Neutrophilia (Neutrophilia, Neutrophilic leukocytosis)


Neutrophilia is an increase in blood neutrophil granulocytes. This condition is not normal for humans. Another name for neutrophilia is neutrophilic leukocytosis.

Neutrophils are white blood cells whose number exceeds the quantitative values ​​of the remaining leukocytes and granulocytes.

Neutrophils take part in all inflammatory processes in the body. Their granules are filled with bactericidal substances, and on their membranes are located receptors for immunoglobulins of class G. This allows neutrophils to attract antibodies possessing a specificity for lgG. Neutrophils first go to the center of inflammation and eliminate it. A single neutrophil is enough to kill up to 30 bacteria at a time.

The normal level of neutrophils is from 2.0 to 5.5 Giga / liter.

Neutrophils can be present in the blood in several varieties:

Myelocytes that are not normally in the blood.

Young neutrophils, there may be no more than 1% of them in the blood.

Band neutrophils - from 1 to 5%.

Segmental neutrophils - from 45 to 70%.

Normally, myelocytes and young neutrophils are present in the bone marrow and are reserve cells. Their appearance in the peripheral blood indicates a serious pathology: leukemia or severe inflammation.

If the number of neutrophils in the blood exceeds the figures of 5.5 x 10 G / l, then they are talking about neutrophilia.

Causes of Neutrophilia

Neutrophil elevation does not always indicate any pathology. Since neutrophils are the first to respond to any changes in the body, their numbers may increase in various situations.

Causes of physiological neutrophilia are as follows:

Overeating (alimentary leukocytosis).

Excessive exercise.

Emotional shock (emotional leukocytosis).

Premenstrual syndrome in women.

The period of carrying a child (the second half of pregnancy).

Abrupt change in ambient temperature.

As a rule, a person does not know that his neutrophil level rises in the blood. These conditions do not pose a threat to health and do not show any pathological symptoms. Therefore, most often a temporary increase in the level of neutrophils goes unnoticed and passes on its own.

However, if a person experiences certain symptoms of indisposition, and an increase in the level of neutrophils is detected in a blood test, this may indicate the following pathologies:

An inflammatory reaction is triggered in the body. It can be any acute viral and bacterial infections, or purulent inflammation.

A person develops a malignant neoplasm.

The body develops a fungal infection.

The man received some kind of injury, ranging from burns and ending with surgical intervention.

In pregnant women, neutrophilia may indicate eclampsia.

In men and women, leaps in the level of neutrophils are sometimes a sign of diabetes mellitus.

In the first 24 hours after surgery, the level of neutrophils will be increased, which is a normal reaction of the body to the intervention. If their indicators do not decrease on the second day after the operation, this indicates the accession of the infection and requires additional treatment.

With transfusion, neutrophil levels will be elevated. A similar situation is observed on the background of acute blood loss.

Myocardial infarction always occurs on the background of neutrophilia.

The bites of poisonous insects and snakes leads to an increase in the level of neutrophils in the blood.

Types of neutrophilia depending on the degree of nuclear shift in the leukocyte formula

To make a correct diagnosis and prescription of treatment, it is important to consider the degree of nuclear shift in the leukocyte formula:

There is no nuclear shift. At the same time, the number of mature segmental nuclear neutrophils increases in the blood and total leukocytosis is diagnosed. A similar situation is observed after a hearty meal, after physical effort, with bleeding, or against the background of a mild infectious disease.

Nuclear shift to the left. Neutrophilia is characterized by an increase in the number of polymorphonuclear neutrophils and a small increase in myelocytes. A similar blood picture is characteristic of pneumonia, scarlet fever, diphtheria and typhoid.

Neutrophilia is accompanied by a significant jump in the level of myelocytes. This will indicate severe infection or purulent-septic inflammation.

Neutrophilia with deregenerative nuclear shift. In this case, modified neutrophils appear in the blood, which signals severe infections and intoxication of the body, or indicates a bone marrow damage.

Neutrophilia with nuclear shifts to the left. Neutrophils are present in the blood, having more than 5 segments. Sometimes they are found in healthy people, and sometimes they are a sign of Addison-Birmer anemia.

Mechanisms of development of neutrophilia

There are several options for the development of neutrophilia, including:

The process of maturation of neutrophils in the bone marrow starts at a heightened pace. An increase in the number of neutrophils in the blood occurs within a few days. A similar clinical picture is observed in the case when a person has a malignant neoplasm in the body, or an infection that causes the launch of purulent processes develops. The mechanism of accelerated neutrophil maturation in the bone marrow is also called chronic neutrophilia. This process is activated against the background of stimulation of bone marrow fibroblasts by cytokines, which produce macrophages and monocytes during inflammation or bacterial infection. Bone marrow fibroblasts, in turn, begin to produce hematopoietic growth factors that are aimed at accelerated maturation and stimulation of neutrophil release from the depot. The rate of neutrophil maturation can be increased by 3 times (with a purulent infection) or even more (with diseases of the blood system, with sepsis). The maximum number of neutrophils in the blood was reached after 7 days.

For a long time, the bone marrow is not able to provide the body with neutrophils, as its depot is depleted. At the same time not only their number in blood decreases, but also life expectancy decreases. The forecast in this case is significantly worse.

Neutrophils from the bone marrow are released in an immature form, which occurs in a few hours. Such neutrophilia is an acute condition and develops against the background of a pronounced inflammatory reaction. When there are not enough neutrophils circulating in the bloodstream to neutralize it, the bone marrow activates the reserve. To this end, he produces segmented and stab neutrophil forms. In the presence of acute inflammation in the body, such a reaction will not be triggered only when neutrophil production in the bone marrow is seriously impaired. For example, when a patient is undergoing a course of chemotherapy.

Neutrophilia can develop due to the release of the marginal pool. It manifests within a few minutes. Such neutrophilia is called pseudoneutrophilia. It starts with emotional upheaval, with intense physical exertion, with catecholamine treatment due to an increase in heart blood flow. All of these reasons lead to the fact that the rate of blood flow through the vessels increases, while the leukocytes occupy a marginal position, the number of monocytes and lymphocytes increases.

Neutrophilia with a decrease in neutrophil output from the bloodstream in the tissue. Neutrophils from the vascular bed can be released into the tissues if they have certain structural defects. These can be diseases of congenital or acquired nature. Modified neutrophils occupy a marginal position in the vessels, and then go out of their bed. Therefore, this situation can develop with almost any infection.

Neutrophilia, which develops under the influence of several factors. At the same time, several mechanisms will be launched simultaneously, leading to an increase in the number of leukocyte cells.

Symptoms and signs of neutrophilia

Neutrophilia is not a disease, so it’s impossible to list its symptoms. They are determined by the violation that triggered a jump in neutrophils.

Therefore, if the following symptoms occur, you should consult a doctor and have a blood test taken:

Weakness and discomfort.

Pains of different localization.

Episodes of unconsciousness.

Increased sweating, not related to objective reasons.

A sharp deterioration in well-being.

Unexplained weight loss.

Bleeding from the digestive tract.

What can affect the test results?

Sometimes a doctor with an increase in the level of neutrophils in the blood recommends that the patient re-take a blood test. It is possible that the specialist has any doubts about the purity of the study. To eliminate the likelihood of diagnostic inaccuracy, you must follow these guidelines:

A blood test should be taken strictly on an empty stomach. The use of pure non-carbonated water is allowed.

Before taking a blood test, it is necessary to eliminate physical overwork and emotional overload.

It is important to avoid sudden changes in temperature, as this may trigger an increase in the level of neutrophils.

During pregnancy, neutrophils can be elevated, which is an indicator of the norm.

Treatment of neutrophilia

Neutrophilia is not an independent disease. It only indicates that something is wrong in the body. To begin treatment, it is necessary to find out the exact cause of neutrophilia. Therefore, the patient must undergo a comprehensive diagnosis.

When confirming infectious processes in the body, antiviral, antibacterial or antimycotic treatment is required (depending on the type of pathogen). To increase the body's resistance, immunostimulants can be prescribed. Corticosteroids are indicated when a patient has rheumatic lesions. Emotional neutrophilia requires the appointment of sedatives. In severe cases, conduct leukapheresis. This procedure allows you to clear the blood of excess leukocytes.

The level of neutrophils is the most important indicator of a patient’s health or illness. It must be taken into account when performing a blood test.

Education: Moscow Medical Institute. I. M. Sechenov, specialty - “Medicine” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.

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Neutrophilia

Neutrophilia (or neutrophil leukocytosis) is a pathological condition in which a person has a high content of neutrophilic granulocytes in the blood.

This pathological condition can occur in acute infectious diseases, purulent inflammatory processes, myocardial infarction, poisonous insect bites, after acute blood loss, as well as alimentary and emotional physiological leukocytosis. The definition is of practical importance. the degree of nuclear shift in the leukocyte formula.

According to this criterion, six types of neutrophilic leukocytosis are distinguished:

  1. without nuclear shift - an increase in the number of mature segmented neutrophils on the background of general leukocytosis,
  2. with hyporegenerative nuclear shift to the left - an increase in the content of the band-shaped forms of neutrophils (over 5%) against the background of neutrophilia, is characteristic of a mild course of a number of infections and inflammations,
  3. with a regenerative nuclear shift to the left, metamyelocytes are found on the background of neutrophilia and an increased content of band-nuclear forms, the total number of leukocytes, as a rule, is increased, characteristic of septic processes,
  4. with hyperregenerative nuclear left shift - characterized by the appearance in the hemogram of even younger forms of leukocytes (myelocytes and even individual promyelocytes and myeloblasts), while eosinophils are often absent (aneosinophilia). This picture is an alarming indicator indicating an unfavorable course of infectious and septic diseases,
  5. with a degenerative nuclear shift to the left - an increase in the content of stab neutrophils is accompanied by the appearance of a significant number of destructively modified segmented forms (pycnosis of nuclei, toxogenic granularity and vacuolization of the cytoplasm, etc.). A degenerative nuclear shift to the left is an indicator of inhibition of the functional activity of the bone marrow and may occur in severe cases of infectious diseases, endogenous intoxication, etc.,
  6. with a degenerative nuclear shift to the right - characterized by the appearance in the hemogram of hypersegmented (more than 5 segments) neutrophils, noted in radiation sickness, Addison-Birmer malignant anemia, but in some cases it can be found in practically healthy people.

Classification

Neutrophilic leukocytes themselves are of two main types: segmented (mature) and stab (young). The stab neutrophils normally make up from 1 to 5% of the total number of leukocytes, segmented neutrophils - from 35 to 65%. According to the ratio of young and mature cells, neutrophiliases with and without nuclear shift are isolated. Nuclear left shift implies an increase in the number of young forms of neutrophils and is divided into the following types:

  • Hyporegenerative. Slight increase in stab neutrophil leukocytes. The cause is infectious, inflammatory diseases with a mild course.
  • Regenerative. It is characterized by the appearance of metamyelocytes in the blood (intermediate forms between myeloblastic cells and granulocytes). It occurs during infections with moderate severity (typhoid fever, pneumonia).
  • Hyperregenerative. Severe hyperactivation of granulocyte bone marrow germ with impaired granulocyte maturation. The number of stab neutrophils, metamyelocytes, promyelocytes is sharply increased in the blood, sometimes myeloblasts are present. Possible aneosinophilia (complete absence of eosinophils). This form of neutrophilia is observed at the very beginning of purulent-inflammatory processes (sepsis, abscesses, phlegmons).
  • Degenerative. Along with the increased number of stab leukocytes in the blood, a large number of destructively modified segmented neutrophils (toxic granularity, pycnosis of nuclei) appear. It indicates the inhibition of the functional activity of the bone marrow. Characterized by the height of severe infections.

In neutrophilia with a nuclear shift to the right, the hemogram shows the absence of young forms of granulocytes and the appearance of hypersegmented (containing more than 5 segments) neutrophils. Neutrophilia without nuclear shift is accompanied by an increase in only segmented neutrophils. In relation to other types of leukocytes emit:

  • Relative neutrophilia. The increase in the percentage of neutrophils (in adults more than 75%, in children under 5 years old - more than 55%) in the leukocyte formula, the total number of leukocytes is normal.
  • Absolute neutrophilia. Increased neutrophil count while increasing white blood cell count.

Physiological causes

There is a so-called physiological neutrophilia, or pseudoneutrophilia.Its occurrence is not associated with increased production of neutrophils, but their redistribution, i.e. changing the ratio of the wall and circulating neutrophil pool towards the latter. Pseudoneutrophilia is observed during stress, intense physical exertion, exposure to heat or cold, after eating. Also, neutrophils are often increased during pregnancy in a newborn baby.

Infections in children

A child of preschool age (up to 5-6 years) due to a physiological decrease in the level of neutrophils due to leukocyte overlap there is an increased susceptibility to bacterial infections. In children, neutrophils increase mainly in scarlet fever, streptococcal angina. In the children's population, such a dangerous infection as diphtheria is quite common. Parasitic invasions (ascariasis, enterobiasis, toxocarosis) are also common among preschoolers. In these diseases, in addition to neutrophilia in the blood, there is a high eosinophilia.

Infections in adults

Most often, neutrophils are increased in bacterial infections. The main function of neutrophils - anti-infective protection of the microorganism, namely, the destruction of bacteria. They also take part in the fight against viruses, parasites. Migrating through the vascular wall, neutrophils are sent to the site of localization of the pathogenic microorganism. By secreting cytokines and inflammatory mediators, neutrophils activate other components of the immune system (complement, T-B lymphocytes).

Neutrophilic leukocytes first phagocytirut (absorb) an infectious agent, then secretes degradation enzymes (lysozyme, lactoferrin, phosphatases) and reactive oxygen species (superoxide anion, hydroxyl radical, hydrogen peroxide), which contributes to the death of microorganisms. Neutrophilia is rapidly increasing, reaching a maximum in parallel with the height of the disease, gradually decreasing after antibacterial therapy.

The most common cause of neutrophilia in adults is acute localized bacterial (pneumonia, sinusitis, pyelonephritis) or specific infections (typhoid fever). For them, moderate neutrophilia is typical. Less commonly, severe generalized infections (bacterial endocarditis, sepsis, meningococcal meningitis), characterized by high neutrophilia with hyperregenerative or degenerative changes, become the cause.

Acute Surgical Pathologies

Quite often, neutrophils are increased in acute abdominal pathology (cholecystitis, pancreatitis, perforation of gastric or duodenal ulcer), purulent processes (cellulitis, abscess). Neurophilia in a child is often found in appendicitis. The increase in the number of neutrophilic leukocytes in these diseases acts as a reaction to the inflammatory process. An exact correlation has been established between the severity of inflammation and the degree of neutrophil increase. High neutrophilia is usually observed with a degenerative shift of the leukocyte formula to the left, which quickly regresses after emergency surgery. However, neutrophils can remain in the normal range.

Damage or decay of tissue

These conditions include heart attacks of various organs (myocardium, lungs, intestines), abdominal surgery, gangrene, pancreatic necrosis. The cause of neutrophilia is stimulation by the decay products of granulocytopoiesis in the bone marrow. An additional role is played by reactive neutrophilia, resulting from the release into the blood of a large number of stress hormones (catecholamines, glucocorticosteroids).

Also, the occurrence of neutrophilia in these conditions contributes to the accession of a secondary infection (for example, pneumonia due to pulmonary infarction). The degree of neutrophilia correlates with the volume of damaged, necrotic tissue, often reaches very high values ​​(especially in a child), can persist for a long time, and decreases with recovery.

Rheumatological diseases

Neutrophilia can be observed in some chronic inflammatory pathologies of a rheumatic nature. There is an assumption that mediators, cytokines, autoantibodies, which are formed in the process of rheumatic inflammation, stimulate bone marrow production of neutrophilic granulocytes. The appearance of neutrophilia along with other laboratory markers, such as an increased erythrocyte sedimentation rate, C-reactive protein, usually indicates an exacerbation of the disease.

After anti-inflammatory treatment, the concentration of neutrophils gradually returns to normal. In adults, especially high neutrophilia is characteristic of acute gouty attack, necrotizing vasculitis (polyarteritis nodosa, granulomatosis with polyangiitis). A child has neutrophils increased most often with dermatomyositis.

  • Joint diseases: rheumatoid arthritis, ankylosing spondylitis (ankylosing spondylitis).
  • Diffuse connective tissue diseases (collagenosis): systemic lupus erythematosus, systemic scleroderma, Sjogren's disease.
  • Inflammatory bowel disease: Crohn's disease, ulcerative colitis.
  • Systemic vasculitis: nonspecific aortoarteritis Takayasu, Horton's giant cell arteritis.

Oncological diseases

Neutrophilia may sometimes indicate a malignant tumor. Two mechanisms contribute to its emergence - the disintegration of tumor tissue and the ability of some tumor cells to secrete granulocyte colony-stimulating growth factors (paraneoplastic syndrome). The most common neutrophilia occurs in patients with cancer of the breast, lung, colon, ovaries. Neutrophilia grows slowly, as the tumor grows, reaches moderate numbers, gradually regresses after chemotherapy, or quickly returns to normal after surgical removal of neoplasia.

Hematological diseases

High neutrophilia is observed in hematologic diseases. It can reach very high numbers (up to 100 thousand) in myeloproliferative diseases (acute, chronic myeloid leukemia). In lymphoproliferative pathologies (non-Hodgkin lymphomas, lymphosarcomas), neutrophilia is slightly less pronounced, almost always accompanied by absolute lymphocytosis. In a child, lymphogranulomatosis (Hodgkin's lymphoma) becomes the most common cause.

In addition to neutrophilia itself, in patients with acute leukemia in the blood there is a basophilic-eosinophilic association, a large number of blast cells and the absence of intermediate forms (leukemic failure). The mechanism of neutrophilic leukocytosis lies in the malignant transformation of the hematopoietic stem cell. Granulocyte counts return to normal only after several courses of chemotherapy or bone marrow transplantation.

Rare causes

  • Endocrine disorders: Cushing's disease or syndrome, thyrotoxic crisis.
  • Blood diseases: hemolytic anemia, polycythemia vera, malignant anemia of Addison-Birmer.
  • Endogenous intoxication: chronic renal failure, liver failure, diabetic ketoacidosis.
  • The phenomenon of bone marrow hyperactivity: after agranulocytosis, treatment of megaloblastic anemia.
  • Drug use: adrenaline, cardiac glycosides, glucocorticosteroids, lithium.
  • Intoxication with mercury, lead.
  • Exposure to ionizing radiation.

Diagnostics

Detection of neutrophilia requires differential diagnosis. For this you need to consult a general practitioner. In order to obtain primary information, anamnesis is being collected - how long the symptoms have appeared, whether there has recently been contact with infectious patients, whether there was an increase in body temperature, pain, skin rashes.

If there is a suspicion of acute surgical abdominal pathology, palpation of the abdomen is necessary for the presence of tension in the muscles of the anterior abdominal wall, the presence of a positive Shchetkin-Blumberg symptom. However, it is necessary to take into account that it is difficult to identify these signs in a child under 9 years of age. To confirm the diagnosis is assigned an additional examination, including:

  • Blood tests. The total number and percentage of all types of white blood cells is calculated. The concentration of erythrocytes, platelets, inflammatory markers (ESR, CRP) is measured. The morphology of granulocytes is studied (toxic granularity, karyopynosis). In the septic state, the level of presepsin and procalcitonin is determined. The presence of autoantibodies (antibodies to DNA, topoisomerase, anti-neutrophil) is checked.
  • Identification of the pathogen. Bacteriological culture, microscopy of sputum, urine, pharyngeal and tonsil smears are performed to identify the pathogenic microorganism. For the diagnosis of helminth infections, feces are analyzed for eggs of the worm, a blood test for specific immunoglobulins, and the child is scraped from the perianal folds.
  • Ultrasound. A sign of pyelonephritis on abdominal ultrasound is the expansion, compaction of the renal pelvis system, pancreatitis - an increase, diffuse changes in the pancreatic parenchyma, cholecystitis - thickening of the gallbladder walls, often the presence of stones.
  • X-ray. On chest radiographs for pneumonia, foci of infiltration and darkening are visible. In case of perforation, the ulcers in the pictures find the presence of free gas in the abdominal cavity ("sickle symptom"). With inflammatory diseases of the joints on the X-ray marked narrowing of the joint space, regional osteoporosis.
  • ECG. Electrocardiography in myocardial infarction reveals ST segment elevation, blockade of the left bundle of His, ventricular tachycardia, and other cardiac arrhythmias. When pulmonary embolism leads to pulmonary infarction, there are signs of overload of the right heart - a deep Q wave in III, a S wave in I lead, a high pointed P wave (P-pulmonale) in leads II, III, aVF.
  • Histological examination. The final diagnosis of cancer can only be based on a biopsy. The main feature of solid tumors is a large number of atypical cells. In leukemias in bone marrow biopsy, granulocyte germ hyperplasia, blast cells predominate, and diffuse proliferation of cells with blast morphology in lymph node tissues in lymphomas.

Conservative therapy

There are no direct ways to normalize the number of neutrophil granulocytes. To combat neutrophilia, it is necessary to treat the underlying disease, against which it has developed. Short-term neutrophilia after eating, stress or physical work does not require any intervention, since it is not a sign of the disease or pathological condition. Neutrophilia, resulting from surgery, also do not need to be treated. In the case of persistent neutrophilia, you should consult a doctor to determine the cause and purpose of differential treatment:

  • Antimicrobial (Antiparasitic) Therapy. Antibiotics (amoxicillin, cefixime) are used for bacterial infections. For generalized infections (sepsis, bacterial endocarditis), a combination of 2 antibacterial drugs should be used. When helminthic invasion in a child antihelminthic drugs (mebendazole) are prescribed.
  • Hemorheological therapy. For infarction of any localization caused by thrombosis or thromboembolism, antiplatelet (acetylsalicylic acid), anticoagulant (low molecular weight, unfractionated heparin), sometimes thrombolytic drugs (alteplase) are used.
  • Antisecretory and antienzyme therapy. In order to reduce the release of hydrochloric acid in peptic ulcer disease, proton pump inhibitors (omeprazole, pantoprazole), H2-blockers (famotidine, ranitidine) are used. Enzyme inhibitors (aprotinin) are effective in suppressing the destructive action of proteolytic enzymes in acute pancreatitis and pancreatic necrosis.
  • Anti-inflammatory treatment. To achieve remission of rheumatological diseases, drugs are prescribed to stop the inflammatory process. These include glucocorticosteroids (prednisolone), 5-aminosalicylic acid derivatives (sulfasalazine), immunosuppressants (cyclophosphamide, methotrexate).
  • Chemotherapy. For the treatment of malignant tumors, chemotherapeutic drugs are used (cytostatics, antimetabolites, hormone antagonists) in combination with radiotherapy. For oncohematological diseases, a combination of several anticancer agents is necessary.

Surgery

Many diseases associated with neutrophilia (mostly acute abdominal pathologies) require emergency surgery - laparoscopic appendectomy, laparotomy and suturing of the ulcer, cholecystectomy, opening and draining the abscess, etc. In myeloproliferative diseases, cases, the case, you can be in the same case, and you can be applied to the same cases when you have a case, and you can be in the same situation, and when you have the same time, you can be in the same situation, and you will be in the same situation, and when you have the same time, you can check, you will be in the case of myeloproliferative pathology, ulceration, opening and drainage of the abscess, etc.). cells.

Only one neutrophilia can not predict the prognosis. It all depends on the disease, which served as the background for the onset of neutrophilia. For example, a transient increase in the number of neutrophils after stress, food intake or in a child on the first day of life is absolutely benign, transient. And vice versa, severe purulent-septic pathologies, oncological diseases have a rather large frequency of lethal outcomes. Therefore, any excess of the reference values ​​of neutrophils (especially higher and persistent) requires an appeal to a doctor.

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