What does a blood test say? Deciphering the general blood test of adult men and women Erythrocyte sedimentation rate.
This is an attempt to decipher the results of some of the blood tests that are done in modern laboratories.
There are no generally accepted standards - each laboratory has its own. Find out the norms in the laboratory where you took the tests.
Of course, not all of the reasons for changes in the results of analyzes are indicated - only the most frequent ones. It is impossible to interpret the analyzes according to this "tutorial" - only the attending physician can do this. Not only the results of a separate analysis are important, but also the ratio of different results to each other. Therefore, you cannot diagnose yourself and self-medicate - the description is given only for orientation - so that you do not make unnecessary diagnoses for yourself, interpreting the analysis too badly when you see that it goes beyond the norm.
BIOCHEMISTRY
Glucose
A universal source of energy for cells is the main substance from which any cell of the human body receives energy for life. The body's need for energy, and therefore - for glucose - increases in parallel with physical and psychological stress under the influence of the stress hormone - adrenaline, during growth, development, recovery (growth hormones, thyroid gland, adrenal glands). For the absorption of glucose by cells, a normal content of insulin, a hormone of the pancreas, is necessary. With its deficiency (diabetes mellitus), glucose cannot pass into the cells, its level in the blood is increased, and the cells starve.
Increase (hyperglycemia):
total protein
"Life is a way of existence of protein bodies." Proteins are the main biochemical criterion of life. They are part of all anatomical structures (muscles, cell membranes), transport substances through the blood and into cells, accelerate the course of biochemical reactions in the body, recognize substances - their own or others and protect from strangers, regulate metabolism, retain fluid in the blood vessels and do not let it go into the fabric.
Proteins are synthesized in the liver from food amino acids. Total blood protein consists of two fractions: albumins and globulins.
Raise (hyperproteinemia):
Reduction:
Protein starvation
Excess protein intake (pregnancy, acromegaly)
Malabsorption
Creatinine
multiple myeloma
Toxicosis of pregnant women
Foods rich in nucleic acids (liver, kidneys)
hard physical work
Decrease (hypouricemia):
Wilson-Konovalov disease
Fanconi syndrome
Diet low in nucleic acids
Alanine aminotransferase (ALAT)
An enzyme produced by liver, skeletal muscle, and heart cells.
Boost:
Destruction of liver cells (necrosis, cirrhosis, jaundice, tumors, alcohol)
Destruction of muscle tissue (trauma, myositis, muscular dystrophy)
Toxic effect on the liver of drugs (antibiotics, etc.)
Aspartate aminotransferase (AST)
An enzyme produced by heart, liver, skeletal muscle cells and red blood cells.
Boost:
Liver cell damage (hepatitis, drug toxicity, alcohol, liver metastases)
Heart failure, myocardial infarction
Burns, heat stroke
Hyperthyroidism (overactive thyroid gland)
prostate cancer
Too much vitamin D
Dehydration
Decrease (hypocalcemia):
Decreased thyroid function
magnesium deficiency
Too much vitamin D
Fracture healing
Decreased function of the parathyroid glands.
Reduction:
Lack of growth hormone
Vitamin D deficiency
Malabsorption, severe diarrhea, vomiting
Hypercalcemia
Magnesium
calcium antagonist. Promotes muscle relaxation. Participates in protein synthesis.
Increase (hypermagnesemia):
Dehydration
kidney failure
Adrenal insufficiency
multiple myeloma
Decrease (hypomagnesemia):
Violation of the intake and / or absorption of magnesium
Acute pancreatitis
Decreased parathyroid function
lactate
Lactic acid. It is formed in cells during respiration, especially in muscles. With a full supply of oxygen, it does not accumulate, but is destroyed to neutral products and excreted. Under conditions of hypoxia (lack of oxygen), it accumulates, causes a feeling of muscle fatigue, disrupts the process of tissue respiration.
Boost:
meal
Aspirin intoxication
Insulin administration
Hypoxia (insufficient oxygen supply to tissues: bleeding, heart failure, respiratory failure, anemia)
Third trimester of pregnancy
Chronic alcoholism
Creatine kinase
Muscle injuries (myopathy, myodystrophy, trauma, surgery, heart attacks)
Pregnancy
Alcoholic delirium (delirium tremens)
Reduction:
Small muscle mass
sedentary lifestyle
Lactate dehydrogenase (LDH)
An intracellular enzyme found in all tissues of the body.
Boost:
Destruction of blood cells (sickle cell, megaloblastic, hemolytic anemia)
Liver diseases (hepatitis, cirrhosis, obstructive jaundice)
Tumors, leukemia
Damage to internal organs (kidney infarction, acute pancreatitis)
Phosphatase alkaline
Enzyme formed in bone tissue, liver, intestines, placenta, lungs.
Boost:
Pregnancy
Increased bone turnover (rapid growth, fracture healing, rickets, hyperparathyroidism)
Bone diseases (osteogenic sarcoma, bone cancer metastases, multiple myeloma)
Reduction:
Hypothyroidism (hypothyroidism)
Reduction:
Organophosphate poisoning
Liver pathology (hepatitis, cirrhosis, liver metastases)
Dermatomyositis
Condition after surgery
Lipase
An enzyme that breaks down food fats. It is secreted by the pancreas. In pancreatitis, it is more sensitive and specific than amylase; in simple mumps, unlike amylase, it does not change.
Boost:
Pancreatitis, tumors, pancreatic cysts
biliary colic
Hollow organ perforation, intestinal obstruction, peritonitis
Amylase pancreatic
An enzyme produced by the pancreas.
Boost:
Acute and chronic pancreatitis
Reduction:
Necrosis of the pancreas
Glycosylated hemoglobin
It is formed from hemoglobin at a long-term elevated glucose level - for at least 120 days (erythrocyte lifespan), is used to assess the compensation of diabetes mellitus, long-term control of the effectiveness of treatment.
Boost:
Prolonged hyperglycemia (more than 120 days)
Fructosamine
It is formed from blood albumin with a short-term increase in glucose levels - glycated albumin. It is used, unlike glycated hemoglobin, for short-term monitoring of the condition of patients with diabetes mellitus (especially newborns), the effectiveness of treatment.
C-peptide
metabolic product of insulin. It is used to assess the level of insulin when its direct determination in the blood is difficult: the presence of antibodies, the introduction of an insulin preparation from the outside.
LIPIDS
Lipids (fats) are substances necessary for a living organism. The main lipid that a person receives from food, and from which their own lipids are then formed, is cholesterol. It is part of cell membranes, maintains their strength. So-called. steroid hormones: hormones of the adrenal cortex that regulate water-salt and carbohydrate metabolism, adapting the body to new conditions; sex hormones. Bile acids are formed from cholesterol, which are involved in the absorption of fats in the intestines. From cholesterol in the skin under the influence of sunlight, vitamin D is synthesized, which is necessary for the absorption of calcium. If the integrity of the vascular wall is damaged and / or an excess of cholesterol in the blood, it is deposited on the wall and forms a cholesterol plaque. This condition is called vascular atherosclerosis: plaques narrow the lumen, interfere with blood flow, disturb the smoothness of the blood flow, increase blood clotting, and contribute to the formation of blood clots. Various complexes of lipids with proteins circulating in the blood are formed in the liver: high, low and very low density lipoproteins (HDL, LDL, VLDL); total cholesterol is divided between them. Low and very low density lipoproteins are deposited in plaques and contribute to the progression of atherosclerosis. High-density lipoproteins, due to the presence of a special protein in them - apoprotein A1 - contribute to the "pulling" of cholesterol from plaques and play a protective role, stop atherosclerosis. To assess the risk of a condition, it is not the total level of total cholesterol that is important, but the ratio of its fractions.
total cholesterol
Boost:
Genetic features (familial hyperlipoproteinemias)
Liver disease
Hypothyroidism (underactive thyroid)
LDL cholesterol
Boost:
Hypothyroidism
Liver disease
Pregnancy
Taking drugs of sex hormones
Apoprotein A1
Protective factor against atherosclerosis.
Normal serum levels depend on age and sex. g/l.
Boost:
Weight loss
Reduction:
Genetic features of lipid metabolism
Early atherosclerosis of the coronary vessels
Smoking
Food rich in carbohydrates and fats
Apoprotein B
risk factor for atherosclerosis
Normal serum levels vary by sex and age. g/l.
Boost:
Alcohol abuse
Taking steroid hormones (anabolics, glucocorticoids)
Early atherosclerosis of the coronary vessels
Liver disease
Pregnancy
Diabetes
Hypothyroidism
Reduction:
Diet low in cholesterol
hyperthyroidism
Genetic features of lipid metabolism
Weight loss
Acute stress (severe illness, burns)
B\A1
This ratio is a more specific marker of atherosclerosis and coronary heart disease than the ratio of LDL/HDL fractions. The higher, the greater the risk.
Triglycerides
Another class of lipids that is not derived from cholesterol. Boost:
Genetic features of lipid metabolism
Impaired glucose tolerance
Liver diseases (hepatitis, cirrhosis)
Alcoholism
Cardiac ischemia
Hypothyroidism
Pregnancy
Diabetes
Taking drugs of sex hormones
Reduction:
hyperthyroidism
Malnutrition, absorption
CARDIOMARKS
myoglobin
The protein in muscle tissue is responsible for its respiration.
Uremia (kidney failure)
Muscle strain (sports, electrical impulse therapy, convulsions)
Injuries, burns
Reduction:
Autoimmune conditions (autoantibodies against myoglobin): polymyositis, rheumatoid arthritis, myasthenia gravis.
Creatine kinase MB
One of the fractions of total creatine kinase.
Boost:
Acute myocardial infarction
Acute skeletal muscle injury
Troponin I
Specific contractile protein of the cardiac muscle.
Boost:
DIAGNOSIS OF ANEMIA (BIOCHEMISTRY)
The main function of blood is to transport oxygen to the cells of the body. This function is performed by red blood cells - erythrocytes. These cells are formed in the red bone marrow, leaving it, they lose the nucleus - a depression forms in its place, and the cells take the form of a biconcave disk - with this form, the maximum surface area for oxygen addition is provided. The entire interior of the erythrocyte is filled with the protein hemoglobin, the red blood pigment. In the center of the hemoglobin molecule is an iron ion, it is to it that oxygen molecules are attached. Anemia is a condition in which the supply of oxygen does not meet the needs of the tissues for it. It manifests itself in the form of oxygen starvation (hypoxia) of organs and tissues, deterioration of their work. Possible causes of anemia are divided into 3 groups: insufficient oxygen consumption (lack of it in the atmospheric air, pathology of the respiratory organs), violation of its transport into tissues (blood pathology - lack or destruction of red blood cells, iron deficiency, hemoglobin pathology, diseases of the cardiovascular system) and increased oxygen consumption (bleeding, tumors, growth, pregnancy, severe illness). To diagnose the cause of anemia, the following tests are performed.
Iron
Normal serum levels vary by sex
Boost:
Hemolytic anemia (destruction of red blood cells and release of their contents into the cytoplasm)
Sickle cell anemia (hemoglobin pathology, red blood cells are irregularly shaped and also destroyed)
Aplastic anemia (bone marrow pathology, red blood cells are not formed, and iron is not used)
Acute leukemia
Overtreatment with iron supplements
Reduction:
Iron-deficiency anemia
Hypothyroidism
Malignant tumors
Occult bleeding (gastrointestinal, gynecological)
ferritin
The protein, which contains iron in the depot, stocking up for the future. By its level, one can judge the sufficiency of iron stores in the body.
Boost:
Too much iron (certain liver disease)
Acute leukemia
Inflammatory process
Reduction:
iron deficiency
Total iron-binding capacity of serum
Shows the presence of iron in the blood serum - in transport form (in connection with a special protein - transferrin). Iron-binding capacity increases with a lack of iron and decreases with its excess.
Boost:
Iron-deficiency anemia
Late pregnancy
Reduction:
Anemia (not iron deficiency)
Chronic infections
Cirrhosis of the liver
folate
Boost:
Vegetarian diet (too much folic acid in food)
Reduction:
folic acid deficiency
Vitamin B12 deficiency
Alcoholism
Malnutrition
What you can read about your health in the most informative analysis
Whatever you fall ill with, the first analysis that a competent doctor will send you to will be a general (general clinical) blood test, says our expert - a cardiologist, a doctor of the highest category Tamara Ogieva.
Blood for general analysis is taken venous or capillary, that is, from a vein or from a finger. The primary general analysis can be taken not on an empty stomach. A detailed blood test is given only on an empty stomach.
For biochemical analysis, blood will have to be taken only from a vein and always on an empty stomach. After all, if you drink in the morning, say, coffee with sugar, the glucose content in the blood will certainly change and the analysis will be incorrect.
A competent doctor will definitely take into account your gender and physiological state. For example, in women during “critical days”, the ESR increases and the number of platelets decreases.
A general analysis provides more information about inflammation and the state of the blood (a tendency to blood clots, the presence of infections), and a biochemical analysis is responsible for the functional and organic state of the internal organs - the liver, kidneys, pancreas.
General analysis indicators:
1. HEMOGLOBIN (Hb)- a blood pigment found in erythrocytes (red blood cells), its main function is the transfer of oxygen from the lungs to the tissues and the removal of carbon dioxide from the body.
Normal values for men are 130-160 g / l, women - 120-140 g / l.
Reduced hemoglobin occurs with anemia, blood loss, latent internal bleeding, with damage to internal organs, such as kidneys, etc.
It can rise with dehydration, with blood diseases and some types of heart failure.
2. erythrocytes- blood cells contain hemoglobin.
Normal values are (4.0-5.1) * 10 to the 12th power / L and (3.7-4.7) * 10 to the 12th power / L, for men and women, respectively.
An increase in red blood cells occurs, for example, in healthy people at high altitude in the mountains, as well as in congenital or acquired heart defects, diseases of the bronchi, lungs, kidneys and liver. The increase may be due to an excess of steroid hormones in the body. For example, in case of Cushing's disease and syndrome, or in the treatment of hormonal drugs.
Decrease - with anemia, acute blood loss, with chronic inflammatory processes in the body, as well as in late pregnancy.
3. Leukocytes- white blood cells, they are formed in the bone marrow and lymph nodes. Their main function is to protect the body from adverse effects. Norm - (4.0-9.0) x 10 to the 9th degree / l. Excess indicates the presence of infection and inflammation.
There are five types of leukocytes (lymphocytes, neutrophils, monocytes, eosinophils, basophils), each of them performs a specific function. If necessary, a detailed blood test is done, which shows the ratio of all five types of leukocytes. For example, if the level of leukocytes in the blood is increased, a detailed analysis will show, due to which type their total number has increased. If due to lymphocytes, then there is an inflammatory process in the body, if there are more than the norm of eosinophils, then an allergic reaction can be suspected.
WHY IS THERE A LOT OF LEUKOCYTES?
There are many conditions in which there is a change in the level of leukocytes. This does not necessarily indicate illness. Leukocytes, as well as all indicators of the general analysis, react to various changes in the body. For example, during stress, pregnancy, after physical exertion, their number increases.
An increased number of leukocytes in the blood (in other words, leukocytosis) also occurs with:
- + infections (bacterial),
- + inflammatory processes,
- + allergic reactions,
- + malignant neoplasms and leukemias,
- + taking hormonal drugs, some heart drugs (for example, digoxin).
But a reduced number of leukocytes in the blood (or leukopenia): this condition often occurs with a viral infection (for example, with the flu) or taking certain medications, for example, analgesics, anticonvulsants.
4. PLATELETS- blood cells, an indicator of normal blood clotting, are involved in the formation of blood clots.
Normal amount - (180-320) * 10 to the 9th degree / l
An increased amount occurs when:
chronic inflammatory diseases (tuberculosis, ulcerative colitis, liver cirrhosis), after surgery, treatment with hormonal drugs.
Reduced at:
alcohol, heavy metal poisoning, blood diseases, kidney failure, diseases of the liver, spleen, hormonal disorders. And also under the action of certain drugs: antibiotics, diuretics, digoxin, nitroglycerin, hormones.
5. ESR or ROE- erythrocyte sedimentation rate (erythrocyte sedimentation reaction) is one and the same, an indicator of the course of the disease. Usually, ESR increases on the 2nd-4th day of the disease, sometimes reaching a maximum during the recovery period. The norm for men is 2-10 mm / h, for women - 2-15 mm / h.
Increased at:
infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation.
Downgraded:
with circulatory failure, anaphylactic shock.
Indicators of biochemical analysis:
6. GLUCOSE- it should be 3.5-6.5 mmol / liter. Decrease - with insufficient and irregular nutrition, hormonal diseases. Increase - with diabetes.
7. TOTAL PROTEIN- norm - 60-80 grams / liter. Decreases with deterioration of the liver, kidneys, malnutrition (a sharp decrease in total protein is a common symptom that a rigid restrictive diet clearly did not benefit you).
8. TOTAL BILIRUBIN- norm - not higher than 20.5 mmol / liter shows how the liver works. Increase - with hepatitis, cholelithiasis, destruction of red blood cells.
9. Creatinine- should be no more than 0.18 mmol / liter. The substance is responsible for the functioning of the kidneys. Exceeding the norm is a sign of kidney failure, if it does not reach the norm, then it is necessary to increase immunity.
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Clinical analyzes carry a huge amount of information for the doctor about the state of health of the patient, and their importance for medical practice can hardly be overestimated. These research methods are quite simple, require minimal equipment and are available for implementation in the laboratory of almost any medical institution. For this reason, clinical examinations of blood, urine, and feces are routine and must be performed on all people admitted to a hospital, hospital or clinic for treatment, as well as on most patients undergoing outpatient examination for various diseases.
1.1. General clinical blood test
Blood is a liquid tissue that continuously circulates through the vascular system and delivers oxygen and nutrients to all parts of the human body, and also removes “waste” waste products from them. The total amount of blood is 7-8% of a person's weight. Blood consists of a liquid part - plasma and formed elements: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (platelets).
How is blood obtained for a clinical trial?
For clinical analysis, capillary blood is used, which is obtained from the finger of the hand (usually the ring finger, less often the middle and index fingers) by puncturing the lateral surface of the soft tissues of the terminal phalanx with a special disposable lancet. This procedure is usually carried out by a laboratory assistant.
Before taking blood, the skin is treated with a 70% alcohol solution, the first drop of blood is blotted with a cotton ball, and the subsequent ones are used to prepare blood smears, set in a special glass capillary to determine the erythrocyte sedimentation rate, as well as evaluate other indicators, which will be discussed below. .Basic rules for taking blood from a finger
To avoid mistakes when performing a clinical blood test, you need to follow some rules. A blood test from a finger should be taken in the morning after an overnight fast, that is, 8-12 hours after the last meal. The exception is cases when the doctor suspects the development of a serious acute disease, such as acute appendicitis, pancreatitis, myocardial infarction, etc. In such situations, blood is taken regardless of the time of day or food intake.
Moderate consumption of drinking water is allowed before visiting the laboratory. If you drank alcohol the day before, it is better to donate blood for analysis no earlier than in 2-3 days.
In addition, before taking blood for research, it is advisable to avoid excessive physical exertion (cross, weight lifting, etc.) or other intense effects on the body (visiting a steam room, saunas, swimming in cold water, etc.). In other words, the mode of physical activity before donating blood should be the most common.
You should not knead and rub your fingers before taking blood, as this can lead to an increase in the level of leukocytes in the blood, as well as a change in the ratio of the liquid and solid parts of the blood.
The main indicators of a clinical blood test and what their changes may indicate
The most important indicators for assessing the health status of the subject are such indicators as the ratio of the volume of liquid and cellular parts of the blood, the number of cellular elements in the blood and the leukocyte formula, as well as the content of hemoglobin in erythrocytes and the erythrocyte sedimentation rate.
1.1. 1. Hemoglobin
Hemoglobin- This is a special protein that is contained in red blood cells and has the ability to attach oxygen and transfer it to various human organs and tissues. Hemoglobin has a red color, which determines the characteristic color of blood. The hemoglobin molecule consists of a small non-protein part called heme and contains iron, as well as a protein called globin.
A decrease in hemoglobin below the lower limit of normal is called anemia and can be caused by various reasons, among which the most common are iron deficiency in the body, acute or chronic blood loss, lack of vitamin B 12 and folic acid. Anemia is often found in patients with cancer. It should be remembered that anemia is always a serious symptom and requires an in-depth examination to determine the causes of its development.
With anemia, the supply of oxygen to body tissues is sharply reduced, while oxygen deficiency primarily affects those organs in which metabolism is most intensive: the brain, heart, liver and kidneys.
The more pronounced the decrease in hemoglobin, the more severe the anemia. A decrease in hemoglobin below 60 g / l is considered life-threatening for the patient and requires an urgent blood or red blood cell transfusion.
The level of hemoglobin in the blood increases with some serious blood diseases - leukemia, with "thickening" of the blood, for example, due to dehydration, and also compensatory in healthy people who are in high altitude conditions or in pilots after flying at high altitude.
1.1.2. red blood cells
red blood cells, or red blood cells, are small, flat, round cells about 7.5 microns in diameter. Since the erythrocyte is slightly thicker at the edges than in the center, then “in profile” it looks like a biconcave lens. This form is the most optimal and allows the erythrocytes to be maximally saturated with oxygen and carbon dioxide when they pass through the pulmonary capillaries or vessels of the internal organs and tissues, respectively. In healthy men, the blood contains 4.0-5.0 x 10 12 / l, and in healthy women 3.7-4.7 x 10 12 / l.
A decrease in the content of red blood cells in the blood, as well as hemoglobin, indicates the development of anemia in a person. With different forms of anemia, the number of red blood cells and the level of hemoglobin may decrease disproportionately, and the amount of hemoglobin in the red blood cell may be different. In this regard, when conducting a clinical blood test, a color indicator or an average hemoglobin content in an erythrocyte is necessarily determined (see below). In many cases, this helps the doctor quickly and correctly diagnose some form of anemia.
A sharp increase in the number of erythrocytes (erythrocytosis), sometimes up to 8.0-12.0 x 10 12 / l or more, almost always indicates the development of one of the forms of leukemia - erythremia. Less often, in persons with such changes in the blood, the so-called compensatory erythrocytosis is detected, when the number of erythrocytes in the blood increases in response to a person being in an oxygen-rarefied atmosphere (in the mountains, when flying at high altitude). But compensatory erythrocytosis occurs not only in healthy people. So, it was noticed that if a person has severe lung diseases with respiratory failure (pulmonary emphysema, pneumosclerosis, chronic bronchitis, etc.), as well as pathology of the heart and blood vessels that occurs with heart failure (heart defects, cardiosclerosis, etc.), the body compensatory increases the formation of red blood cells in the blood.
Finally, the so-called paraneoplastic ones are known (Greek para - near, at; neo ... + Greek. plasis- education) erythrocytosis, which develop in some forms of cancer (kidney, pancreas, etc.). It should be noted that erythrocytes can have unusual sizes and shapes in various pathological processes, which is of great diagnostic value. The presence of red blood cells of various sizes in the blood is called anisocytosis and is observed in anemia. Red blood cells of normal size (about 7.5 microns) are called normocytes, reduced - microcytes and enlarged - macrocytes. Microcytosis, when small red blood cells predominate in the blood, is observed in hemolytic anemia, anemia after chronic blood loss, and often in malignant diseases. The sizes of erythrocytes increase (macrocytosis) with B 12 -, folic acid deficiency anemia, with malaria, with diseases of the liver and lungs. The largest erythrocytes, larger than 9.5 microns, are called megalocytes and are found in B 12 -, folate deficiency anemia and, less commonly, in acute leukemia. The appearance of irregularly shaped erythrocytes (elongated, worm-shaped, pear-shaped, etc.) is called poikilocytosis and is considered as a sign of defective erythrocyte regeneration in the bone marrow. Poikilocytosis is observed in various anemias, but is especially pronounced in B 12 deficiency anemia.
Some forms of congenital diseases are characterized by other specific changes in the shape of red blood cells. Thus, sickle-shaped erythrocytes are observed in sickle cell anemia, and target-like erythrocytes (with a colored area in the center) are detected in thalassemia and lead poisoning.
In the blood, young forms of red blood cells, which are called reticulocytes, can also be detected. Normally, they are contained in the blood 0.2-1.2% of the total number of red blood cells.
The importance of this indicator is mainly due to the fact that it characterizes the ability of the bone marrow to quickly restore the number of red blood cells in anemia. Thus, an increase in the content of reticulocytes in the blood (reticulocytosis) in the treatment of anemia caused by a lack of vitamin Bx2 in the body is an early sign of recovery. In this case, the maximum increase in the level of reticulocytes in the blood is called a reticulocyte crisis.
On the contrary, an insufficiently high level of reticulocytes in long-term anemia indicates a decrease in the regenerative capacity of the bone marrow and is an unfavorable sign.
It should be borne in mind that reticulocytosis in the absence of anemia always requires additional examination, as it can be observed with cancer metastases to the bone marrow and some forms of leukemia.
Normally, the color index is 0.86-1.05. An increase in the color index above 1.05 indicates hyperchromia (Greek hyper - over, over, on the other side; chroma - color) and is observed in people with Vhg-deficiency anemia.
A decrease in the color index of less than 0.8 indicates hypochromia (Greek hypo - from below, under), which is most often observed with iron deficiency anemia. In some cases, hypochromic anemia develops with malignant neoplasms, more often with stomach cancer.
If the level of red blood cells and hemoglobin is reduced, and the color index is within the normal range, then they speak of normochromic anemia, which includes hemolytic anemia - a disease in which there is a rapid destruction of red blood cells, as well as aplastic anemia - a disease in which insufficient production is produced in the bone marrow. the number of erythrocytes.
Hematocrit, or hematocrit- this is the ratio of the volume of erythrocytes to the volume of plasma, it also characterizes the degree of deficiency or excess of red blood cells in human blood. In healthy men, this figure is 0.40-0.48, in women - 0.36-0.42.
An increase in hematocrit occurs with erythremia, a severe oncological blood disease and compensatory erythrocytosis (see above).
The hematocrit decreases with anemia and dilution of the blood, when the patient receives a large amount of medicinal solutions or takes an excessive amount of liquid inside.
1.1.3. Erythrocyte sedimentation rate
The erythrocyte sedimentation rate (ESR) is perhaps the most famous laboratory indicator, the meaning of which is known to some or, in any case, guessed that “high ESR is a bad sign”, most people who regularly undergo medical examination.
The erythrocyte sedimentation rate is understood as the rate of separation of uncoagulated blood placed in a special capillary into 2 layers: the lower one, consisting of settled erythrocytes, and the upper one, from transparent plasma. This indicator is measured in millimeters per hour.
Like many other laboratory parameters, the ESR value depends on the gender of the person and normally ranges from 1 to 10 mm / h in men, and from 2 to 15 mm / h in women.
ESR increase- always a warning sign and, as a rule, indicates some kind of trouble in the body.
It is assumed that one of the main reasons for the increase in ESR is an increase in the ratio of protein particles of large sizes (globulins) and small sizes (albumins) in the blood plasma. Protective antibodies belong to the class of globulins, so their number in response to the entry of viruses, bacteria, fungi, etc. into the body increases dramatically, which is accompanied by a change in the ratio of blood proteins.
For this reason, the most common cause of an increase in ESR is various inflammatory processes occurring in the human body. Therefore, when someone gets sick with a sore throat, pneumonia, arthritis (inflammation of the joints), or other infectious and non-infectious diseases, the ESR always rises. The more pronounced the inflammation, the more clearly this indicator increases. So, in mild forms of inflammation, ESR can increase up to 15-20 mm/hour, and in some severe diseases - up to 60-80 mm/hour. On the other hand, a decrease in this indicator during treatment indicates a favorable course of the disease and recovery of the patient.
However, we must remember that not always an increase in ESR indicates any inflammation. Other factors can also influence the value of this laboratory indicator: a change in the ratio of the liquid and dense parts of the blood, a decrease or increase in the number of red blood cells, protein loss in the urine or a violation of protein synthesis in the liver, and in some other cases.
The following are the groups of non-inflammatory diseases that usually lead to an increase in ESR:
Severe kidney and liver diseases;
Malignant formations;
Some severe blood diseases (multiple myeloma, Waldenström's disease);
Myocardial infarction, lung, stroke;
Frequent blood transfusions, vaccine therapy.
It is necessary to take into account the physiological reasons for the increase in ESR. Thus, an increase in this indicator is observed in women during pregnancy and can be observed during menstruation.
It should be borne in mind that a regular increase in ESR in the above diseases does not occur if the patient has such concomitant pathology as chronic heart and cardiopulmonary insufficiency; conditions and diseases in which the number of erythrocytes in the blood increases (compensatory erythrocytosis, erythremia); acute viral hepatitis and obstructive jaundice; increase in protein in the blood. In addition, the intake of drugs such as calcium chloride and aspirin can influence the ESR value in the direction of reducing this indicator.
1.1.4. Leukocytes
Leukocytes, or white blood cells, are colorless cells of different sizes (from 6 to 20 microns), rounded or irregular in shape. These cells have a nucleus and are able to move independently like a single-celled organism - an amoeba. The number of these cells in the blood is much less than erythrocytes and in a healthy person is 4.0-8.8 x 109/l. Leukocytes are the main protective factor in the fight of the human body against various diseases. These cells are “armed” with special enzymes that are able to “digest” microorganisms, bind and break down foreign protein substances and decay products that are formed in the body during life. In addition, some forms of leukocytes produce antibodies - protein particles that affect any foreign microorganisms that enter the bloodstream, mucous membranes and other organs and tissues of the human body.
There are two main types of white blood cells. In cells of one type, the cytoplasm has a granularity, and they are called granular leukocytes - granulocytes. There are 3 forms of granulocytes: neutrophils, which, depending on the appearance of the nucleus, are divided into stab and segmented, as well as basophils and eosinophils.
In the cells of other leukocytes, the cytoplasm does not contain granules, and two forms are distinguished among them - lymphocytes and monocytes. These types of leukocytes have specific functions and change differently in various diseases (see below), so their quantitative analysis is a serious help to the doctor in finding out the causes of the development of various forms of pathology.
An increase in the number of white blood cells in the blood is called leukocytosis, and a decrease is called leukopenia.
Leukocytosis is physiological, i.e. occurs in healthy people in some quite ordinary situations, and pathological, when it indicates a disease.
Physiological leukocytosis is observed in the following cases:
2-3 hours after eating - digestive leukocytosis;
After intense physical work;
After hot or cold baths;
After psycho-emotional stress;
In the second half of pregnancy and before menstruation.
For this reason, the number of leukocytes is examined in the morning on an empty stomach in a calm state of the subject, without previous physical exertion, stressful situations, water procedures.
The most common causes of pathological leukocytosis include the following:
Various infectious diseases: pneumonia, otitis media, erysipelas, meningitis, pneumonia, etc.;
Suppuration and inflammatory processes of various localization: pleura (pleurisy, empyema), abdominal cavity (pancreatitis, appendicitis, peritonitis), subcutaneous tissue (panaritium, abscess, phlegmon), etc .;
Sufficiently large burns;
Heart attacks of the heart, lungs, spleen, kidneys;
Conditions after severe blood loss;
Leukemia;
Chronic renal failure;
diabetic coma.
It must be remembered that in patients with weakened immunity (elderly people, malnourished people, alcoholics and drug addicts), leukocytosis may not be observed during these processes. The absence of leukocytosis in infectious and inflammatory processes indicates a weakness of the immune system and is an unfavorable sign.
Leukopenia- a decrease in the number of leukocytes in the blood below 4.0 H 10 9 /l in most cases indicates inhibition of the formation of leukocytes in the bone marrow. More rare mechanisms for the development of leukopenia are increased destruction of leukocytes in the vascular bed and redistribution of leukocytes with their retention in depot organs, for example, during shock and collapse.
Most often, leukopenia is observed due to the following diseases and pathological conditions:
Exposure to ionizing radiation;
Taking certain medications: anti-inflammatory (amidopyrine, butadione, pyra-butol, reopyrin, analgin); antibacterial agents (sulfonamides, synthomycin, chloramphenicol); agents that depress thyroid function (mercasolil, propicil, potassium perchlorate); drugs used to treat oncological diseases - cytostatics (methotrexate, vincristine, cyclophosphamide, etc.);
Hypoplastic or aplastic diseases, in which, for unknown reasons, the formation of leukocytes or other blood cells in the bone marrow is sharply reduced;
Some forms of diseases in which the function of the spleen increases (hypersplenism), cirrhosis of the liver, lymphogranulomatosis, tuberculosis and syphilis, occurring with damage to the spleen;
Separate infectious diseases: malaria, brucellosis, typhoid fever, measles, rubella, influenza, viral hepatitis;
Systemic lupus erythematosus;
Anemia associated with vitamin B 12 deficiency;
With oncopathology with metastases to the bone marrow;
In the initial stages of the development of leukemia.
Leukocyte formula- this is the ratio in the blood of various forms of leukocytes, expressed as a percentage. Normative values of the leukocyte formula are presented in table. 1.
Table 1
Leukocyte blood formula and the content of various types of leukocytes in healthy people
The name of the condition in which an increase in the percentage of one or another type of leukocyte is detected is formed by adding the ending “-iya”, “-oz” or “-ez” to the name of this type of leukocyte
(neutrophilia, monocytosis, eosinophilia, basophilia, lymphocytosis).
A decrease in the percentage of various types of leukocytes is indicated by adding the ending “-singing” to the name of this type of leukocytes (neutropenia, monocytopenia, eosinopenia, basopenia, lymphopenia).
To avoid a diagnostic error when examining a patient, it is very important for a doctor to determine not only the percentage of different types of leukocytes, but also their absolute number in the blood. For example, if the number of lymphocytes in the leukoformula is 12%, which is significantly below the norm, and the total number of leukocytes is 13.0 x 10 9 / l, then the absolute number of lymphocytes in the blood is 1.56 x 10 9 / l, i.e. " fit into the standard value.
For this reason, there are absolute and relative changes in the content of one form or another of leukocytes. Cases when there is a percentage increase or decrease in various types of leukocytes with their normal absolute content in the blood are designated as absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc. In situations where both the relative (in%) and the absolute number of certain forms of leukocytes, speak of absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc.
Different types of leukocytes “specialize” in different protective reactions of the body, and therefore the analysis of changes in the leukocyte formula can tell a lot about the nature of the pathological process that has developed in the body of a sick person and help the doctor make a correct diagnosis.
Neutrophilia, as a rule, indicates an acute inflammatory process and is most pronounced in purulent diseases. Since inflammation of an organ in medical terms is indicated by adding the ending “-itis” to the Latin or Greek name of the organ, neutrophilia appears with pleurisy, meningitis, appendicitis, peritonitis, pancreatitis, cholecystitis, otitis media, etc., as well as acute pneumonia, phlegmon and abscesses of various locations, erysipelas.
In addition, an increase in the number of neutrophils in the blood is detected in many infectious diseases, myocardial infarction, stroke, diabetic coma and severe renal failure, after bleeding.
It should be remembered that neutrophilia can cause the use of glucocorticoid hormonal drugs (dexamethasone, prednisolone, triamcinolone, cortisone, etc.).
Most of all, stab leukocytes react to acute inflammation and purulent process. A condition in which the number of leukocytes of this type in the blood increases is called a stab shift, or a shift of the leukocyte formula to the left. Band shift always accompanies pronounced acute inflammatory (especially suppurative) processes.
Neutropenia is noted in some infectious (typhoid fever, malaria) and viral diseases (influenza, poliomyelitis, viral hepatitis A). A low level of neutrophils often accompanies a severe course of inflammatory and purulent processes (for example, in acute or chronic sepsis, a serious illness when pathogenic microorganisms enter the bloodstream and settle freely in internal organs and tissues, forming numerous purulent foci) and is a sign that worsens the prognosis of severe sick.
Neutropenia can develop with suppression of bone marrow function (aplastic and hypoplastic processes), with B 12 - deficiency anemia, exposure to ionizing radiation, as a result of a number of intoxications, including when taking drugs such as amidopyrine, analgin, butadione, reopyrin, sulfadimetoksin , biseptol, levomycetin, cefazolin, glibenclamide, mercazolil, cytostatics, etc.
If you paid attention, then the factors leading to the development of leukopenia simultaneously reduce the number of neutrophils in the blood.
Lymphocytosis is characteristic of a number of infections: brucellosis, typhoid and relapsing endemic fever, tuberculosis.
In patients with tuberculosis, lymphocytosis is a positive sign and indicates a favorable course of the disease and subsequent recovery, while lymphopenia worsens the prognosis in this category of patients.
In addition, an increase in the number of lymphocytes is often detected in patients with reduced thyroid function - hypothyroidism, subacute thyroiditis, chronic radiation sickness, bronchial asthma, B 12 deficiency anemia, and fasting. An increase in the number of lymphocytes has been described with certain drugs.
Lymphopenia indicates immunodeficiency and is most often detected in people with severe and long-term infectious and inflammatory processes, the most severe forms of tuberculosis, acquired immunodeficiency syndrome, with certain forms of leukemia and lymphogranulomatosis, prolonged starvation leading to the development of dystrophy, as well as in people who are chronically alcohol abusers, substance abusers and drug addicts.
Monocytosis is the most characteristic sign of infectious mononucleosis, and can also occur in some viral diseases - infectious mumps, rubella. An increase in the number of monocytes in the blood is one of the laboratory signs of severe infectious processes - sepsis, tuberculosis, subacute endocarditis, some forms of leukemia (acute monocytic leukemia), as well as malignant diseases of the lymphatic system - lymphogranulomatosis, lymphoma.
Monocytopenia is detected with bone marrow damage - aplastic anemia and hairy cell leukemia.
Eosinopenia can be observed at the height of the development of infectious diseases, B 12 deficiency anemia and damage to the bone marrow with a decrease in its function (aplastic processes).
Basophilia is usually detected in chronic myeloid leukemia, a decrease in thyroid function (hypothyroidism), and a physiological increase in basophils in the premenstrual period in women has been described.
Basopenia develops with an increase in thyroid function (thyrotoxicosis), pregnancy, stress, Itsenko-Cushing's syndrome - a disease of the pituitary or adrenal glands, in which the level of hormones of the adrenal cortex - glucocorticoids - is increased in the blood.
1.1.5. platelets
Platelets, or platelets, are the smallest among the cellular elements of the blood, the size of which is 1.5-2.5 microns. Platelets perform the most important function of preventing and stopping bleeding. With a lack of platelets in the blood, the bleeding time increases dramatically, and the vessels become brittle and bleed more easily.
Thrombocytopenia is always an alarming symptom, as it creates a threat of increased bleeding and increases the duration of bleeding. A decrease in the number of platelets in the blood accompanies the following diseases and conditions:
. autoimmune (idiopathic) thrombocytopenic purpura (Purpura / purpura is a medical symptom characteristic of the pathology of one or more links of hemostasis) (Werlhof's disease), in which a decrease in the number of platelets is due to their increased destruction under the influence of special antibodies, the mechanism of formation of which has not yet been established;
. acute and chronic leukemia;
. a decrease in the formation of platelets in the bone marrow in aplastic and hypoplastic conditions of unknown cause, B 12 -, folic acid deficiency anemia, as well as in cancer metastases to the bone marrow;
. conditions associated with increased activity of the spleen in liver cirrhosis, chronic and, less commonly, acute viral hepatitis;
. systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, dermatomyositis;
. dysfunction of the thyroid gland (thyrotoxicosis, hypothyroidism);
. viral diseases (measles, rubella, chicken pox, influenza);
. syndrome of disseminated intravascular coagulation (DIC);
. taking a number of medications that cause toxic or immune damage to the bone marrow: cytostatics (vinblastine, vincristine, mercaptopurine, etc.); chloramphenicol; sulfanilamide preparations (biseptol, sulfadimethoxine), aspirin, butadione, reopyrin, analgin, etc.
Due to the possible severe complications of low platelets in the blood, a bone marrow aspiration and antiplatelet antibodies are usually performed to determine the cause of thrombocytopenia.
Platelets, although it does not pose a threat of bleeding, is no less serious laboratory sign than thrombocytopenia, as it often accompanies diseases that are very serious in terms of consequences.
The most common causes of thrombocytosis are:
. malignant neoplasms: stomach cancer and kidney cancer (hypernephroma), lymphogranulomatosis;
. oncological diseases of the blood - leukemia (megacaricytic leukemia, polycythemia, chronic myeloid leukemia, etc.).
It should be noted that in leukemia, thrombocytopenia is an early sign, and with the progression of the disease, thrombocytopenia develops.
It is important to emphasize (all experienced doctors know about this) that in the cases listed above, thrombocytosis can be one of the early laboratory signs and its detection requires a thorough medical examination.
Other causes of thrombocytosis of less practical importance include:
. condition after massive (more than 0.5 l) blood loss, including after major surgical operations;
. condition after removal of the spleen (thrombocytosis usually persists for 2 months after surgery);
. with sepsis, when the platelet count can reach 1000 x 10 9 /l.
1.2. General clinical examination of urine
Urine is formed in the kidneys. Blood plasma is filtered in the capillaries of the glomeruli. This glomerular filtrate is the primary urine, containing all the constituents of blood plasma except proteins. Then, in the tubules of the kidneys, epithelial cells reabsorb into the blood (reabsorption) up to 98% of the renal filtrate with the formation of the final urine. Urine consists of 96% water, contains the end products of metabolism (urea, uric acid, pigments, etc.) of mineral salts in dissolved form, as well as a small amount of cellular elements of the blood and urinary tract epithelium.
Clinical examination of urine gives an idea, first of all, of the state and function of the genitourinary system. In addition, certain changes in the urine can be used to diagnose certain endocrine diseases (diabetes and diabetes insipidus), identify certain metabolic disorders, and in some cases suspect a number of other diseases of the internal organs. Like many other tests, repeat urine testing helps to judge the effectiveness of the treatment.
Conducting a clinical analysis of urine includes an assessment of its general properties (color, transparency, odor), as well as physico-chemical qualities (volume, relative density, acidity) and microscopic examination of the urinary sediment.
Urinalysis is one of the few that is collected by the patient himself. In order for the analysis of urine to be reliable, that is, to avoid artifacts and technical errors, it is necessary to follow a number of rules when collecting it.
Basic rules for collecting urine for analysis, its transportation and storage.
There are no dietary restrictions, but you should not "lean" on mineral water - the acidity of urine may change. If a woman has a period of menstruation, the collection of urine for analysis should be postponed until it ends. On the eve and immediately before passing urine for analysis, intense physical exertion should be avoided, as in some people this can lead to the appearance of protein in the urine. The use of medicinal substances is also undesirable, since some of them (vitamins, antipyretic and analgesic drugs) may affect the results of biochemical studies. On the eve of the test, you need to limit yourself to the use of sweets and foods that have a bright color.
For general analysis, “morning” urine is usually used, which is collected in the bladder during the night; this reduces the influence of natural daily fluctuations in urine parameters and characterizes the studied parameters more objectively. The required volume of urine to perform a full-fledged study is approximately 100 ml.
Urine should be collected after thorough toileting of the vulva, especially in women. Failure to comply with this rule may result in the detection of an increased number of leukocytes, mucus, and other contaminants in the urine, which may complicate the study and distort the result.
Women need to use a soapy solution (followed by washing with boiled water) or weak solutions of potassium permanganate (0.02 - 0.1%) or furacilin (0.02%). Antiseptic solutions should not be used when passing urine for bacteriological analysis!
Urine is collected in a dry, clean, well-washed small jar of 100-200 ml from cleaners and disinfectants or in a special disposable container.
Due to the fact that elements of inflammation in the urethra and external genital organs can get into the urine, it is first necessary to release a small portion of urine and only then substitute a jar under the jet and fill it to the required level. The container with urine is tightly closed with a lid and transferred to the laboratory with the necessary direction, where the name and initials of the subject, as well as the date of the analysis, must be indicated.
It must be remembered that urinalysis should be performed no later than 2 hours after receiving the material. Urine that is stored longer may be contaminated with extraneous bacterial flora. In this case, the pH of the urine will shift to the alkaline side due to the ammonia released into the urine by bacteria. In addition, microorganisms feed on glucose, so you can get negative or low results of sugar in the urine. Storage of urine longer than the due date also leads to the destruction of erythrocytes and other cellular elements in it, and in daylight - bile pigments.
In winter, it is necessary to avoid freezing urine during its transportation, since salts that precipitate in this case can be interpreted as a manifestation of renal pathology and complicate the research process.
1.2.1. General properties of urine
As you know, ancient doctors did not have such instruments as a microscope, spectrophotometer, and, of course, did not have modern diagnostic strips for express analysis, but they could skillfully use their senses: sight, smell and taste.
Indeed, the presence of a sweet taste in the urine of a patient with complaints of thirst and weight loss allowed the ancient healer to very confidently establish the diagnosis of diabetes, and the urine of the color of “meat slops” testified to a serious kidney disease.
Although at the present time it would not occur to any doctor to taste urine, the assessment of the visual properties and smell of urine still has not lost its diagnostic value.
Color. In healthy people, urine has a straw-yellow color due to the content of urinary pigment in it - urochrome.
The more concentrated the urine, the darker it is. Therefore, during intense heat or intense physical exertion with profuse sweating, less urine is excreted, and it is more intensely colored.
In pathological cases, the intensity of urine color increases with an increase in edema associated with kidney and heart diseases, with loss of fluid associated with vomiting, diarrhea, or extensive burns.
Urine becomes dark yellow (the color of dark beer) sometimes with a greenish tinge with increased excretion of bile pigments in the urine, which is observed with parenchymal (hepatitis, cirrhosis) or mechanical (blockage of the bile duct with cholelithiasis) jaundice.
Red or reddish color of urine may be due to the use of large amounts of beets, strawberries, carrots, as well as some antipyretic drugs: antipyrine, amidopyrine. Large doses of aspirin can turn urine pink.
A more serious cause of reddening of the urine is hematuria, an admixture of blood in the urine, which may be associated with kidney or extrarenal diseases.
So, the appearance of blood in the urine can be with inflammatory diseases of the kidneys - nephritis, however, in such cases, urine, as a rule, becomes cloudy, as it contains an increased amount of protein, and resembles the color of "meat slops", i.e. the color of water, in which meat was washed.
Hematuria may be due to damage to the urinary tract during the passage of a kidney stone, as occurs during attacks of renal colic in people with urolithiasis. More rarely, blood in the urine is observed with cystitis.
Finally, the appearance of blood in the urine may be associated with the collapse of a kidney or bladder tumor, injuries to the kidneys, bladder, ureters or urethra.
The greenish-yellow color of urine may be due to the admixture of pus, which occurs when a kidney abscess is opened, as well as with purulent urethritis and cystitis. The presence of pus in the urine with its alkaline reaction leads to the appearance of dirty brown or gray urine.
A dark, almost black color occurs when hemoglobin enters the urine due to massive destruction of erythrocytes in the blood (acute hemolysis), when taking certain toxic substances - hemolytic poisons, transfusion of incompatible blood, etc. The black tint that appears when standing urine is observed in patients with alkaptonuria , in which homogentisic acid is excreted in the urine, darkening in air.
Transparency. Healthy people have clear urine. Cloud-like turbidity of urine, which occurs when it is standing for a long time, has no diagnostic value. Pathological turbidity of urine may be due to the release of a large amount of salts (urates, phosphates, oxalates) or an admixture of pus.
Smell. Fresh urine of a healthy person does not have a sharp and unpleasant odor. The appearance of a fruity smell (the smell of soaked apples) occurs in patients with diabetes mellitus who have a high blood glucose level (usually exceeding 14 mmol / l for a long time), when a large amount of special products of fatty metabolism, ketone acids, is formed in the blood and urine. Urine acquires a sharp unpleasant odor when eating a large amount of garlic, horseradish, asparagus.
When evaluating the physical and chemical properties of urine, its daily amount, relative density, acid-base reaction, protein, glucose, content of bile pigments are examined.
1.2.2. Daily amount of urine
The amount of urine that a healthy person excretes per day, or daily diuresis, can vary significantly, as it depends on the influence of a number of factors: the amount of fluid drunk, the intensity of sweating, respiratory rate, the amount of fluid excreted with feces.
Under normal conditions, the average daily diuresis is normally 1.5-2.0 liters and corresponds to approximately 3/4 of the volume of fluid drunk.
A decrease in urine output occurs with profuse sweating, for example, when working in conditions of high temperature, with diarrhea and vomiting. Also, low diuresis contributes to fluid retention (increased edema in renal and heart failure) in the body, while the patient's body weight increases.
A decrease in urine output less than 500 ml per day is called oliguria, and less than 100 ml per day is called anuria.
Anuria is a very formidable symptom and always indicates a serious condition:
. a sharp decrease in blood volume and a drop in blood pressure associated with heavy bleeding, shock, indomitable vomiting, severe diarrhea;
. a pronounced violation of the filtration capacity of the kidneys - acute renal failure, which can be observed in acute nephritis, kidney necrosis, acute massive hemolysis;
. blockage of both ureters with stones or their compression by a closely located large tumor (cancer of the uterus, bladder, metastases).
Ischuria should be distinguished from anuria - urinary retention due to a mechanical obstruction to urination, for example, with the development of a tumor or inflammation of the prostate gland, narrowing of the urethra, compression of the tumor or blockage of the outlet in the bladder, dysfunction of the bladder with damage to the nervous system.
An increase in daily diuresis (polyuria) is observed when edema converges in people with renal or heart failure, which is combined with a decrease in the patient's body weight. In addition, polyuria can be observed in diabetes and diabetes insipidus, chronic pyelonephritis, with prolapse of the kidneys - nephroptosis, aldosteroma (Conn's syndrome) - an adrenal tumor that produces an increased amount of mineralocorticoids, in hysterical conditions due to excessive fluid intake.
1.2.3. Relative density of urine
The relative density (specific gravity) of urine depends on the content of dense substances in it (urea, mineral salts, etc., and in cases of pathology - glucose, protein) and is normally 1.010-1.025 (water density is taken as 1). An increase or decrease in this indicator may be the result of both physiological changes and occur in some diseases.
An increase in the relative density of urine leads to:
. low fluid intake;To reduce the relative density of urine lead to:
. large loss of fluid with sweating, vomiting, diarrhea;
. diabetes;
. fluid retention in the body in the form of edema in cardiac or acute renal failure.
. plentiful drink;
. convergence of edema during therapy, diuretic drugs;
. chronic renal failure in chronic glomerulonephritis and pyelonephritis, nephrosclerosis, etc.;
. diabetes insipidus (usually below 1.007).
A single study of relative density allows only a rough estimate of the state of the concentration function of the kidneys, therefore, to clarify the diagnosis, daily fluctuations of this indicator in the Zimnitsky sample are usually evaluated (see below).
1.2.4. Chemical study of urine
urine reaction. With a normal diet (a combination of meat and plant foods), the urine of a healthy person has a slightly acidic or acidic reaction and its pH is 5-7. The more meat a person eats, the more acidic his urine, while plant foods help shift the pH of urine to the alkaline side.
A decrease in pH, i.e., a shift in the reaction of urine to the acid side, occurs during hard physical work, fasting, a sharp increase in body temperature, diabetes mellitus, and impaired kidney function.
On the contrary, an increase in the pH of urine (a shift in acidity to the alkaline side) is observed when taking a large amount of mineral water, after vomiting, convergence of edema, inflammation of the bladder, when blood enters the urine.
The clinical significance of determining the pH of urine is limited by the fact that a change in the acidity of urine to the alkaline side contributes to a more rapid destruction of the formed elements in the urine sample during storage, which must be taken into account by the laboratory assistant conducting the analysis. In addition, changes in urine acidity are important to know for people with urolithiasis. So, if the stones are urates, then the patient should strive to maintain the alkaline acidity of the urine, which will help dissolve such stones. On the other hand, if the kidney stones are tripelphosphates, then an alkaline urine reaction is undesirable, as it will contribute to the formation of such stones.
Protein. In a healthy person, urine contains a small amount of protein, not exceeding 0.002 g / l or 0.003 g in daily urine.
Increased excretion of protein in the urine is called proteinuria and is the most common laboratory sign of kidney damage.
For patients with diabetes mellitus, a “border zone” of proteinuria was identified, which was called microalbuminuria. The fact is that microalbumin is the smallest protein in the blood and, in the case of kidney diseases, enters the urine earlier than others, being an early marker of nephropathy in diabetes mellitus. The importance of this indicator lies in the fact that the appearance of microalbumin in the urine in patients with diabetes mellitus characterizes the reversible stage of kidney damage, in which, with the help of prescribing special medications and following some doctor's recommendations, patients can restore damaged kidneys. Therefore, for diabetic patients, the upper limit of the normal content of protein in the urine is 0.0002 g / l (20 μg / l) and 0.0003 g / day. (30 mcg/day).
The appearance of protein in the urine can be associated with both kidney disease and pathology of the urinary tract (ureters, bladder, urethra).
Proteinuria associated with urinary tract disease is characterized by a relatively low protein level (usually less than 1 g/l) in combination with a large number of leukocytes or erythrocytes in the urine, as well as the absence of casts in the urine (see below).
Renal proteinuria is physiological, i.e. observed in a completely healthy person, and may be pathological - as a result of some disease.
Causes of physiological renal proteinuria are:
. the use of a large amount of protein that has not undergone heat treatment (unboiled milk, raw eggs);
. intense muscle load;
. prolonged stay in an upright position;
. bathing in cold water;
. severe emotional stress;
. epileptic attack.
Pathological renal proteinuria is observed in the following cases:
. kidney diseases (acute and chronic inflammatory diseases of the kidneys - glomerulonephritis, pyelonephritis, amyloidosis, nephrosis, tuberculosis, toxic kidney damage);
. nephropathy of pregnant women;
. increased body temperature in various diseases;
. hemorrhagic vasculitis;
. severe anemia;
. arterial hypertension;
. severe heart failure;
. hemorrhagic fevers;
. leptospirosis.
In most cases, it is true that the more pronounced proteinuria, the stronger the damage to the kidneys and the worse the prognosis for recovery. In order to more accurately assess the severity of proteinuria, the protein content in the urine collected by the patient per day is estimated. Based on this, the following degrees of gradation of proteinuria according to severity are distinguished:
. mild proteinuria - 0.1-0.3 g / l;
. moderate proteinuria - less than 1 g / day;
. severe proteinuria - 3 g / day. and more.
Urobilin.
Fresh urine contains urobilinogen, which is converted to urobilin when the urine is standing. Urobilinogen bodies are substances that are formed from bilirubin, a liver pigment, during its transformation in the biliary tract and intestines.
It is urobilin that causes dark urine in jaundice.
In healthy people with a normally functioning liver, so little urobilin enters the urine that routine laboratory tests give a negative result.
An increase in this indicator from a weakly positive reaction (+) to a sharply positive reaction (+++) occurs with various diseases of the liver and biliary tract:
The determination of urobilin in urine is a simple and quick way to identify signs of liver damage and subsequently clarify the diagnosis using biochemical, immunological and other tests. On the other hand, a negative reaction to urobilin allows the doctor to exclude the diagnosis of acute hepatitis.
Bile acids. In the urine of a person without liver pathology, bile acids never appear. Detection in the urine of bile acids of varying severity: weakly positive (+), positive (++) or sharply positive (+++) always indicates a gross lesion of the liver tissue, in which the bile formed in the liver cells, along with entry into the bile ducts and intestines directly into the blood.
The reasons for the positive reaction of urine to bile acids are acute and chronic hepatitis, cirrhosis of the liver, obstructive jaundice caused by blockage of the bile ducts.
At the same time, it should be said that with the most severe liver damage due to the cessation of the production of bile acids, the latter may not be detected in the urine.
Unlike urobilin, bile acids do not appear in the urine of patients with hemolytic anemia, so this indicator is used as an important differential sign to distinguish between jaundice associated with liver damage and jaundice caused by increased destruction of red blood cells.
Bile acids in the urine can also be detected in people with liver damage without external signs of jaundice, so this analysis is important for those who are suspected of having liver disease, but not having jaundice of the skin.
1.2.5. Examination of urine sediment
The study of the urinary sediment is the final stage of the clinical analysis of urine and characterizes the composition of cellular elements (erythrocytes, leukocytes, cylinders, epithelial cells), as well as salts in the analysis of urine. In order to conduct this study, urine is poured into a test tube and centrifuged, while dense particles settle to the bottom of the test tube: blood cells, epithelium, and salts. After that, the laboratory assistant transfers part of the sediment from the test tube onto a glass slide with a special pipette and prepares a preparation that is dried, stained and examined by a doctor under a microscope.
To quantify the cellular elements found in the urine, special units of measurement are used: the number of certain cells of the urinary sediment in the field of view during microscopy. For example: "1-2 erythrocytes in the field of view" or "single epithelial cells in the field of view" and "leukocytes cover the entire field of view."
Erythrocytes. If a healthy person does not detect erythrocytes in the urine sediment or they are present in “single copies” (no more than 3 in the field of view), their appearance in the urine in a larger amount always indicates some pathology from the kidneys or urinary tract.
It should be said that even the presence of 2-3 erythrocytes in the urine should alert the doctor and the patient and requires at least a second urine test or special tests (see below). Single erythrocytes can appear in a healthy person after heavy physical exertion, with prolonged standing.
When the admixture of blood to the urine is determined visually, i.e. the urine has a red color or shade (gross hematuria), then there is no great need to evaluate the number of erythrocytes with microscopy of the urinary sediment, since the result is known in advance - the erythrocytes will cover the entire field of view, i.e. their number will be many times higher than the normative values. In order for urine to become red, only 5 drops of blood (containing approximately 1 x 10 12 red blood cells) per 0.5 l of urine are enough.
A smaller admixture of blood, which is invisible to the naked eye, is called microhematuria and is detected only by microscopy of the urinary sediment.
The appearance of an admixture of blood in the urine may be associated with any disease of the kidneys, urinary tract (ureters, bladder, urethra), prostate gland, as well as some other diseases not associated with the genitourinary system:
. glomerulonephritis (acute and chronic);
. pyelonephritis (acute and chronic);
. malignant tumors of the kidneys;
. cystitis;
. prostate adenoma;
. urolithiasis disease;
. kidney infarction;
. amyloidosis of the kidneys;
. nephrosis;
. toxic kidney damage (for example, when taking analgin);
. kidney tuberculosis;
. kidney injury;
. hemorrhagic diathesis;
. hemorrhagic fever;
. severe circulatory failure;
. hypertonic disease.
For practice, it is important to know how to roughly determine the place where blood enters the urine using laboratory methods.
The main sign, presumably indicating the entry of erythrocytes into the urine from the kidneys, is the concomitant appearance of protein and cylinders in the urine. In addition, for these purposes, the three-glass sample is still widely used, especially in urological practice.
This test consists in the fact that the patient, after holding urine for 4-5 hours or in the morning after sleep, collects urine sequentially into 3 jars (containers): the first is released into the 1st, the intermediate into the 2nd, and the last (final!) portion of urine. If erythrocytes are found in the largest number in the 1st portion, then the source of bleeding is in the urethra, in the 3rd, the source in the bladder is more likely. Finally, if the number of red blood cells is approximately the same in all three portions of urine, then the source of bleeding is the kidneys or ureters.
Leukocytes. Normally, up to 5 leukocytes are found in the urinary sediment in a healthy woman, and up to 3 leukocytes in a healthy man in the field of view.
An increased amount of white blood cells in the urine is called leukocyturia. Too pronounced leukocyturia, when the number of these cells exceeds 60 in the field of view, is called pyuria.
As already mentioned, the main function of leukocytes is protective, so their appearance in the urine, as a rule, indicates some kind of inflammatory process in the kidneys or urinary tract. In this situation, the rule “the more leukocytes in the urine, the more pronounced the inflammation and the more acute the process” remains valid. However, the degree of leukocyturia does not always reflect the severity of the disease. So, there can be a very moderate increase in the number of leukocytes in the urinary sediment in people with severe glomerulonephritis and reach the degree of pyuria in people with acute inflammation of the urethra - urethritis.
The main causes of leukocyturia are inflammatory diseases of the kidneys (acute and chronic pyelonephritis) and urinary tract (cystitis, urethritis, prostatitis). In more rare cases, kidney damage in tuberculosis, acute and chronic glomerulonephritis, and amyloidosis can lead to an increase in the number of leukocytes in the urine.
For the doctor, and even more so for the patient, it is very important to establish the cause of leukocyturia, that is, to approximately establish the place of development of the inflammatory process of the genitourinary system. By analogy with the story about the causes of hematuria, laboratory signs indicating an inflammatory process in the kidneys as the cause of leukocyturia is the concomitant appearance of protein and cylinders in the urine. In addition, a three-glass test is also used for these purposes, the results of which are evaluated similarly to the results of this test when determining the source of blood entering the urine. So, if leukocyturia is detected in the 1st portion, this indicates that the patient has an inflammatory process in the urethra (urethritis). If the highest number of leukocytes is in the 3rd portion, then it is most likely that the patient has inflammation of the bladder - cystitis or prostate gland - prostatitis. With approximately the same number of leukocytes in the urine of different portions, one can think of an inflammatory lesion of the kidneys, ureters, and also the bladder.
In some cases, a three-glass sample is carried out more quickly - without microscopy of the urinary sediment and is guided by such signs as turbidity, as well as the presence of filaments and flakes in each of the portions of urine, which to a certain extent are equivalent to leukocyturia.
In clinical practice, for an accurate assessment of the number of erythrocytes and leukocytes in the urine, a simple and informative Nechiporenko test is widely used, which allows you to calculate how many of these cells are contained in 1 ml of urine. Normally, 1 ml of urine contains no more than 1000 erythrocytes and 400 thousand leukocytes.
The cylinders are formed from protein in the tubules of the kidneys under the influence of the acidic reaction of urine, being, in fact, their cast. In other words, if there is no protein in the urine, then there can be no cylinders, and if they are, then you can be sure that the amount of protein in the urine is increased. On the other hand, since the acidity of urine affects the process of formation of cylinders, then with its alkaline reaction, despite proteinuria, cylinders may not be detected.
Depending on whether cellular elements from urine are included in the cylinders and which ones, hyaline, epithelial, granular, waxy, erythrocyte and leukocyte, as well as cylindroids are distinguished.
The reasons for the appearance of cylinders in the urine are the same as for the appearance of protein, with the only difference that the protein is detected more often, since, as already indicated, an acidic environment is necessary for the formation of cylinders.
Most often in practice, there are hyaline cylinders, the presence of which may indicate acute and chronic kidney disease, but they can also be found in people without pathology of the urinary system in cases of prolonged stay in an upright position, strong cooling or, conversely, overheating, heavy physical exertion.
Epithelial casts always indicate the involvement of the tubules of the kidneys in the pathological process, which most often occurs with pyelonephritis and nephrosis.
Waxy casts are usually indicative of severe kidney damage, and the presence of red blood cell casts in the urine strongly suggests that hematuria is due to kidney disease.
Epithelial cells line the mucous membrane of the urinary tract and enter the urine in large quantities during inflammatory processes. In accordance with what type of epithelium lines a particular section of the urinary tract during various inflammatory processes, a different type of epithelium appears in the urine.
Normally, in the urinary sediment, squamous epithelial cells are found in very small numbers - from single in the preparation to single in the field of view. The number of these cells increases significantly with urethritis (inflammation of the urinary canal) and prostatitis (inflammation of the prostate gland).
Transitional epithelial cells appear in the urine with acute inflammation in the bladder and renal pelvis, urolithiasis, tumors of the urinary tract.
Cells of the renal epithelium (urinary tubules) enter the urine with nephritis (inflammation of the kidneys), poisoning with poisons that damage the kidneys, and heart failure.
Bacteria in the urine are examined in a sample taken immediately after urination. Particular importance in this type of analysis is given to the correct processing of the external genital organs before taking the analysis (see above). The detection of bacteria in the urine is not always a sign of an inflammatory process in the genitourinary system. The main value for the diagnosis is an increased number of bacteria. So, in healthy people, no more than 2 thousand microbes are found in 1 ml of urine, while 100 thousand bacteria in 1 ml are typical for patients with inflammation in the urinary organs. If an infectious process in the urinary tract is suspected, doctors supplement the determination of microbial bodies in the urine with a bacteriological study, in which urine is cultured under sterile conditions on special nutrient media and, according to a number of signs of a grown colony of microorganisms, they determine the belonging of the latter, as well as their sensitivity to certain antibiotics. to choose the right treatment.
In addition to the components of the urinary sediment listed above, unorganized urine sediments or various inorganic compounds are isolated.
The precipitation of various inorganic deposits depends primarily on the acidity of the urine, which is characterized by pH. With an acid reaction of urine (pH less than 5), salts of uric and hippuric acids, calcium phosphate, etc. are determined in the sediment. With an alkaline reaction of urine (pH more than 7), amorphous phosphates, tripel phosphates, calcium carbonate, etc. appear in the sediment.
At the same time, by the nature of this or that urine sediment, one can also say about the possible disease of the person being examined. Thus, uric acid crystals appear in large quantities in the urine in case of renal failure, dehydration, in conditions accompanied by a large breakdown of tissues (malignant blood diseases, massive, decaying tumors, resolving massive pneumonia).
Oxalates (salts of oxalic acid) appear with the abuse of foods containing oxalic acid (tomatoes, sorrel, spinach, lingonberries, apples, etc.). If a person did not use these products, then the presence of oxalates in the urinary sediment indicates a metabolic disorder in the form of oxalo-acetic diathesis. In some rare cases of poisoning, the appearance of oxalates in the urine makes it possible to confirm with high accuracy the use of a toxic substance, ethylene glycol, by the victim.
1.2.6. Tests characterizing kidney function
The work of the kidneys as a whole consists of the performance of various functions, called partial ones: concentration of urine (concentration function), urine excretion (glomerular filtration) and the ability of the kidney tubules to return substances useful to the body that have entered the urine: protein, glucose, potassium, etc. (tubular reabsorption) or, conversely, release some metabolic products into the urine (tubular secretion). A similar violation of these functions can be observed in various forms of kidney disease, so their study is necessary for the doctor not so much to make a correct diagnosis, but to determine the degree and severity of kidney disease, and also helps to evaluate the effectiveness of treatment and determine the prognosis of the patient's condition.
The most widely used samples in practice are the Zimnitsky test and the Reberg-Tareev test.
The Zimnitsky test allows you to assess the ability of the kidneys to concentrate urine by measuring the density of urine collected every 3 hours during the day, i.e., a total of 8 urine samples are examined.
This test should be carried out under the usual drinking regimen; it is undesirable for patients to take diuretic drugs. It is also necessary to take into account the amount of liquid taken by a person in the form of water, drinks and the liquid part of food.
The daily volume of urine is obtained by adding the volumes of the first 4 portions of urine collected from 09.00 to 21.00 h, and the nocturnal diuresis is obtained by summing from the 5th to the 8th portions of urine (from 21.00 to 09.00).
In healthy people, 2/3 - 4/5 (65-80%) of the liquid drunk per day is excreted during the day. In addition, daytime diuresis should be approximately 2 times higher than nighttime, and the relative density of individual portions of urine should fluctuate within fairly large limits - at least 0.012-0.016 and reach at least one of the portions of an indicator equal to 1.017.
An increase in the daily amount of urine excreted compared to the liquid drunk can be observed with the convergence of edema, and a decrease, on the contrary, with an increase in edema (renal or cardiac).
An increase in the ratio between nocturnal and daytime urine output is characteristic of patients with heart failure.
The low relative density of urine in various portions collected per day, as well as a decrease in daily fluctuations in this indicator, is called isohyposthenuria and is observed in patients with chronic kidney diseases (chronic glomerulonephritis, pyelonephritis, hydronephrosis, polycystic). The concentration function of the kidneys is disturbed earlier than other functions, therefore, the Zimnitsky test makes it possible to detect pathological changes in the kidneys in the early stages, before the appearance of signs of severe renal failure, which, as a rule, is irreversible.
It should be added that a low relative density of urine with small fluctuations during the day (no more than 1.003-1.004) is characteristic of a disease such as diabetes insipidus, in which the production of the hormone vasopressin (antidiuretic hormone) in the human body decreases. This disease is characterized by thirst, weight loss, increased urination and an increase in the volume of urine excreted several times, sometimes up to 12-16 liters per day.
Rehberg's test helps the doctor determine the excretory function of the kidneys and the ability of the renal tubules to release or absorb back (reabsorb) certain substances.
The test method consists in the fact that the patient in the morning on an empty stomach in a supine position collects urine for 1 hour and in the middle of this period of time they take blood from a vein to determine the level of creatinine.
Using a simple formula, the value of glomerular filtration (characterizes the excretory function of the kidneys) and tubular reabsorption are calculated.
In healthy men and women of young and middle age, the glomerular filtration rate (CF), calculated in this way, is 130-140 ml / min.
A decrease in CF is observed in acute and chronic nephritis, kidney damage in hypertension and diabetes mellitus - glomerulosclerosis. The development of renal failure and the increase in nitrogenous wastes in the blood occurs with a decrease in CF to about 10% of the norm. In chronic pyelonephritis, the decrease in CF occurs later, and in glomerulonephritis, on the contrary, earlier than violations of the concentration ability of the kidneys.
A persistent drop in CF to 40 ml / min in chronic kidney disease indicates severe renal failure, and a decrease in this indicator to 15-10-5 ml / min indicates the development of the final (terminal) stage of renal failure, which usually requires the patient to be connected to the device " artificial kidney” or a kidney transplant.
Tubular reabsorption normally ranges from 95 to 99% and can drop to 90% or less in people without kidney disease when drinking large amounts of fluid or taking diuretics. The most pronounced decrease in this indicator is observed in diabetes insipidus. A persistent decrease in water reabsorption below 95%, for example, is observed in primary wrinkled (against the background of chronic glomerulonephritis, pyelonephritis) or secondary wrinkled kidney (for example, observed in hypertension or diabetic nephropathy).
It should be noted that usually, along with a decrease in reabsorption in the kidneys, there is a violation of the concentration function of the kidneys, since both functions depend on disorders in the collecting ducts.
Introduction
Currently, there are many ways to diagnose diseases, each of which has its own advantages and disadvantages. Unfortunately, not all studies help to accurately identify a particular pathology. For example, only serious anatomical abnormalities in the development of organs and systems of the body are determined using x-rays and ultrasound, and functional disorders, as a rule, cannot be detected during such an examination. Therefore, doctors, in addition to the research methods mentioned above, prescribe certain tests to patients. It is laboratory studies that make it possible to identify violations in the functioning of organs and systems of the body, detect infectious agents, make the correct diagnosis and prescribe treatment.
Some diseases (cancer, urinary tract infections, endocrine pathologies, etc.) can be almost asymptomatic for a long time, so it is recommended that each person periodically take blood and urine tests to make sure there are no abnormalities or, if any, start treatment on time. In addition to deciphering the most common tests, this book provides schemes for medical examinations, including lists of necessary laboratory tests.
Preparation for testing
Laboratory studies allow timely and accurate diagnosis of various diseases. After all, their manifestations are primarily reflected in the metabolic processes in the body. More than 50% of information about a patient's health status is given to doctors by test results. It is the data of laboratory studies that allow physicians to choose treatment tactics.
The accuracy of the test results depends not only on the qualifications of laboratory assistants and the quality of reagents and equipment, but also on the preparation of the patient for the study, that is, on the time and correctness of collecting the material.
blood donation procedure
Almost all blood tests must be taken on an empty stomach - between the last meal and blood sampling should be at least 8 hours (preferably 12 hours). You can drink only water before taking blood. However, this does not apply to a general blood test: it can be taken 1 hour after breakfast, which may consist of unsweetened tea, sugar-free cereal, butter and milk, and an apple.
Blood for C-peptide and insulin should be taken strictly on an empty stomach until 10 am.
Also, throughout the day, regardless of food intake, you can take tests for genetic polymorphisms.
An analysis for hormones and antibodies to infections can be taken 6 hours after the last meal.
For a number of studies, blood is donated strictly at a certain time of the day. For example, blood for iron and some hormones are taken only until 10 am.
An analysis to determine the lipid profile should be taken 12 hours after a meal.
1 hour before blood sampling, you should refrain from smoking, and on the eve of the study, exclude physical activity.
If an analysis is prescribed that determines the level of uric acid in the blood, a few days before the study, it is necessary to give up meat, liver, kidneys, fish, coffee and tea, and also exclude intense physical activity. The diet should also be observed 2 days before donating blood for viral hepatitis. In this case, citrus fruits and carrots should be excluded from the diet.
If drug treatment is prescribed, blood should be donated before they are taken or no earlier than 10-14 days after they are discontinued.
You can not donate blood after physiotherapy, ultrasound, massage, reflexology, rectal examination and radiography.
Women are recommended to donate blood for hormone testing strictly on the days of the cycle: LH and FSH - 3-5th day, estradiol - 5-7th or 21-23rd, prolactin, DHA-sulfate and testosterone - 7-9 th, progesterone - 21-23 days.
Rules for collecting urine
Hygiene rules
Before collecting urine, women should wash the vagina and labia with a sterile cotton swab moistened with warm soapy water, moving from front to back. After that, it is recommended to wash the genitals with warm boiled water and blot with a sterile napkin.
It is not recommended to take a urine test during menstruation.
Before collecting urine, men need to wash the external opening of the urethra with warm soapy water, then wash with warm boiled water and blot with a sterile napkin.
Collection of urine for general analysis
For a general analysis, the first morning portion of urine should be collected immediately after waking up on an empty stomach.
When urinating, women need to push the labia apart, men completely pull the skin fold and release the external opening of the urethra.
You can store urine in the refrigerator for no more than 1.5 hours.
Daily urine collection
To determine the content of total protein, albumin, glucose, creatinine, bilirubin, calcium, phosphorus, sodium and potassium, urine must be collected within 24 hours with a normal drinking regimen (about 1.5 liters of fluid per day).
The patient should empty the bladder at 6-8 o'clock in the morning (this portion is not given for analysis), and then during the day collect all the urine in a sterile dark glass vessel with a capacity of at least 2 liters. In this case, the last portion of urine must be collected at the same time as the first. Having collected urine, it is necessary to measure and record its volume, and then shake and pour 50-
100 ml for laboratory research in a special container with a lid.
The container with urine must be closed with a lid and stored on the bottom shelf of the refrigerator.
Urine collection for research according to Nechiporenko
In the morning on an empty stomach, a medium portion of urine should be collected. The collection is carried out according to the method of a three-glass sample: first you need to urinate in the first glass, then in the second and in the third. The second (middle) portion of urine should be larger. It is necessary to collect it in sterile glassware, and then pour 20-30 ml into a special container with a lid and deliver it to the laboratory.
Collection of urine for research according to Zimnitsky
At 6 o'clock in the morning, the patient needs to empty the bladder, and then during the day, every 3 hours, collect urine in separate containers, on which the collection time is indicated. There should be 8 servings of urine in total. Analyzes in separate containers must be delivered to the laboratory.
Rules for collecting feces
Hygiene rules
Before collecting feces, it is imperative to urinate, and then carry out hygiene procedures: wash the external genitalia and anus with warm water and soap, and then blot with a sterile napkin.
General analysis and analysis for dysbacteriosis
It is necessary to collect feces for research in the morning. Defecation should be done in a dry, clean container.
You can not take feces for analysis after an X-ray examination, taking a laxative, activated charcoal, iron preparations, bismuth, as well as using rectal suppositories and enemas.
A stool sample (2-4 g) from different parts of the entire portion should be transferred to a special container using a clean spoon.
The container must be closed with a lid and delivered to the laboratory.
occult blood test
3 days before the test, it is necessary to exclude meat, liver, sausages, as well as all products containing iron from the diet. The collection of feces is carried out in the same way as in the previous case.
Analysis for helminth eggs
For this study, you need to take the material from the perianal folds. This should be done in the morning before urination, defecation and hygiene procedures.
With a cotton swab, you need to hold it around the anus several times, then put the wand in a special container and deliver it to the laboratory.
Rules for collecting sputum
To improve expectoration on the eve of the test, expectorants should be taken. Before coughing, the patient needs to brush his teeth and rinse his mouth with boiled water. Sputum must be collected in a sterile container and delivered to the laboratory within 1 hour.
Sperm Collection Rules
Semen analysis is given after 48 hours of sexual abstinence. The same amount of time is not recommended to take alcohol, drugs, bathe in the bath.
In the morning after waking up, the patient needs to urinate, and then wash the external opening of the urethra with warm water and soap. Material for research is given by masturbation into a sterile container.
Blood tests
Blood is a liquid tissue of the body, which includes plasma and formed elements suspended in it. In a healthy adult, blood plasma is about 52-60%, and formed elements - 40-48%. The composition of plasma includes water (90%), proteins dissolved in it (about 7%) and other mineral and organic compounds. The main plasma proteins are globulins, albumins and fibrinogen. Inorganic salts make up about 1% of plasma. Blood plasma also contains nutrients (lipids and glucose), vitamins, enzymes, hormones, metabolic products, and inorganic ions.
The formed elements of blood include leukocytes, erythrocytes and platelets.
Leukocytes are white blood cells that are part of the body's immune system. They produce antibodies and participate in immune responses. Normally, there are fewer leukocytes in the blood than other formed elements.
Erythrocytes - red blood cells - contain hemoglobin (a protein containing iron), which gives the blood its red color. Hemoglobin carries gases, primarily oxygen.
Blood plasma contains gases such as oxygen and carbon dioxide.
Platelets - platelets - are fragments of the cytoplasm of giant bone marrow cells, limited by a cell membrane. They provide blood clotting, thereby protecting the body from severe blood loss.
General blood analysis
A general clinical blood test allows you to identify a number of diseases at the earliest stages of their development. That is why a blood test is always done during preventive examinations. Repeated blood tests allow you to evaluate the effectiveness of the treatment.
The normal values of the complete blood count are shown in tables 1 and 2.
Table 1
Normal blood counts
table 2
Leukocyte formula
red blood cells
The total volume of red blood cells is called the hematocrit value. It is expressed as a percentage. Normal hematocrit in men is 40-48%, in women - 36-42%.
Increased rate
An increased content of erythrocytes is observed with:
Dehydration of the body (toxicosis, vomiting, diarrhea);
Polycythemia;
erythremia;
Hypoxia.
The normal number of red blood cells in men in 1 μl of blood is 4-5 million, in women - 3.74.7 million.
Sometimes an increased content of red blood cells is observed with congenital and acquired heart defects, as well as with insufficient function of the adrenal cortex and an excess of steroids in the body. However, it is impossible to diagnose these diseases only by the results of a general blood test; other studies are also needed.
Reduced rate
A reduced content of erythrocytes is observed with:
Anemia (in this case, there is also a decrease in hemoglobin concentration);
Hyperhydration.
A reduced content of erythrocytes is also observed in acute blood loss, in chronic inflammatory processes, and also in late pregnancy. In addition, a decrease in the number of red blood cells is typical for patients with reduced bone marrow function or its pathological changes.
Hemoglobin
Many blood diseases are associated with a violation of the structure of hemoglobin. If the amount of hemoglobin is higher or lower than normal, this indicates the presence of pathological conditions.
The normal amount of hemoglobin in newborns is 210 g / l, in infants under the age of 1 month - 170.6 g / l, at the age of 1-3 months - 132.6 g / l, 4-6 months - 129.2 g / l, 7-12 months - 127.5 g / l, in children from 2 years old - 116-135 g / l.
Increased rate
An increased hemoglobin content is observed with:
erythremia;
Polycythemia;
Dehydration of the body (with thickening of the blood).
Reduced rate
Decreased hemoglobin content is observed with:
Blood loss, including occult bleeding (Table 3).
In some cardiovascular diseases, the amount of hemoglobin may be higher than normal.
A low hemoglobin content is also characteristic of cancer patients and people who have affected bone marrow, kidneys and some other organs.
With a low hemoglobin content associated with anemia, it is recommended to eat beef liver and pressed caviar.
Table 3
Indicators for blood loss
Hematocrit
Hematocrit measures the ratio of plasma volume to red blood cell volume. This indicator is used to express the total volume of erythrocytes. Hematocrit allows you to judge the severity of anemia, in which it can decrease by 15-25%.
Increased rate
Elevated hematocrit is observed when:
Polycythemia;
Dehydration of the body;
peritonitis.
Reduced rate
Decreased hematocrit is observed when:
Chronic hyperazotemia.
Elevated hematocrit can be observed in burns due to a decrease in the volume of circulating plasma.
Sometimes a low hematocrit indicates a chronic inflammatory process or an oncological disease. Also, the hematocrit decreases in late pregnancy, during fasting, prolonged bed rest, in diseases of the heart, blood vessels and kidneys due to an increase in the volume of circulating plasma.
Average volume of erythrocytes
This indicator is used to determine the type of anemia. The average volume of erythrocytes is calculated by the hematocrit value divided by the number of erythrocytes in 1 μl of blood and multiplied by 10: MCV \u003d H 1 x 10 / RBC (H 1 is hematocrit, RBC is the number of erythrocytes, x 10 12 / l).
Increased rate
An increased indicator of the average volume of erythrocytes is observed with:
Macrocytic and megaloblastic anemia (lack of vitamin B 12, folic acid deficiency);
hemolytic anemia.
Sometimes the average volume of erythrocytes increases with liver disease and certain genetic abnormalities.
Normal
A normal indicator of the average volume of erythrocytes is observed when:
normocytic anemia;
Anemia with normocytosis.
Reduced rate
A reduced indicator of the average volume of erythrocytes is observed with:
Microcytic anemia (iron deficiency, thalassemia);
hemolytic anemia.
Tests are often needed to make a correct diagnosis. The most informative of them is. Its indicators allow you to determine the presence of inflammation, anemia, decreased organ function and make it possible to identify many diseases at their initial stage. After all, blood is the main medium of the human body, and it is she who carries nutrients to the organs and removes metabolic products.
Usually, during the initial treatment of the patient, a general
blood analysis. Normal indicators of such an analysis indicate the proper functioning of all organs. To make the results more accurate, it is advisable to do the analysis in the morning, because after eating it changes.
What are the most important blood test results?
1. Hemoglobin.
It is hemoglobin that determines the red color of blood. It is important because it carries oxygen to the tissues of the body. Normally, the hemoglobin content should be at least 120 grams per liter for women and 130 for men. Hemoglobin is made up of protein and iron, which binds oxygen. With a lack of iron and blood loss, anemia occurs - a low level of hemoglobin. Most of all, the lack of hemoglobin affects
the functioning of the brain. But the increased content of this substance also indicates the presence of disorders in the body. Most often it happens from dehydration, heart and lung diseases.
2. Other important indicators of a blood test are the number and It is they who are carriers of hemoglobin, although its content in these cells may vary. An increase and decrease in their level indicates the same diseases as hemoglobin values. Sometimes the number of red blood cells may decrease after eating or at night. But the increase in their level is much more serious. This can be a sign of oxygen starvation, lung disease and cancer. Normally, the number of red blood cells should be 4-5 * 10 to the 12th degree per liter in men and slightly less in women. But much more important for determining the processes occurring in the body, the value of ESR - speed It can increase with many diseases, most often with inflammation, as well as with cancer, anemia, heart attack or blood diseases. ESR should be in a healthy man 1-10 millimeters per hour, and in a woman from 2 to 15. The rate can decrease with liver disease, blood clotting, starvation and a vegetarian diet.
3. When diagnosing, such indicators of a blood test as a condition are also taken into account
leukocytes. These cells respond to infection, inflammation and provide immune protection. There are several varieties of them, and they react differently to diseases. Therefore, the analysis should take into account the state of all these cells: granulocytes, neutrophils, basophils, eosinophils, lymphocytes and monocytes. The content of these cells is calculated according to a special one. The total number of leukocytes should be from 4 to 9 * 10 to the 9th degree. An increase in the number of white blood cells can indicate infectious diseases, suppuration, inflammation, kidney failure, or a heart attack. Its decrease is observed after taking certain drugs, with tuberculosis, malaria, influenza, hepatitis and oncological diseases.
Another species responsible for its clotting is platelets. An increase or decrease in their number can also indicate serious illnesses. But their number is paid attention when it differs greatly from the norm. Therefore, these blood test indicators are not so important.
