Differential count of white blood cells

When the blood is centrifuged, the surface is grayish white, and this part of the cells is called white blood cells. It is a group of heterogeneous mixed cells with different morphology, function and development and differentiation stages. It is divided into granulocytes, lymphocytes and monocytes according to morphology, function and source. Only the white blood cell count to determine the clinical significance has certain limitations, it should be combined with white blood cell classification and counting to analyze the condition, which is more accurate. Basic Information Specialist classification: growth and development examination classification: blood examination Applicable gender: whether men and women apply fasting: fasting Tips: Try to eat less and eat as much as possible, and arrange your diet reasonably. Normal value Neutrophil rod-shaped nucleus 1% ~ 5% (0.04 ~ 0.5) × 109 / L, lobular nucleus 50% ~ 70% (2 ~ 7) × 109 / L, eosinophils 0.5% ~ 5.0% ( 0.05～0.5)×109/L; basophils 0%～1%(0～0.1)×109/L; lymphocytes 20%～40%(0.2～0.4)×109/L; monocytes 3% ～8% (0.08 to 0.8)×109/L. Clinical significance Abnormal result (1) Neutropenia is seen in acute and suppurative infections (sputum, abscess, pneumonia, appendicitis, erysipelas, sepsis, visceral perforation, scarlet fever, etc.), various poisoning (acidosis, uremia, lead poisoning, mercury poisoning) Etc.), tissue damage, malignant tumors, acute massive hemorrhage, acute hemolysis. Reduce the incidence of infectious diseases such as typhoid, paratyphoid, measles, flu; chemotherapy, radiotherapy. Some blood diseases (aplastic anemia, agranulocytosis, leukopenia, myelodysplastic syndrome, etc.), hypersplenism, autoimmune diseases, and the like. (2) Eosinophilia is found in allergic diseases, skin diseases, parasitic diseases, certain blood diseases, post-radiation, splenectomy, and infectious disease recovery. Reduced in typhoid, paratyphoid, application of glucocorticoids, adrenocorticotropic hormone. (3) Lymphocytosis is seen in certain infectious diseases (pertussis, infectious mononucleosis, infectious lymphocytosis, chickenpox, measles, rubella, mumps, viral hepatitis, lymphocytic leukemia and lymphatics). Tumor, etc.). Reduce the acute phase seen in many infectious diseases, radiation sickness, immunodeficiency disease, etc. (4) Mononuclear cells are found in tuberculosis, typhoid fever, infective endocarditis, malaria, monocytic leukemia, kala-azar, and the recovery period of infectious diseases. (5) basophils are more common in chronic myeloid leukemia, basophilic leukemia, Hodgkin's disease, splenectomy and so on. Precautions The classification of white blood cells is greatly changed by factors such as technical factors and cell distribution factors, so the dispersion of classification counts is large, and the proportion of neutrophils and lymphocytes, which account for a large proportion in the classification, is normally distributed, accounting for a small proportion. Such as eosinophils, basophils and monocytes are Powson distribution. According to Rümke et al., the 95% and 99% confidence limits for white blood cell differential counts. For example, if a blood sample is used for 200 white blood cell classifications, in which 60% (p) of granulocytes and 40% (q) of other cells, the standard error (SEp) of the probability of p is, and n is the number of cells counted. Table Low95% and High95% rows and p60, q40 columns, the intersections get 53 and 67, that is, the 95% confidence limit of this example is 53%, the highest is 67%, the same 99% confidence limit is 51%~ 69%. That is to say, when the same blood sample or another blood sample of the same patient is further classified by white blood cells, there is a 95% probability that the categorical count of granulocytes ranges from 53% to 67%, and the possibility range of 99% is 51% to 69%. If it exceeds this range, it is considered that the classification and counting error is too large, which does not meet the quality requirements, and should be taken seriously. Inspection process (1) Take a small drop of blood on one end of the slide, and use a pusher to push the circumference around 35~45° to leave a proper amount of voids to distinguish the thin blood of the head, body and tail. The length of the blood film is not less than 2.5 cm, and the remaining space to the other end of the slide is about 1 cm. The blood film is dried and stained. (2) Wright's Giemsa composite staining method: flat blood sample on the staining rack, add 3 to 5 drops of staining solution, immediately cover the blood film, add about 5 to 10 drops of buffer after about 30s, gently shake the glass The tablets or lightly blow the mixture to mix the dye solution with the buffer solution. After 5 to 10 minutes, the dye solution is washed away with water and dried for microscopic examination. (3) Rapid method: place the rapid dyeing liquid A and liquid B in the appropriate size dyeing tank, immerse the blood film in the liquid for 30s, wash it, then immerse it in the liquid for 30s, wash it, and dry it for microscopic examination. (4) Microscopic examination: Select the junction of the meninges and tails, and the red blood cells have not overlapped with oil mirrors. The examination should have a certain direction from top to bottom and left and right, and take into account the edges of both sides of the long film of the blood film, otherwise it will affect various cells. Detection rate. Count 100 to 200 white blood cells, classify them according to their morphology, and find the percentage. Not suitable for the crowd Those without examination indications should not be tested. Adverse reactions and risks 1. Infection: Pay attention to aseptic operation when collecting blood, avoid contamination of water and other parts at the blood collection site to avoid local infection. 2, bleeding: after the blood is given a full compression time, especially coagulopathy, bleeding tendency, to avoid local subcutaneous oozing, bruising and swelling.