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Культура Документы
(WBC)
&
DIFFERENCIAL COUNT (DC)
Liu, liu
First Teaching Hospital
ZhengZhou Univ.
1
Liu,
Liu,Yan-Fang
Yan-FangMD,
MD,Ph.
Ph.D.D.First
FirstTeaching
TeachingHospital
HospitalZhengZhou
ZhengZhouUniv
Univ
W B C – Normal value
2
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
W B C – Clinical significance
3
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Differential count -- Methods
• 1. Making Blood smear:
Take a drop of blood, put on a slide, place anothor slide
over the blood and smear across the first slide .
• 2. Staining:
After the smear dry, flood the Wright’s, fixed for 1 ~ 2
min. Alter the relative amounts of buffer, stain for 5 ~
10min, and wash the smear with water, to remove the st
ains. Air dry.
• 3.Examination:
Directly under oil immersion. Record the different kind
s WBC till the total number reaching 100.
4
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Classification of WBC:
• Granulocytes
• Neutrophil,
• Eosinophil,
• Basophil,
• Lymphocytes,
• Monocytes.
5
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Differential count -- Normal value
• Neutrophil:
• Segmental 0.50 ~ 0.70 (50 ~ 70%);
• Stab 0.01 ~ 0.05 (1 ~ 5%);
• Eosinophil: 0.005 ~ 0.05 (0.5 ~ 5%);
• Basophil: 0 ~ 0.001 (0 ~ 1%);
• Lymphocyte: 0.20 ~ 0.40 (20 ~ 40%);
• Monocyte: 0.03 ~ 0.08 (3 ~ 8%).
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Development of neutrophils
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Neutrophils
• Occurance
– 60-70% of all white blood cells
– Most common leukocyte
• Appearance
– Multilobed nucleus
• 3-5 lobes
– “clear” granules
– 10-15 m
8
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Neutrophilic stab granulocyte
9
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Neutrophilic segmental granulocyte
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Neutrophil function
• Earliest to arrive in an infection
• Main component of pus
• Professional phagocyte
– Opsonization increases phagocytic activity
• Coating with antibodie receptors and complement receptors
• Highly motile cells
– Respond to chemotactic factors
• released from damaged tissue
– Leave blood circulation
11
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Increases ( neutrophilia)
-- Physiological
Fetus and neonatal stage (10.0 ~ 20.0)
Pregnant women above 5m(>15.0);
In late Pregnancy may reach 20.0;
(1)Certain infections
Some Gram(-) bacilli infection :
Typhoid fever ,Paratyphoid fever
Virus infection:Influenza
Protozoa infection:
Malaria
Kala-azar
14
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Decreases (neutropenia ) - 2
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Decreases (neutropenia ) - 3
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Eosinophils
• Occurance
• 0.5~5% of all white blood cells
• Appearance
– Multilobed nucleus
– “red-orange” granules
• 10-15 m
• Function
– Phagocytic cells with an affinity for parasites
– Receptors for IgE
• Plays a role in decreasing hypersensitivity reactions
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Eosinophil(segmental)
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Eosinophilia Eosinopenia
Allergic reaction • Acute stress
Parasites • Certion stage of typhoi
dermatosis d
Some kinds of carcinoma • Steroids/Cushing’s
Some hematologic malig syndrome
nant desease
others
19
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Basophils
Occurance
• <1% of all white blood cells
• Least common leukocyte
Appearance
– Multilobed nucleus
– Big “blue” granules
– 10-15 m
Function
– Immediate hypersensitivity responses (allergies)
• Histamine and other mediators of inflammatory
response in granules
20
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Basophil(segmental)
21
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Basophilia Basopenia
• Hypersensitivity
reactions • No significance
- asthma, eczema
• Hematologic
malignancy
• Ulcerative colitis. pox
22
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Monocytes
• Occurance
– 3~8% of WBC
• Appearance
– Large nucleus
• Horseshoe or kidneybean shape
• About 50% of the cell
– small granules
– 10-20 m
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
monocyte
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Monocyte function
• Tranform into macrophages
– After leaving bloodstream
– More phagocytic than neutrophils
– Primary antigen processing and presenting cell
– Responsible for expressing MHC class II to CD4
T cells(major histocompability complex )
• Monocyte-macrophage system
– Skin--Langerhan’s cell
– Bone--Osteoclast
– Liver--Kuppfer cell
– Brain--Microglia
25
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Monocytosis Monocytopenia
Physiological:
child,infant • No significance
pathological
• Infection: subacute bact
erial endocarditis, tuber
culosis
• Hematological desease
-acute leukemia,MDS
26
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Lymphocytes
• Occurance
– 20~40% of all white blood cells
• Appearance
– Round nucleus
• about 90% of cell
– 8-10 m
– Cannot distinguish between B and T lymphocytes
under microscope
27
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Macrolymphocyte and small lympho
cyte
28
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Lymphocyte function
– B lymphocytes
• become plasma cells
– produce antibodies (humoral immunity)
• B cells formed in bone marrow and travel to
lymph nodes and spleen
– T cells
• migrate from bone marrow and mature in
thymus
• Have many immune functions(cell immunity)
29
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Lymphocytosis Lymphopenia
• Count varies with age • Decreased production
• Viral infection – Inherited immune defic
• Other infections iency.
– Tuberculosis,whooping co – AIDS(acquired)
ugh • Increased destruction
• Hemotological desease: a – Steroids/ Cushing’s
cute leukemia; – Radiation, some drugs
lymphoma
others:carcinoma,
graft rejection
30
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
The change of nuclear picture o
f neutrophil granulocyte
Nucleus shifting to the left:
Increase of stab cell with the appearance o
f metamyelocyte, myelocyte and promyelo-cyt
e, etc.
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Change of nucleus
33
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Nucleus shifting to the left
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Nucleus shifting to the right
5 lobed nucleus granulocyte beyond 3%
35
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Nucleus shifting to the right
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Common pathological of WBC
toxic appearance – 1
(1). Size is not uniform:
Large /small is not average.
37
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Size is not uniform
38
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Common pathological of WBC
toxic appearance-2
(2). Toxic granules:
Blue black granules appearance in the cytoplasm (is a
n interference in process of formation of special gran
ule or deterioration of the granules).
(3). Vacuole retrogression:
Single / several vacuoles appeared in the cytoplasm (f
requently seen in severe infection, especially septicem
ia).
40
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Vacuole retrogression
41
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Common pathological of WBC
toxic appearance - 3
(4). Nucleus retrogression:
Pyknotic change -- Appears as a homogeneous
dark purple lump;
Lysis of nucleus -- Swells and stains lightly freq
uently accompanied by break of nuclear membrane;
Break of nucleus -- Nuclear breaks to several pi
eces.
43
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Staff body ( Aure’s body)
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Auer bodies
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical form of lymphocyte - 1
• Abnormal morphology of lymphocytes may be
seen occasionally in a blood smear of normal
person(<2%), this kind cell can be classified
into 3 types.
46
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical form of lymphocyte - 2
47
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical form of lymphocyte - 3
48
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical form of lymphocyte - 4
49
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical lymphocyte-vacuole type
50
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical lymphocyte-irregular type
51
Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical lymphocyte-juvenile type
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Liu, Yan-Fang MD, Ph. D. First Teaching Hospital ZhengZhou Univ
Atypical form of lymphocyte - 5
Clinical significance:
• >10% is significant in differential diagno
sis of infectious mononucleosis.