1白細胞參數檢查

WHITEBLOODCELL2INTRODUCTION白細胞計數(WhiteBloodCellCount,WBC)是測定單位容積血液中各種白細胞的總數。白細胞分類計數(DifferentialCount,DC)是對中性粒細胞、嗜酸性粒細胞、嗜堿性粒細胞、淋巴細胞、單核細胞5種白細胞進行分類計數，求得各種類型白細胞的比值。3【原理和方法】WBC：用白細胞稀釋液，稀釋血液并破壞紅細胞。DC：瑞氏染液：酸性染料伊紅負電堿性染料亞甲藍正電

中性物質(紫紅)

堿性蛋白(紅)酸性蛋白(藍)＋甲醇4WBC–NORMALVALUE

Adult:4.0～10.0×109/L;Newbornbaby:15.0～20.0×109/L;Infant(6m～2ys):11.0～12.0×109/L.

5WBC–CLINICALSIGNIFICANCELeucocytosis:WBC>10.0×109/L;Leucopenia:WBC<4.0×109/L.

TheincreaseordecreaseoftotalnumbersofWBCismainlyinfluencedbyneutrophilicgranulocytes.6DIFFERENTIALWHITEBLOODCOUNT(DC)Thereare5kindsofWBCinbloodNeutrophil,N（中性粒細胞）

Segmented&StabEosinophil,E（嗜酸性粒細胞）Basophil,B（嗜堿性粒細胞）Lymphocyte,L（淋巴細胞）Monocyte,M（單核細胞）7DC:REFERENCERANGECellTypePercentageAbsolutecount(109/L)Neutrophil

Stab0~50.04～0.05

segmented50～702～7Eosinophil0.5～50.05～0.5Basophil0～10～0.1lymphocyte20～400.8～4monocyte3～80.12~0.8NEUTROPHILS中性粒細胞

桿狀核(Stab,St)0.01～0.05

分葉核(Segmented,Sg)0.50～0.70相關知識

血細胞的生成

中性粒細胞動力學NEUTROPHILIAMechanismIncreasedinproduce,Increasedinreleasingfrombonemarrow;MigrationfromMarginalneutrolphilpooltocirculatingneutrophilpool;Decreaseinneutrophilmigratingintotissue.PhysiologicStress,labor,neonate, exercise,pregnancy10NEUTROPHILIA(LEUCOCYTOSIS)Pathologic

Acuteinfection:especiallythepyogens

S.aurous,S.hemolytic,diplococcuspneumonia>20.0.SeveretissueinjuryMajoroperation;acutemyocardialinfarction.AcutemassivehemorrhageanddestructionofalargeamountofRBC.AcutepoisonDisturbanceofmetabolism,acutechemicalpoisoning.Leukemiaandmalignanttumor.Aftertransplantationoforgans.11NEUTROPENIA(LEUCOPENIA)Leukopenia WBC<4×109/LNeutropenia Neutrophil<1.5×109/LAgranulocytosis Neutrophil<0.5×109/LMechanisms

1.Decreasedorineffectiveproduce 2.Consumingincrease 3.Migrationfromcirculatingneutrophilpool toMarginalneutrolphilpool12NEUTROPENIA(LEUCOPENIA)

1.Certaininfections

SomeGram(-)bacilliinfection:

Typhoidfever Paratyphoidfever

Virusinfection:

Influenza

Protozoainfection:

Malaria Kala-azar13NEUTROPENIA(LEUCOPENIA)2.Certainblooddiseases

Aplasticanemia,Aleukemicleukemia Acutegranulocytedeficiencysyndrome.3.Chronicphysicalandchemicalinjury

Longtermcontactlead,Mercury,Benzene.4.AdministrationofBMsuppressingdrug&anti-cancerdrug.5.Longtermexposuretox-ray,afterradiotherapy.14NEUTROPENIA(LEUCOPENIA)6.Auto-immunologicaldiseases

SystemicLupusErythematosus(SLE).7.Hyper-functionofspleen

Splenomeglyofvariouscausesmaydevelopleucopeniasuchasportalcirrhosisofliver,Banti’ssyndrome.EOSINOPHILSAppearanceMultilobednucleus“red-orange”granules 13-15mmNormalrange 0.005～0.0516EOSINOPHILIA Allergicdiseases:asthmaparasites:HookworminfectionDermatologicaldiseaseHematologicaldiseasesTumors:lungcancerInfectiousdiseasesAddison’sdisease17EOSINOPENIAAcutestress:Surgery,BurnInfection:typhoidfeverSteroids/Cushing’ssyndromeBASOPHILSAppearanceMultilobednucleus“blue”granules10-12mmNormalrange0～0.0119BASOPHILIA Hypersensitivityreactionsasthma,eczemaHypothyroidismHematologicalmalignancyUlcerativecolitisVaricella(水痘)pox20BASOPENIANOCLINICALSIGNIFICANCELYMPHOCYTESAppearance

Roundnucleusabout90%ofcellAgranular8-10mmNormalrange0.20～0.4022LYMPHOCYTEFUNCTIONBlymphocytes

becomeplasmacells

produceantibodiesBcellsformedinbonemarrowandtraveltolymphnodes,lymphnodulesandspleenTcells

migratefrombonemarrowandmatureinthymusHavemanyimmunefunctionNKcellsCellularmediatedcytotoxicity23LYMPHOCYTOSIS CountvarieswithageViralinfectionOtherinfectionsSyphilis（梅毒）,toxoplasmosis(弓形蟲),mycoplasma（支原體）DrugsensitivityLymphoidmalignanceMiscellaneousAutoimmune,hyperthyroidism,Addison’s,graftrejection24LYMPHOPENIADecreasedproductionInheritedimmuno-deficient.AIDSIncreaseddestructionSteroids/Cushing’sRadiation,chemoALG/ATGMONOCYTESAppearance LargenucleusHorseshoeorkidneybeanshapeAbout50%ofthecell14-20mmNormalrange 0.03~0.0826MONOCYTOSIS Infections TB,SBE,syphilis,Malaria Kala-azarHematologicaldisease Acutemyeloidleukemia—M4orM5, MM,Lymphoma,MDSCollagenVascularDiseaseGastrointestinaldisorders Ulcerativecolitis27MONOCYTOPENIANOCLINICALSIGNIFICANCE28MORPHOLOGICALCHANGEINPERIPHERALBLOODLEUKOCYTE外周血白細胞形態變化29THECHANGEOFNUCLEARPICTUREOFNEUTROPHILGRANULOCYTE

中性粒細胞的核象變化1.NUCLEUSSHIFTINGTOTHELEFT

（核左移）Definition

Increasednumber(＞0.05)ofthebandneutrophilsorpresenceofimmatureneutrophilsinblood.

Significance

1.Acutebloodloss 2.Acutepoison 3.Acutehemolysis 4.Leukemiaandleukemoidreaction30THESEVERITYOFSHIFTTOLEFTSlightshiftingtotheleft:

Stabcells>5%,noimmature-myelocyte;commoninfection,hemorrhage,hemolyticdiseases.Middleshiftingtotheleft:

Stabcells>10%,afewimmature-myelocyte;severeinfection,acutehemolytic,poisoning.Severeshiftingtotheleft:

Stabcells>25%,moreimmature-myelocyte;myelocyticleukemia.31THECHANGEOFNUCLEARPICTUREOFNEUTROPHILGRANULOCYTE

中性粒細胞的核象變化2.Nucleusshiftingtotheright核右移 5lobednucleusgranulocytebeyond0.03AccompaniedbydecreaseofWBCandmani-festationdeteriorationofhemopoiesisfunction.MegaloblasticanemiaHemopoieticfunctionfailureAnti-metabolismagents:Ara-C,6-TG32331.TOXICCHANGEOFNEUTROPHILAnisocytosis（大小不均）Toxicgranulation（中毒顆粒）Vacuolization（空泡形成)Degenerationofnucleus（核變性）Dohle

body(球形包涵體)胞漿中，圓形、梨形或云霧狀，直徑1～2μm，天藍或灰藍。見于嚴重感染。34MORPHOLOGICALCHANGEOFN.⒉Mega-multilobularN.(巨多分葉核中性粒細胞)見于巨幼細胞貧血、抗代謝藥物治療。⒊Auer

body(棒狀小體)Appearsasaredslenderstafflikesubstanceincytoplasm,oneorseveralinnumberand1-6minlength.ItisonlyseeninAML.

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Pelger-huetanomaly35ATYPICALFORMOFLYMPHOCYTE-1Abnormalmorphologyoflymphocytesmaybeseenoccasionallyinabloodsmearofnormalperson(<2%),thiskindcellcanbeclassifiedinto3types.Owingtotheprogressofimmunology,atypicalcellsareknownas“T”lymphocytes.Itisaresultofstimulatingofthevirusorallergen/hypersensitiveantigen.36ATYPICALFORMOFLYMPHOCYTE-2Type1(vacuoletype): Cellbodylargerthannormallymphocyte, Cytoplasmdeepbluewithnumeroussmallvacuoles.37ATYPICALFORMOFLYMPHOCYTE-3Type2(irregulartype):

Cellbodyisa