urinary tract infections, severe monocytic leukemia, B-cell lymphoma, etc., can lead to falsely low white blood cell counts.
4.Falsely elevated white blood cell count is seen in macroplatelets, antilytic red blood cells, nucleated red blood cells, cryoglobulins, fibrinogen, and excessive volume of blood specimens in vacuum tubes.
02. Absolute number of neutrophils Percentage of neutrophils.
Reference range
Clinical significance. Physiologically elevated:
1.The number of neutrophils varies depending on the time of day, usually higher in the afternoon than in the morning.
2.Strenuous exercise, emotional agitation, high temperatures, severe cold.
3.Newborn.
4.More than 5 months of pregnancy and during childbirth.
Pathologic elevation:
1.Acute infection: sepsis, acute rheumatic fever, tonsillitis, etc. caused by pyogenic cocci (Staphylococcus aureus, hemolytic streptococcus, etc.).
2.Severe tissue damage: after major surgery, severe burns, acute myocardial infarction, acute hemolysis, etc.
3.Acute hemorrhage: rupture of internal organs, rupture of ectopic pregnancy, etc.
4.Acute poisoning: poisoning by chemical drugs such as sleeping pills and organophosphates; Metabolic poisoning such as diabetic ketoacidosis and uremia.
5.Tumors: liver cancer, gastric cancer and other malignant tumors of the non-hematopoietic system.
6.Leukemia: acute and chronic myeloid leukemia, etc. (excluding acute and chronic lymphocytic leukemia, etc.).
Pathologic reduction:
1.Some gram-negative bacilli infections: typhoid, Salmonella paratyphi.
2.Viral infections: human herpesvirus type 6 virus, measles virus, rubella virus, varicella-zoster virus, hepatitis virus, cytomegalovirus, Epstein-Barr virus, HIV, etc.
3.Blood diseases: aplastic anemia and non-leukemic leukemia.
4.People who have been exposed to ionizing radiation and chemical drugs for a long time.
5.Autoimmune diseases: systemic lupus erythematosus, etc.
6.Hypersplenism.
Influencing factors. 1.Some hematology analyzers do not have fluorescent staining channels, and heterolytic, lipid granules, and immature granulocytes will affect the absolute value of the classification results.
2.Factors that interfere with white blood cell count results can also interfere with absolute monocyte differential results.
03. Absolute number of lymphocytes Percentage of lymphocytes
Reference range
Clinical significance. Physiological changes:
The proportion of neonatal lymphocytes gradually increases after the first week of birth, and the physiological increase of lymphocytes in childhood, and gradually decreases to the normal level after the age of 4 and 6 years.
Pathologic elevation:
1) Primary acute or chronic lymphocytic leukemia, prolymphocytic leukemia, hairy cell leukemia, **T-cell leukemia, B-cell lymphoma leukemia, large granular lymphocytic leukemia, monoclonal B lymphocytosis, persistent polyclonal B lymphocytosis.
2) Reactivity.
1.Certain viral or bacterial infections: Epstein-Barr virus, cytomegalovirus, human immunodeficiency virus, herpes simplex virus type, rubella virus, mouse toxoplasmosis, adenovirus, infectious hepatitis virus, dengue virus, HHV-6, HHV-8, varicella-zoster virus, pertussis bacillus, NK cytosis.
2.Acute stress lymphocytosis: cardiovascular system disorders, staphylococcal toxic shock syndrome, drug induction, major surgery, sickle cell crisis, status epilepticus, trauma.
3.Subacute or chronic persistent lymphocytosis: tumors, smoking, splenic insufficiency.
4.Slow** infection: leishmaniasis, leprosy and strongyloidiasis, etc.
Pathologically reduced:
1.Adrenocorticosteroids, alkylating agents, anti-lymphocyte globulin, etc. are used.
2.Radiation damage.
3.T-cell immunodeficiency disease, gamma globulin deficiency (B lymphocyte immunodeficiency), etc.
4.Severe acute respiratory syndrome coronavirus, new coronavirus infection, H1N1, SARS, Middle East respiratory syndrome (MERS), etc.
Elevated lymphocytes can also be divided into absolute and relative elevations.
Absolute increase refers to an increase in the total number of white blood cells, as well as an increase in the total number of lymphocytes, such as certain viral or bacterial infections, convalescent phase of chronic infection, acute and chronic lymphocytic leukemia.
Relative elevation refers to the relative increase in the percentage of lymphocytes due to a significant neutropenia, such as aplastic anemia.
Similarly, all kinds of ** that cause a significant increase in neutrophils lead to a relative decrease in lymphocytes.
Influencing factors. 1.Cold agglutination of red blood cells can cause falsely increased (electrical impedance) or falsely decreased lymphocytes (laser method).
2.Elevated cryoglobulin falsely increases lymphocytes.
3.Some hematology analyzers do not have fluorescent staining channels, and heterolytic, lipid granules, and immature granulocytes will affect the absolute value of the classification results.
4.Factors that interfere with white blood cell count results can also interfere with absolute monocyte differential results.
04. Absolute number of monocytes Percentage of monocytes
Reference range
Clinical significance. Physiologically elevated:
Healthy children have slightly higher levels of monocytes than healthy**. Pathologic elevation:
1.Certain infections: subacute ** infected endocarditis, malaria, kala-azar, convalescent from acute **infection, active tuberculosis.
2.Certain blood disorders: monocytic leukemia, convalescent agranulocytosis, lymphoma, and myelodysplastic syndromes.
Monocytopenia is of little significance.
Influencing factors. 1.Some hematology analyzers do not have fluorescent staining channels, and heterolytic, lipid granules, and immature granulocytes will affect the absolute value of the classification results.
2.Factors that interfere with white blood cell count results can also interfere with absolute monocyte differential results.
05. Absolute number & percentage of eosinophils
Reference range
Clinical significance. Physiological changes:
Affected by labor, temperature, hunger, mental stimulation, etc., the eosinophils of healthy people are lower during the day and higher at night, fluctuating greatly in the morning and more stable in the afternoon.
Pathologic elevation:
1.Parasitic diseases: infection with roundworms, hookworms, tapeworms, lung flukes, hydatids, schistosomiasis, filaria, etc.
2.Hypersensitivity diseases: bronchial asthma, urticaria, food allergies, hypersensitivity pneumonitis, angioedema, etc.
3.Drug factors: penicillin, cephalosporins, etc.
4.Lung diseases: COPD, idiopathic pulmonary fibrosis.
5.Diseases: psoriasis, eczema, dermatitis herpetiformis, fungal disease, eosinophilic dermatitis.
6.Blood diseases: chronic myeloid leukemia, eosinophilic leukemia.
7.Certain malignancies: Hodgkin's disease.
8.Certain infectious diseases: scarlet fever.
Influencing factors. 1.Patients with malaria may have falsely eosinophil elevations.
2.Failure to dry the quick-drying gel at the time of peripheral blood collection may lead to falsely eosinophil elevation.
3.Some hematology analyzers do not have fluorescent staining channels, and heterolytic, lipid granules, and immature granulocytes will affect the absolute value of the classification results.
4.Factors that interfere with white blood cell count results can also interfere with eosinophil absolute differential.
06. Percentage of absolute number of basophils
Reference range
Clinical significance. Elevated:
1.Blood diseases: chronic myeloid leukemia, basophilic leukemia.
2.Malignant tumors: metastatic cancer, etc.
3.Allergic diseases: colitis, hypersensitivity, etc.
4.Connective tissue diseases: rheumatoid arthritis, etc.
5.Myelofibrosis.
Basophilopenia is of little significance.
Influencing factors. 1.Some hematology analyzers do not have fluorescent staining channels, and heterolytic, lipid granules, and immature granulocytes will affect the absolute value of the classification results.
2.Factors that interfere with the white blood cell count can also interfere with the basophil absolute differential.
07. Red blood cell count
Reference rangeClinical significance. Physiologically elevated:
1.Hypoxia: Residents living in highland areas, newborns and fetuses, healthy people who exercise vigorously or do heavy physical work.
2.Androgens: Adult males are higher than females.
3.Mood swings.
4.Long-term smoking.
5.Capillary blood is higher than venous blood.
6.Venous compression for more than 2 minutes.
Physiological reduction:
1.Infants and toddlers aged 6 months and 2 years.
2.Pregnant women in the second and third trimesters of pregnancy.
3.Older people with hematopoietic insufficiency.
Pathological elevation is divided into relative and absolute
Relativity is elevated:
Severe repeated vomiting or diarrhea, extensive burns, diabetes insipidus, etc.
Absolutely:
1.Essential polycythemia: polycythemia vera, chronic myeloproliferative neoplasms.
2.Secondary polycythemia: compensatory increase in erythropoietin: severe chronic cardiopulmonary disease, cyanotic congenital heart disease, cor pulmonale, chronic obstructive pulmonary emphysema, abnormal hemoglobinopathy. Uncompensated elevation of erythropoietin: renal cancer, liver cancer, uterine fibroids, ovarian cancer, renal embryoma, hydronephrosis, polycystic kidney disease, and after kidney transplantation.
3.Medications: epinephrine, glucocorticoid drugs.
4.Familial spontaneous elevated erythropoietin concentrations.
Pathologic reduction:
1.Bone marrow hematopoietic dysfunction: aplastic anemia, leukemia, myeloma, etc.
2.Deficiency or impaired utilization of hematopoietic substances: iron deficiency anemia, sideroblastic anemia, megaloblastic anemia, etc.
3.Acute and chronic blood loss: surgery, acute blood loss after trauma, peptic ulcer, parasitic diseases, etc.
4.Destruction of blood cells: hemolytic anemia.
5.Other: anemia caused by or associated with inflammation, liver disease, endocrine system disease.
Influencing factors. 1.High leukocyte count, presence of cold agglutinins, cryoglobulins, etc. will interfere with the test results of the instrument.
2.Erythrocyte agglutination can make RBC falsely reduced.
3.If the specimen is left for a long time or not well mixed, red blood cell deposition may also be falsely elevated.
08. Amount of hemoglobin
Reference rangeClinical significance. Hemoglobin increase or decrease in HGB: the clinical significance of hemoglobin increase or decrease is broadly similar to that of red blood cell count increase or decrease, but hemoglobin is more reflective of the degree of anemia.
Influencing factors. 1.Hyperpaturation can occur in lipidaemia or the presence of large amounts of lipoproteins in the specimen, which can cause falsely elevated hemoglobin.
2.Pseudoelevated hemoglobin may also be cloudy as a white blood cell count > 20 x 10 9 L, a platelet count > 700 x 10 9 L, and an increase in abnormal globulin.
3.Gas poisoning or heavy smoking can also increase carboxyhemoglobin in the blood, which can also increase the measured value.
4.Cryoglobulins can also cause falsely elevated hemoglobin counts.
09. Hematocrit
Reference rangeClinical significance. Physiological reduction:
Athletes, pregnant women in the second and third trimesters of pregnancy, excessive hydration.
Pathologic elevation:
1.Hemoconcentration: severe vomiting, diarrhea, profuse sweating, extensive burns, etc.;
2.Polycythemia: polycythemia vera, hypoxia, altitude sickness, chronic cor pulmonale, etc.
Pathologic decrease:
1.Anemia: acute and chronic bleeding, iron deficiency anemia, and aplastic anemia, the degree of reduction in HCT is not exactly consistent with the reduction in RBC HB.
2.Secondary fibrinolysis.
3.Medications: interferon, penicillin, indomethacin (indomethacin), vitamins, etc
Influencing factors. 1.Instrument method: Factors such as clots, hemolysis, and severe lipidemia in blood samples can lead to unreliable test results.
2.Capillary centrifugation: The accuracy of the results is easily affected by centrifugation conditions.
3.Aggregation of red blood cells can make HCT falsely reduced.
10. Mean corpuscular volume
Reference rangeClinical significance. Heightened:
When the size of red blood cells increases, megaloblastic anemia, alcoholic cirrhosis, acquired hemolytic anemia, hemorrhagic anemia after regeneration, and hypothyroidism.
Decrease: decreased red blood cells, seen in chronic ** staining, chronic liver and kidney diseases, chronic blood loss, globin production disorder anemia, iron deficiency anemia, etc.;
Influencing factors. Since MCV, MCH, and MCCH are all indirect, the factors affecting red blood cell count, hemoglobin concentration, and hematocrit can be referred to above.
11. Mean corpuscular hemoglobin amount
Reference rangeClinical significance. Heightened:
Megaloblastic anemia, pernicious anemia, aplastic anemia, reticulocytosis, hypothyroidism, etc.
Lower: 1simple microcytic anemia caused by chronic infection, chronic liver and kidney diseases, chronic blood loss, etc.;
2.Small cell hypochromic anemia caused by iron deficiency and poor iron utilization.
3.Pregnancy, sprue, etc. MCH is usually normal in acute hemorrhagic anemia and some hemolytic anemias:
Influencing factors. 1.Severe in vivo or in vitro haemolysis specimens, resulting in falsely elevated MCH.
2.Chyle blood specimens often cause falsely elevated MCH.
3.Since MCV, MCH, and MCCH are all indirect, the factors affecting red blood cell count, hemoglobin concentration, and hematocrit can be referred to above.
12. Mean corpuscular hemoglobin concentration
Reference rangeClinical significance. Increased MCHC:
Abnormal concentration of hemoglobin in red blood cells, such as burns, severe vomiting, frequent diarrhea, chronic carbon monoxide poisoning, compensatory insufficiency, hereditary spherocytosis, and relatively rare congenital disorders.
MCHC decreases:
Microcytic hypochromic anemias, such as iron deficiency anemia and impaired egg molarization anemia
Influencing factors. 1.MCCH results are more stable, such as MCCH 400 G L, the instrument and specimen status need to be checked, and the instrument failure or specimen condensation should be checked.
2.Severe in vivo or in vitro hemolytic specimens result in falsely elevated MCCHC.
3.Chyle blood specimens often cause falsely elevated MCHC.
4.Because MCCH is calculated indirectly, the factors affecting red blood cell count, hemoglobin concentration, and hematocrit can be referred to above.
13. Width of erythrocyte volume distribution.
Reference rangerdw-cv：11.9%~14.5%
RDW-SD: Male: 390l~52.3 fl；Female: 390l~51.5 fl。
Clinical significance. Elevated RDW can distinguish mild globininogenic anemia (normal RDW) from iron deficiency anemia (abnormal RDW); RDW can be used for early diagnosis and efficacy observation of iron deficiency anemia; RDW MCV can also be used to classify anaemia morphologically, and RDW is positively correlated with sepsis severity.
Influencing factors. See the influencing factors of red blood cells above.
14. Platelet count
Reference rangeClinical significance. Physiological changes:
1.Time: Slightly higher in the afternoon than in the morning, higher in winter than in spring.
2.High-altitude healthy people are higher than plain healthy people.
3.Postmenstrual periods are higher than premenstrual periods.
4.The second and third trimesters of pregnancy are higher than the first trimester and after delivery.
5.Neonates are slightly lower, significantly higher after two weeks, and can reach ** level within half a year.
6.Venous platelet count is higher than capillary platelet count.
Drug-induced platelet elevation:
Oral contraceptives, estrogen, epinephrine, cephalosporins, interferons, steroids, propranolol, immunoglobulin, recombinant human erythropoietin, etc.
Drug-induced thrombocytopenia:
Acetaminophen, aspirin, chemotherapy drugs, chloramphenicol, chloroquine hydrochloride, chlorothiazide, quinidine, phenytoin, rifampicin, sulfonamides, chloramphenicol, nitroglycerin, tricyclic antidepressants, etc.
Pathologic elevation:
1.Primary elevation: myeloproliferative syndrome, essential thrombocythemia, chronic myeloid leukemia, polycythemia vera, idiopathic myelofibrosis, etc.
2.Elevated reactivity: acute and chronic inflammation, acute massive blood loss, acute hemolysis, tumors, recent surgery (especially after splenectomy), iron deficiency anemia, early malignancy, etc.
3.Others: heart disease, cirrhosis of the liver, chronic membranous adenitis, burns, kidney failure, precursor pain, severe frostbite, etc.
Pathologically reduced:
1.Thrombocytopoietic disorders: aplastic anemia, acute leukemia, acute radiation sickness, megaloblastic anemia, myelofibrosis, etc.
2.Increased platelet destruction: primary thrombocytopenic purpura (ITP), hypersplenism, systemic lupus erythematosus, platelet alloantibodies, etc.
3.Increased platelet consumption: diffuse intravascular coagulation, thrombotic thrombocytopenic purpura, etc.
4.Abnormal distribution: splenomegaly, diluted blood, etc.
5.Congenital: neonatal thrombocytopenia, macroplatelet syndrome, etc.
Influencing factors. 1.Blood clotting is a major factor in pseudodecreased platelets.
2.Small red blood cells and red blood cell fragments may be counted as platelets, resulting in falsely elevated platelets; False hypotropia of platelets may be counted as small red blood cells in large thrombocytosis;
3.Chyle blood specimens often cause falsely elevated PLT (electrical impedance);
4.EDTA-dependent hypotropia of platelets;
5.Cryoglobulins can also interfere with the measurement of platelet count by a hematology analyzer;
6.Decreased platelet count can be caused by prolonged storage, abnormal proteinemia, hypermagnesemia, high cholesterol, and hypertriglyceridemia;
7.Hypothermia activates platelets and can also lead to pseudotropenia.
15. Average platelet volume
Reference range**80 100 fl children: 79 104 fl
Clinical significance. 1.When platelets are low:
Normal or elevated MPV: primary immune platelet oligosymptoms, hypersplenism, systemic lupus erythematosus, etc. Normal or reduced MPV: aplastic anemia. MPV reduction: acute leukemia, AIDS, etc.
2.Used to assess the recovery of bone marrow hematopoiesis:
Bone marrow hematopoiesis is suppressed, MPV is reduced, and MPV is elevated in leukemia remission; If MPV and PLT are persistently low, it is a sign of bone marrow hematopoietic failure. The smaller the MPV, the more severely the bone marrow is suppressed. When bone marrow function is restored, MPV rises first and then PLT rises gradually.
The influencing factors refer to the platelet influencing factors.
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