Increased neutrophils

Introduction Neutrophil elevation is common in bacterial infections. Neutrophils have active deformation and phagocytic functions and play an important defense role. Its phagocytosis is dominated by bacteria and also devours foreign bodies. After phagocytosis and treatment of a large number of bacteria, neutrophils die by themselves and become pus cells. Neutrophils enter the bloodstream from the bone marrow, stay for about 6 to 8 hours, then leave and survive in connective tissue for 2 to 3 days.

Cause

Neutrophils are derived from bone marrow hematopoietic stem cells that enter the blood or tissue after differentiation and development in the bone marrow. The ratio of the distribution of bone marrow, blood and connective tissue is 28:1:25, and the number of neutrophils in the blood of adults accounts for about 55% to 70% of the total number of white blood cells. Neutrophils are a type of polymorphonuclear leukocytes. Since the number is the largest in granulocytes, polymorphonuclear leukocytes are referred to as neutrophils. The cell contains a number of finely distributed fine red or light purple specific particles containing myeloperoxidase, acid phosphatase, phagocytosis, lysozyme and the like. Myeloperoxidase is unique to neutrophils, and there is little or no such enzyme even in macrophages with strong phagocytosis. In cytochemistry, this myeloperoxidase is generally used as a marker for neutrophils. Neutrophils have a strong chemotactic effect. The so-called chemotaxis is the movement of cells in the direction of stimulation of a chemical substance. A substance that acts as a chemotactic agent for neutrophils, called neutrophil chemotactic factor. There is a chemokine receptor on the neutral crude cell membrane. The receptor binds to the chemokine, activates the calcium pump on the membrane, and the cell protrudes forward to the foot, moving the cell to the site where the chemokine is produced.

When the neutrophils are contacted with the foreign matter that produces the chemokine, the cytoplasm around the contact forms a bulge, that is, the pseudopod, and the cell membrane of the contact site is concave, and the foreign matter is surrounded to form a phagosome or a phagocytic bubble containing the foreign matter. The surface of the neutrophil membrane has an IgGFc receptor and a complement C3 receptor, which accelerates phagocytosis. When the phagocytic foreign body is wrapped with antibodies and complement, it binds to the corresponding receptor on the neutrophil membrane, which enhances the phagocytosis of the cell, which is called opsonization.

As the phagocytosis begins, the cells cause a disorder of the cell membrane and cause a respiratory burst. The oxygen consumption of the cells increases, and a large number of cytotoxic effect molecules such as peroxides and superoxides are produced, which have a killing activity against the parasite. Under the stimulation of IFN- and TNF, more peroxygen anion can be produced to kill extracellular parasites. Neutrophils die by killing foreign substances such as phagocytic bacteria, and dead neutrophils are called pus cells.

When neutrophils are affected by bacterial products, antigen-antibody complexes, etc., the granular contents of the cells are released to the outside of the cells. The released acid protease and neutral protease can decompose vascular basement membrane, glomerular basement membrane, collagen and elastin of connective tissue, and complement C5, C15 and kininogen in plasma. Some of its decomposition products are neutrophil chemokines, which can attract more neutrophils. Among the substances released by neutrophils, there are eosinophil chemokines, neutrophil immobility factor (NIF), kininogen, plasminogen, coagulation factor, leukotriene, etc. Cheng Lingzhong, 1993).

In addition to playing an important defense role in anti-infection, neutrophils can cause an inflammatory reaction at the site of infection and participate in allergic reactions caused by parasitic infections, thereby causing immunopathological damage. The antibody directly acts on the antigen on the tissue or the cell. The neutral crude cell binds to the IgGFc segment on the surface of the target cell through its Fc receptor, and exerts an ADCC action, thereby causing damage to the cytotoxic allergic reaction; when the antigen-antibody ratio is suitable, the 19S is formed. The size of the immune complex is not easily phagocytized, deposits on the capillary wall, activates complement, and attracts neutrophils to the local area.

Neutrophils bind to and phagocytose immune complexes via Fc receptors and C3b receptors. Degranulation during phagocytosis, releasing a series of lysosomal enzymes, causing damage to blood vessels and surrounding tissues; in the site of IgE-mediated immediate allergic reactions, there are also neutrophil accumulation, indicating that neutrophils are also Participated in pathological damage caused by immediate allergic reactions.

an examination

Related inspection

Blood routine bone marrow analysis six tests of blood biochemistry

The absolute value of neutrophils was high (8.50*10^9/L), the percentage of neutrophils was high (67.9%), and the blood leukocytes were increased (12.50*10^9/L).

1. Raise the baby by about 220% (corticosteroids, adrenal treatment), about 40% increase in hard and hard exercise, and women's pregnancy will increase. Ring nuclear neutrophils 23%, smoking increased by about 18%, circadian rhythm increased by about 14% at night, and luteal phase increased by about 9%.

2. Peripheral blood neutrophils are changing in one day. After high intensity exercise or labor in the afternoon, the temperature is high, cold, full meal, after shower, late pregnancy and childbirth.

Differential diagnosis

Eosinophilia: A condition in which eosinophils in peripheral blood exceed normal values (normally no more than 450 per microliter or less than 7% of total white blood cells). Eosinophil description: The cytoplasm contains deep red large particles. The shape of the nucleus is similar to that of neutrophils, usually 2-3 leaves, accounting for about 4% of the total number of white blood cells, and eosinophils in the blood account for 2%-4% of the total number of white blood cells, ie, 100-350 cells/1. The number of eosinophils in the blood has obvious day and night cyclical fluctuations, the number of cells in the morning decreases, and the number of cells increases at midnight.

This periodic change in the number of cells is related to the diurnal fluctuations in the amount of glucocorticoid released from the adrenal cortex. When the concentration of corticosteroids in the blood increases, the number of eosinophils decreases; and when the concentration of corticosteroids decreases, the number of cells increases. Eosinophils contain large, elliptical eosinophilic granules in the cytoplasm. Such white blood cells also have a phagocytic function.

Neonatal neutrophilia: Peripheral blood leukocytes are often increased in patients with sclerotin, mainly neutrophils. Clinical manifestations vary widely, the main clinical types are purulent meningoencephalitis, sepsis and perinatal infection, leading to miscarriage or neonatal sclerotia. Peripheral blood leukocytes often increase in patients with sclerotin, mainly neutrophils. Examination of cerebrospinal fluid in patients with meningoencephalitis showed that the protein content increased and the sugar drop was not obvious. Only half of the human cerebrospinal fluid sugar was less than 2mmol/l, and the number of white blood cells often increased, and the range fluctuated between (50-1000)×106/l.

White blood cell classification is dominated by an increase in multinucleated cells. Since it is difficult to distinguish from other bacterial infections in the clinical situation, the diagnosis depends on bacterial culture. If the pathogen can be isolated, the diagnosis can be confirmed. However, the bacteria are easily confused with streptococcus and coryneform bacteria, so when there are unexplained infection patients, the possibility of the disease should be considered when separating the diphtheria-like or non-pathogenic bacteria from the infected specimen.

Granulocyte reduction: Neutropenia is an absolute granulocyte deficiency in the blood circulation pool of neutral polymorphonuclear cells (PMN).

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