{"id":192,"date":"2025-06-11T11:44:21","date_gmt":"2025-06-11T11:44:21","guid":{"rendered":"https:\/\/analizesanocare.ro\/?post_type=product&#038;p=192"},"modified":"2025-08-08T13:58:14","modified_gmt":"2025-08-08T13:58:14","slug":"hemograma-cu-formula-leucocitara-cu-hb-ht-si-indici","status":"publish","type":"product","link":"https:\/\/analizesanocare.ro\/en\/analiz\u0103\/hemograma-cu-formula-leucocitara-cu-hb-ht-si-indici\/","title":{"rendered":"Hemogram\u0103 cu formul\u0103 leucocitar\u0103 cu Hb, Ht \u0219i indici"},"content":{"rendered":"<div class=\"info-content content-informatii-generale\">\n<h2><strong>Informa\u021bii generale Hemogram\u0103 cu formul\u0103 leucocitar\u0103 cu Hb, Ht \u0219i indici<\/strong><\/h2>\n<p><strong>Hemograma<\/strong> const\u0103 din m\u0103surarea urm\u0103torilor parametrii:<\/p>\n<ul>\n<li>num\u0103r de leucocite;<\/li>\n<li>num\u0103r de eritrocite;<\/li>\n<li>concentra\u0163ia de hemoglobin\u0103;<\/li>\n<li>hematocrit;<\/li>\n<li>indici eritrocitari: volumul eritrocitar mediu (VEM), hemoglobina eritrocitar\u0103 medie (HEM), concentra\u0163ia medie de hemoglobin\u0103 (CHEM) \u015fi l\u0103rgimea distribu\u0163iei eritrocitare (RDW);<\/li>\n<li>num\u0103r de trombocite \u015fi indici trombocitari: volumul trombocitar mediu (VTM) si l\u0103rgimea distribu\u0163iei trombocitare (PDW);<\/li>\n<li>formula leucocitar\u0103.<\/li>\n<\/ul>\n<p>Hemograma este un test screening de baz\u0103, fiind unul din cele mai frecvent cerute teste de laborator, reprezent\u00e2nd adesea primul pas\u00a0\u00een stabilirea statusului hematologic\u00a0\u015fi diagnosticul diverselor afec\u0163iuni hematologice \u015fi nehematologice. Cuantificarea parametrilor hematologici, asociat\u0103 uneori cu examinarea frotiului de s\u00e2nge, aduce informa\u0163ii pre\u0163ioase, orient\u00e2nd\u00a0\u00een continuare spre efectuarea altor teste specifice<sup>9<\/sup>.<\/p>\n<h2><strong>Preg\u0103tire pacient<\/strong><\/h2>\n<p>Hemograma se poate recolta \u00e0 jeun (pe nem\u00e2ncate) sau postprandial (trebuie totu\u015fi evitate mesele bogate \u00een lipide care pot interfera cu anumi\u0163i parametrii ai hemogramei).<\/p>\n<p>Sexul, v\u00e2rsta pacientului, precum \u015fi anumite condi\u0163ii cum ar fi: starea de \u015foc, v\u0103rs\u0103turi incoercibile, administrarea masiv\u0103 de lichide i.v. etc., care pot duce la <a href=\"https:\/\/www.synevo.ro\/totul-despre-deshidratare\/\" data-wpel-link=\"internal\">deshidratarea<\/a>, respectiv hiperhidratarea pacientului, precum \u015fi anumite tratamente urmate de pacient trebuie comunicate laboratorului.<\/p>\n<p>Este de preferat evitarea pe c\u00e2t posibil a stresului \u00een momentul recolt\u0103rii.<\/p>\n<p>In cazul monitoriz\u0103rii regulate (zilnic sau la dou\u0103 zile) a anumitor parametri, proba de s\u00e2nge pentru efectuarea hemogramei trebuie ob\u0163inut\u0103\u00a0\u00een acela\u015fi moment al zilei (datorita fluctua\u0163iilor fiziologice circadiene ale unor parametrii) <sup>4;6;9;19<\/sup>.<\/p>\n<p><strong>Specimen recoltat, recipient \u015fi cantitate recoltat\u0103<\/strong> \u2013 s\u00e2nge venos recoltat pe anticoagulant: EDTA tripotassium\/dipotasium\/disodium (vacutainer cu capac mov\/roz \u2013 K3 EDTA);<\/p>\n<p>la copii mici se poate recolta s\u00e2nge capilar din deget\/c\u0103lc\u00e2i pe heparina (microtainer).<\/p>\n<p>Se amestec\u0103 con\u0163inutul prin inversiunea u\u015foar\u0103 a tubului de cca. 10 ori.<\/p>\n<p>Tubul trebuie s\u0103 fie umplut cel pu\u0163in trei sferturi pentru ca raportul s\u00e2nge\/anticoagulant s\u0103 fie optim (concentra\u0163ia recomandat\u0103 de EDTA este de 1.2 \u2013 2.0 mg\/mL de s\u00e2nge) <sup>4;6;9;19<\/sup>.<\/p>\n<p><strong>Cauze de respingere a probei<\/strong><\/p>\n<ul>\n<li>tub incorect;<\/li>\n<li>specimen coagulat;<\/li>\n<li>specimen hemolizat;<\/li>\n<li>cantitate insuficient\u0103<sup>9<\/sup>.<\/li>\n<\/ul>\n<p><strong>Prelucrare necesar\u0103 dup\u0103 recoltare<\/strong> \u2013 dac\u0103 proba nu este trimis\u0103 imediat la laborator trebuie refrigerat\u0103<sup>9<\/sup>.<\/p>\n<p><strong>Stabilitate prob\u0103 <\/strong>\u2013\u00a024 ore la 18-26 \u00b0C sau la 2-8 \u00b0C<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 analizor automat pe principiul citometriei\u00a0\u00een flux cu fluorescent\u0103 utiliz\u00e2nd LASER semiconductor \u015fi focusare hidrodinamic\u0103<sup>9<\/sup>.<\/p>\n<h3><strong>\u00a0<\/strong><strong>NUMARUL DE ERITROCITE (NUMARUL DE CELULE ROSII)\u00a0 <\/strong><\/h3>\n<p>Num\u0103rul de eritrocite reprezint\u0103 testul de baz\u0103 pentru evaluarea eritropoiezei. Eritrocitele sunt investigate\u00a0\u00een continuare prin m\u0103surarea concentra\u0163iei de hemoglobin\u0103 \u015fi a hematocritului, iar pe baza lor analizorul calculeaz\u0103 indicii eritrocitari: VEM, HEM, CHEM si RDW, care caracterizeaza din punct de vedere calitativ popula\u0163ia eritrocitar\u0103.<\/p>\n<p>Eritrocitele sunt cele mai numeroase celule din s\u00e2nge, sunt anucleate, fiind necesare pentru respira\u0163ia tisulara. Eritrocitele sunt cele mai specializate celule ale organismului, principala func\u0163ie const\u00e2nd\u00a0\u00een transportul 0<sub>2<\/sub> de la pl\u0103m\u00e2n la \u0163esuturi \u015fi transferul CO<sub>2<\/sub> de la \u0163esuturi la pl\u0103m\u00e2n. Acest lucru se realizeaz\u0103 prin intermediul hemoglobinei con\u0163inute \u00een eritrocite. Forma eritrocitelor de disc biconcav confer\u0103 raportul volum\/suprafa\u0163\u0103 optim pentru schimbul de gaze \u015fi le asigur\u0103 acestora deformabilitatea \u00een timpul travers\u0103rii microcircula\u0163iei.<\/p>\n<p><strong>Indica\u0163ii<\/strong> \u2013 \u00een combina\u0163ie cu hematocritul \u015fi concentra\u0163ia de hemoglobin\u0103, num\u0103rul de eritrocite este util \u00een detectarea \u015fi monitorizarea <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemiei<\/a> \u015fi eritrocitozei\/policitemiei.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 eritrocitele sunt num\u0103rate de analizorul automat\u00a0\u00een timpul trecerii acestora printr-un orificiu prin care sunt dirijate \u00eentr-un singur r\u00e2nd prin metoda de focusare hidrodinamic\u0103<sup>4;6-8;9;14;16;19<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 valori diferite\u00a0\u00een func\u0163ie de v\u00e2rst\u0103 \u015fi sex (vezi anexa 7.1.1); se exprim\u0103 \u00een num\u0103r de eritrocite x10<sup>6<\/sup>\/\u03bcL (mm<sup>3<\/sup>) sau num\u0103r de eritrocite x10<sup>12<\/sup>\/L<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>Num\u0103rul de eritrocite ca singur parametru are valoare diagnostic\u0103 mic\u0103; o evaluare corect\u0103 a masei de eritrocite a organismului poate fi ob\u0163inut\u0103 doar\u00a0\u00een corela\u0163ie cu hematocritul. Num\u0103rul de eritrocite este influen\u0163at de modific\u0103rile volumului plasmatic, ca de exemplu\u00a0\u00een sarcin\u0103 sau\u00a0\u00een tulbur\u0103ri ale echilibrului hidro-electrolitic<sup>4;6;14<\/sup>.<\/p>\n<p>1. Sc\u0103derea num\u0103rului de eritrocite: determin\u0103 <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemie<\/a>. <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">Anemia<\/a> este definit\u0103 din punct de vedere func\u0163ional printr-o mas\u0103 eritrocitar\u0103 insuficient\u0103 pentru asigurarea unei cantit\u0103\u0163i adecvate de oxigen \u0163esuturilor periferice. In practic\u0103, se consider\u0103 <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemie<\/a> atunci c\u00e2nd concentra\u0163ia de hemoglobin\u0103, hematocritul \u015fi\/sau num\u0103rul de eritrocite sunt sub valorile de referin\u0163\u0103<sup>7<\/sup>. Diagnosticul este dificil dac\u0103 doar unul din parametrii este sub valorile limit\u0103; \u00een acest caz hemograma trebuie monitorizat\u0103 \u00een continuare pentru stabilirea unui diagnostic corect.<\/p>\n<p>In <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemia<\/a> acut\u0103 datorat\u0103 hemoragiei, num\u0103rul de eritrocite \u015fi concentra\u0163ia de hemoglobin\u0103 r\u0103m\u00e2n nemodificate \u00een primele ore datorit\u0103 pierderii concomitente de plasm\u0103; ele \u00eencep s\u0103 scad\u0103 pe m\u0103sur\u0103 ce se produce corec\u0163ia deficitului volemic.<\/p>\n<p>In <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemiile<\/a> cronice volumul sanguin este aproape normal prin cre\u015fterea compensatorie a volumului plasmatic, iar num\u0103rul de eritrocite \u015fi hematocritul sunt de obicei sc\u0103zute. Totu\u015fi, \u00een condi\u0163iile asociate cu microcitoza marcat\u0103 (anemie feripriv\u0103 sever\u0103, talasemie), num\u0103rul de eritrocite poate r\u0103m\u00e2ne \u00een limite normale sau poate fi chiar crescut.<\/p>\n<p><a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">Anemia<\/a> relativ\u0103 este o condi\u0163ie caracterizat\u0103 prin masa normal\u0103 de eritrocite, dar cu volum sanguin crescut prin cre\u015fterea volumului plasmatic, ca de exemplu\u00a0\u00een sarcin\u0103, splenomegalie masiv\u0103. In aceast\u0103 situa\u0163ie proteinele totale plasmatice sunt la limita inferioar\u0103 a normalului, spre deosebire de anemia cronic\u0103\u00a0\u00een care proteinele totale sunt\u00a0\u00een limite normale<sup>19<\/sup>.<\/p>\n<p>Pentru a identifica cauza <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemiei<\/a>, informa\u0163iile privind istoricul bolii \u015fi examinarea fizic\u0103 trebuie integrate cu c\u00e2teva teste de laborator cheie, cum ar fi <a href=\"https:\/\/www.synevo.ro\/shop\/hemograma-cu-formula-leucocitara-hbhtindici-si-reticulocite-hemoleucograma\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">determinarea num\u0103rului de reticulocite<\/a>, indicilor eritrocitari, examinarea frotiului de s\u00e2nge colorat \u015fi eventual a m\u0103duvei osoase. Prezen\u0163a altor anomalii hematologice (trombocitopenie, anomalii ale leucocitelor) orienteaz\u0103 diagnosticul spre o posibil\u0103 insuficien\u0163\u0103 medular\u0103 datorat\u0103 <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemiei<\/a> aplastice, unei boli hematologice maligne sau disloc\u0103rii m\u0103duvei osoase prin procese patologice de cauza extrahematologic\u0103. Pancitopenia poate ap\u0103rea \u015fi ca urmare a distruc\u0163iei periferice sau sechestr\u0103rii celulare prin hipersplenism.<\/p>\n<p>2. Cre\u015fterea num\u0103rului de eritrocite (concentra\u0163iei de hemoglobin\u0103 \u015fi\/sau hematocritului) determin\u0103 eritrocitoza. Eritrocitoza poate fi rezultatul cre\u015fterii masei eritrocitare totale (policitemie\/eritrocitoza absolut\u0103) ori poate fi consecin\u0163a reducerii volumului plasmatic (eritrocitoza relativ\u0103\/fals\u0103)<sup>14<\/sup>.<\/p>\n<p>Clasificarea eritrocitozei<sup>14<\/sup><\/p>\n<p>A. Eritrocitoza\/policitemie relativ\u0103 (peudoeritrocitoza): hemoconcentra\u0163ie; sindromul Gaisb\u0151ck.<\/p>\n<p>B. Policitemie (eritrocitoza absolut\u0103)<\/p>\n<ol>\n<li>Policitemie primar\u0103: policitemia vera; policitemia primar\u0103 familial\u0103.<\/li>\n<li>Policitemie secundar\u0103:<\/li>\n<\/ol>\n<ul>\n<li>Secundar\u0103 sc\u0103derii oxigen\u0103rii tisulare (eritrocitoza fiziologic\u0103\/hipoxic\u0103):\n<ul>\n<li>eritrocitoza de altitudine;<\/li>\n<li>boli pulmonare: cord pulmonar cronic; hipertensiune pulmonar\u0103 primar\u0103;<\/li>\n<li>boli congenitale de cord cianogene;<\/li>\n<li>sindroame de hipoventilatie: hipoventilatie alveolar\u0103 primar\u0103; sindromul Pickwick; apneea de somn;<\/li>\n<li>hemoglobine anormale: ereditare\/dob\u00e2ndite (medicamente, substan\u0163e chimice, fumat: carboxihemoglobina);<\/li>\n<li>policitemia familial\u0103.<\/li>\n<\/ul>\n<\/li>\n<li>Secundar\u0103 produc\u0163iei aberante de eritropoietina (eritrocitoza nefiziologic\u0103):\n<ul>\n<li>boli renale: carcinomul renal \u015fi alte tumori renale; rinichiul polichistic; rinichiul \u00een potcoav\u0103; hidronefroza; stenoz\u0103 de arter\u0103 renal\u0103;<\/li>\n<li>carcinomul hepatocelular \u015fi alte tumori hepatice;<\/li>\n<li>tumori vasculare cerebeloase;<\/li>\n<li>leiomiomul \u015fi tumori fibroide uterine;<\/li>\n<li>boli endocrine: sindrom Cushing, hiperaldosteronism primar, tumori ovariene virilizante, sindrom Barter, feocromocitom;<\/li>\n<li>medicamente: androgeni, abuz de eritropoietin\u0103;<\/li>\n<li>policitemia familial\u0103.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>3. Policitemie idiopatic\u0103.<\/p>\n<p><strong>Interferen\u0163e<\/strong> <sup>4;6;8;16;19<\/sup><\/p>\n<p>1. Recoltarea cu pacientul \u00een pozi\u0163ie culcat\u0103 determin\u0103 sc\u0103derea num\u0103rului de eritrocite (\u015fi hematocritului) cu 5 \u2013 10% (prin redistribuirea lichidului din spa\u0163iul intersti\u0163ial spre circula\u0163ie datorit\u0103 modific\u0103rii presiunii hidrostatice la nivelul membrelor inferioare).<\/p>\n<p>2. Stresul poate determina cre\u015fterea num\u0103rului de eritrocite.<\/p>\n<p>3. Staza venoas\u0103 prelungit\u0103 &gt;2 minute \u00een timpul venopunc\u0163iei determin\u0103 cre\u015fterea num\u0103rului de eritrocite cu ~10% (si cre\u015fterea semnificativ\u0103 a hematocritului). De asemenea, recoltarea dup\u0103 efort fizic intens determin\u0103 cre\u015fterea num\u0103rului de eritrocite cu p\u00e2n\u0103 la 10% (ca \u015fi cre\u015fterea concentra\u0163iei de hemoglobin\u0103). Toate acestea se datoreaz\u0103 hemoconcentra\u0163iei.<\/p>\n<p>4. Deshidratarea cu hemoconcentra\u0163ie consecutiv\u0103 (\u015foc, arsuri severe, obstruc\u0163ie intestinal\u0103, v\u0103rs\u0103turi\/diaree persistente, abuz de diuretice) poate masca prezen\u0163a <a href=\"https:\/\/www.synevo.ro\/ce-este-si-ce-se-ascunde-in-spatele-unei-anemii\/\" target=\"_blank\" rel=\"noopener\" data-wpel-link=\"internal\">anemiei<\/a>. De asemenea, hiperhidratarea pacientului (administrarea masiv\u0103 de lichide i.v.) poate determina niveluri fals sc\u0103zute ale num\u0103rului de eritrocite.<\/p>\n<p>5. Prezen\u0163a aglutininelor la rece \u00een titru mare determin\u0103, dac\u0103 s\u00e2ngele este p\u0103strat la temperatura camerei, niveluri fals sc\u0103zute ale num\u0103rului de eritrocite \u015fi un VEM fals crescut; \u00een consecin\u0163\u0103 hematocritul este fals sc\u0103zut, iar HEM \u015fi CHEM sunt crescute.<\/p>\n<p>6. Prezen\u0163a de crioglobuline \u00een concentra\u0163ie mare poate interfera cu determinarea num\u0103rului de eritrocite.<\/p>\n<p>7. Trombocitele mari\/macrotrombocitele (ex.: din trombocitemia esen\u0163ial\u0103) pot fi num\u0103rate ca eritrocite.<\/p>\n<p>8. Numeroase medicamente pot determina cre\u015fterea sau sc\u0103derea num\u0103rului de eritrocite:<\/p>\n<ul>\n<li>pot sc\u0103dea num\u0103rul de eritrocite aproape toate clasele de medicamente;<\/li>\n<li>pot determina cre\u015fteri ale num\u0103rului de eritrocite: corticotropina, glucocorticoizii, danazolul, eritropoietina, antitiroidienele, hidroclorotiazida, pilocarpina, mycophenolatul<sup>6<\/sup>.<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><\/p>\n<h3><strong>HEMATOCRITUL (VOLUMUL PACHETULUI DE CELULE)<\/strong><\/h3>\n<p>Hematocritul m\u0103soar\u0103 raportul dintre volumul ocupat de eritrocite \u015fi volumul sanguin total.<\/p>\n<p><strong>Indica\u0163ii<\/strong> \u2013 detectarea \u015fi monitorizarea anemiei \u015fi policitemiei.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 analizorul automat calculeaz\u0103 hematocritul prin determinarea num\u0103rului de eritrocite\/L de s\u00e2nge \u015fi m\u0103surarea amplitudinii impulsurilor\u00a0\u00een eritrocite prin metoda luminii dispersate<sup>9<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 diferite \u00een func\u0163ie de v\u00e2rst\u0103 \u015fi sex (vezi anexa 7.1.1). Hematocritul se exprim\u0103 ca frac\u0163ie decimal\u0103\/ca procent<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>Hematocritul depinde de masa eritrocitar\u0103, volumul eritrocitar mediu \u015fi volumul plasmatic.<\/p>\n<p>De obicei, atunci c\u00e2nd hematiile sunt de m\u0103rime normal\u0103, modific\u0103rile hematocritului le urmeaz\u0103 pe cele ale num\u0103rului de eritrocite. Totu\u015fi\u00a0\u00een anemia micro-\/macrocitar\u0103 rela\u0163ia poate s\u0103 nu se p\u0103streze. De exemplu,\u00a0\u00een talasemie hematocritul scade deoarece hematiile microcitare ocup\u0103 un volum mai mic,\u00a0\u00een timp ce num\u0103rul de eritrocite poate fi normal\/crescut<sup>8;16<\/sup>.<\/p>\n<p>1.Sc\u0103derea hematocritului:<\/p>\n<p>\u2013 anemie; la un Hct &lt;30% (0.30) un pacient este moderat \u2013 sever anemic;<\/p>\n<p>\u2013 cre\u015fterea volumului plasmatic (sarcin\u0103).<\/p>\n<p>2. Cre\u015fterea hematocritului:<\/p>\n<p>\u2013 eritrocitoz\u0103\/policitemie;<\/p>\n<p>\u2013 hemoconcentra\u0163ie (ex.: \u015foc; aport insuficient de lichide: copii mici, v\u00e2rstnici; poliurie etc.)<sup>8<\/sup>.<\/p>\n<p><strong>Valori critice<\/strong>\u00a0\u00a0 \u2013\u00a0<strong>Hct &lt; 20%<\/strong> poate determina insuficien\u0163\u0103 cardiac\u0103 \u015fi deces;<\/p>\n<p>\u2013 <strong>Hct &gt; 60%<\/strong> se asociaz\u0103 cu coagularea spontan\u0103 a s\u00e2ngelui<sup>6<\/sup>.<\/p>\n<p><strong>Interferen\u0163e <\/strong><\/p>\n<p>1. Excesul de anticoagulant (cantitate insuficient\u0103 de s\u00e2nge) determin\u0103 sc\u0103derea volumului eritrocitar \u015fi \u00een consecin\u0163\u0103 sc\u0103derea Hct determinat manual (efect mai pronun\u0163at pentru K3-EDTA dec\u00e2t pentru K2-EDTA).<\/p>\n<p>2. In s\u00e2ngele arterial Hct este cu ~2% mai mare dec\u00e2t \u00een s\u00e2ngele venos.<\/p>\n<p>3. In reticulocitoz\u0103, leucocitoza marcat\u0103, prezen\u0163a de crioglobuline sau macrotrombocite analizorul automat poate determina valori fals crescute ale Hct (volumele mai mari ale reticulocitelor \u015fi leucocitelor intr\u0103 \u00een calculul Hct).<\/p>\n<p>4. Valori fals sc\u0103zute ale Hct pot ap\u0103rea \u00een cazuri de hemoliz\u0103 in vitro, autoaglutinare, microcitoza<sup>4;6;8;16;1<\/sup><sup>9<\/sup>.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h3><strong>HEMOGLOBINA <\/strong><\/h3>\n<p>Hemoglobina reprezint\u0103 componentul principal al eritrocitelor (95% din proteinele citoplasmatice eritrocitare) \u015fi serve\u015fte ca vehicul pentru transportul O<sub>2<\/sub> \u015fi CO<sub>2<\/sub>. Hemoglobina este o protein\u0103 conjugat\u0103 const\u00e2nd dintr-un tetramer format din 2 perechi de lan\u0163uri polipeptidice (globine), fiecare dintre acestea fiind conjugat cu un grup hem, un complex al unui ion de fier cu pigmentul ro\u015fu, porfirina, care confer\u0103 s\u00e2ngelui culoarea ro\u015fie. Fiecare gram de hemoglobin\u0103 poate transporta 1.34 mL O<sub>2<\/sub> per 100 mL de s\u00e2nge.<\/p>\n<p>Hemoglobina serve\u015fte de asemenea ca tampon\u00a0\u00een lichidul extracelular. In \u0163esuturi, la pH sc\u0103zut, O<sub>2<\/sub> se disociaz\u0103 de Hb; Hb deoxigenat\u0103 se leag\u0103 de ionii de hidrogen; \u00een eritrocite anhidraza carbonic\u0103 converte\u015fte CO<sub>2<\/sub> \u00een bicarbonat \u015fi ioni de hidrogen. Pe m\u0103sura ce ionii de hidrogen se leag\u0103 de hemoglobin\u0103, ionii bicarbonat p\u0103r\u0103sesc celula; pentru fiecare ion bicarbonat care p\u0103r\u0103se\u015fte celula intr\u0103 un ion de clor<sup>6<\/sup>.<\/p>\n<p>Formele de hemoglobin\u0103 prezente\u00a0\u00een mod normal\u00a0\u00een circula\u0163ie includ: deoxihemoglobina (HHb), oxihemoglobina (O<sub>2<\/sub>Hb), carboxihemoglobina (COHb) \u015fi methemoglobina (MetHb), toate acestea fiind determinate \u00eempreun\u0103\u00a0\u00een s\u00e2ngele total. In anumite situa\u0163ii clinice diferitele forme de Hb pot fi determinate individual<sup>19<\/sup>.<\/p>\n<p><strong>Indica\u0163ii <\/strong>\u2013 \u00eempreun\u0103 cu Hct \u015fi num\u0103rul de eritrocite, este util\u0103 pentru detectarea \u015fi monitorizarea anemiei \u015fi policitemiei.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 Hb este determinat\u0103 automat prin metoda fotometric\u0103 \u00een urma conversiei\u00a0\u00een SLS-Hb cu ajutorul unui surfactant Sodium Lauryl Sulfate<sup>9<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 diferite \u00een func\u0163ie de v\u00e2rst\u0103 \u015fi sex (vezi anexa 7.1.1). Hb se exprim\u0103 \u00een g\/L sau g\/dL. In cazul exprimarii ca \u015fi concentra\u0163ie \u00een mmol\/L se utilizeaz\u0103 urm\u0103torii factori de conversie<sup>19<\/sup>:<\/p>\n<p>mmol\/L = g\/L x 0.0621<\/p>\n<p>mmol\/L = g\/dL x 0.621<\/p>\n<p>g\/dL = mmol\/L x 1.61<\/p>\n<p>g\/L = mmol\/L x 16.1<\/p>\n<p>Num\u0103rul de eritrocite, Hb \u015fi Hct pot fi analizate aplic\u00e2nd \u201cregula lui trei\u201d<sup>4<\/sup>: dac\u0103 eritrocitele sunt normocitare\/normocrome: nr. Er x3 ~ valoarea Hb.<\/p>\n<p>Hematocritul poate fi estimat din hemoglobin\u0103 utiliz\u00e2nd urm\u0103toarea formula:<\/p>\n<p>Hct = Hb (g\/dL) x 2.8 + 0.8 sau Hct = Hb x 3<\/p>\n<p>Dac\u0103 exist\u0103 o deviere semnificativ\u0103 de la aceast\u0103 regul\u0103 trebuie verificat\u0103 existen\u0163a de anomalii ale indicilor eritrocitari \u015fi aspectul frotiului de s\u00e2nge<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Sc\u0103derea hemoglobinei sub nivelurile de referin\u0163\u0103 determin\u0103 apari\u0163ia anemiei. Hb trebuie evaluat\u0103 \u00eempreun\u0103 cu Hct, num\u0103rul de eritrocite, indicii eritrocitari \u015fi morfologia celular\u0103 pe frotiu pentru clasificarea anemiei. O valoare normal\u0103 a concentra\u0163iei de Hb nu exclude anemia datorat\u0103 hemoragiei acute.<\/p>\n<p>In sarcin\u0103 concentra\u0163ia de hemoglobin\u0103 scade cu 2\u20133 g\/dL datorit\u0103 unei cre\u015fteri dispropor\u0163ionate a volumului plasmatic fa\u0163\u0103 de masa eritrocitar\u0103<sup>1<\/sup><sup>9<\/sup>.<\/p>\n<p>La nou-n\u0103scut masa eritrocitar\u0103 este mai mare la na\u015ftere dec\u00e2t la adult \u015fi scade continuu \u00een prima s\u0103pt\u0103m\u00e2n\u0103 de via\u0163\u0103, Hb put\u00e2nd ajunge p\u00e2n\u0103 la 9 g\/dL \u00een s\u0103pt\u0103m\u00e2nile 11\u201312 de via\u0163\u0103 (anemie fiziologic\u0103). Sc\u0103derea apare mai precoce \u015fi este mai pronun\u0163at\u0103 la prematuri. Nivelurile de la adult sunt atinse \u00een jurul v\u00e2rstei de 14 ani; la v\u00e2rstnici apare o sc\u0103dere gradual\u0103 a concentra\u0163iei de hemoglobin\u0103.<\/p>\n<p>2. Cre\u015fterea hemoglobinei apare \u00een eritrocitoza\/policitemie. Dup\u0103 convie\u0163uirea un timp \u00eendelungat la altitudine survine o cre\u015ftere a Hb corespunz\u0103toare la 1 g\/dL pentru 2000 m.<\/p>\n<p><strong>Valori critice<\/strong>\u00a0 \u2013 la <strong>Hb &lt;5g\/dL<\/strong> apare insuficien\u0163a cardiac\u0103 \u015fi poate surveni decesul;<\/p>\n<p>\u2013 o concentra\u0163ie de <strong>Hb &gt;20 g\/dL<\/strong> poate duce la blocarea capilarelor ca urmare a hemoconcentra\u0163iei<sup>6<\/sup>.<\/p>\n<p><strong>Interferen\u0163e<\/strong><\/p>\n<p>1. Turbiditatea serului datorat\u0103 hiperlipemiei (hipertrigliceridemiei), leucocitozei &gt;50000\/\u03bcL, trombocitozei &gt;700000\/\u03bcL sau hiperproteinemiei determin\u0103 valori fals crescute ale hemoglobinei.<\/p>\n<p>2. Prezen\u0163a de crioglobuline \u00een concentra\u0163ie mare poate afecta determinarea Hb (prin fenomenul de floculare).<\/p>\n<p>3. Efortul fizic intens poate determina cre\u015fterea Hb.<\/p>\n<p>4. Interferen\u0163e medicamentoase<sup>6<\/sup><\/p>\n<p>\u2013 numeroase medicamente pot sc\u0103dea Hb;<\/p>\n<p>\u2013 pot cre\u015fte Hb: gentamicina, methyldopa<sup>4;6;8;16;19<\/sup>.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h3><strong>INDICII ERITROCITARI <\/strong><\/h3>\n<p>Evaluarea eritrocitelor din punct de vedere al volumului \u015fi con\u0163inutului in hemoglobin\u0103 se realizeaz\u0103 prin m\u0103surarea sau calcularea urm\u0103torilor parametri:<\/p>\n<p><strong>Volumul eritrocitar mediu <\/strong>(VEM) \u2013 reprezint\u0103 volumul ocupat de un singur eritrocit.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 VEM este calculat dup\u0103 urm\u0103toarea formul\u0103:<\/p>\n<p>Hct (%) x 10<\/p>\n<p>VEM =\u00a0\u00a0\u00a0 \u2014\u2014\u2014\u2014\u2014\u2014\u2013<\/p>\n<p>Nr.Er.(x10<sup>6<\/sup>\/\u03bcL)<\/p>\n<p>Prin metoda automat\u0103, VEM este determinat prin imp\u0103r\u0163irea sumei volumelor eritrocitare la num\u0103rul de eritrocite<sup>9<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103 <\/strong>\u2013 VEM se exprim\u0103 in micrometri cubi sau femtolitri (fL). La adult este cuprins intre 80\u2013100 fL (valori mai mari la nou-n\u0103scu\u0163i, precum \u015fi la varstnici; valori mai mici la copii pan\u0103 la 18 ani \u2013 vezi anexa 7.1.1)<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>VEM este un indice util pentru clasificarea anemiilor \u015fi poate sugera mecanismul fiziopatologic al afect\u0103rii eritrocitare. Impreun\u0103 cu ceilal\u0163i indici eritrocitari, poate permite detectarea precoce a unor procese care vor cauza anemie. VEM depinde de osmolaritatea plasmatic\u0103 \u015fi num\u0103rul diviziunilor eritrocitare.<\/p>\n<p>1. VEM normal: anemie normocitar\u0103 (dac\u0103 se asociaz\u0103 cu RDW &lt;15).<\/p>\n<p><strong>Clasificarea anemiilor normocitare <\/strong><\/p>\n<p><strong>\u00a0<\/strong>I. Anemie asociat\u0103 cu r\u0103spuns eritropoietic adecvat:<\/p>\n<ul>\n<li>Anemie posthemoragic\u0103.<\/li>\n<li>Anemie hemolitic\u0103 (poate fi \u015fi usor macrocitar\u0103).<\/li>\n<\/ul>\n<p>II. Anemie asociat\u0103 cu secre\u0163ie sc\u0103zut\u0103 de eritropoietina:<\/p>\n<ul>\n<li>Afectarea sursei de eritropoietina:\n<ul>\n<li>Renal\u0103: anemia din insuficien\u0163\u0103 renal\u0103.<\/li>\n<li>Hepatic\u0103: anemia din bolile hepatice.<\/li>\n<\/ul>\n<\/li>\n<li>Reducerea stimulului (sc\u0103derea nevoilor tisulare de oxigen):\n<ul>\n<li>Anemia din insuficien\u0163ele endocrine.<\/li>\n<\/ul>\n<\/li>\n<li><a href=\"https:\/\/www.synevo.ro\/malnutritia-analize-evaluarea-nutrientilor\/\" data-wpel-link=\"internal\">Malnutri\u0163ia<\/a> protein-caloric\u0103.<\/li>\n<li>Anemia din bolile cronice (poate fi \u015fi microcitar\u0103)<sup>7<\/sup>.<\/li>\n<\/ul>\n<p>III. Anemie asociat\u0103 cu r\u0103spuns medular inadecvat:<\/p>\n<ul>\n<li>Aplazia eritroid\u0103 pur\u0103, anemia aplastic\u0103 (pancitopenie).<\/li>\n<li>Boli medulare infiltrative: primare hematologice sau secundare (anemia mieloftizic\u0103).<\/li>\n<li>Anemii mielodisplazice.<\/li>\n<li>Anemii diseritropoietice (anemia diseritropoietic\u0103 congenital\u0103 tip II).<\/li>\n<li>Deficit de fier precoce.<\/li>\n<\/ul>\n<p>2. VEM sc\u0103zut (&lt;80 fL): anemie microcitar\u0103. Majoritatea anemiilor microcitare se datoreaz\u0103 sintezei deficitare de hemoglobin\u0103, adesea asociat\u0103 cu deficitul de fier sau cu alterarea utiliz\u0103rii fierului, precum \u015fi cu unele condi\u0163ii ereditare. Datorit\u0103 acestei deficien\u0163e precursorii eritroizi parcurg mai multe diviziuni dec\u00e2t in mod normal, duc\u00e2nd la formarea de eritrocite mature de dimensiuni mai mici. RDW este &gt;15<sup>7;19<\/sup>.<\/p>\n<p><strong>Clasificarea anemiilor microcitare<\/strong><\/p>\n<p>I. Afec\u0163iuni ale metabolismului fierului:<\/p>\n<ul>\n<li>Anemia feripriv\u0103.<\/li>\n<li>Anemia din bolile cornice.<\/li>\n<li>Atransferinemia congenital\u0103.<\/li>\n<li>Anemia microcitar\u0103 hipocrom\u0103 congenital\u0103 cu supra\u00eenc\u0103rcare cu fier (sindromul Shahidi-Nathan-Diamond).<\/li>\n<\/ul>\n<p>II. Boli ale sintezei moleculelor de globin\u0103:<\/p>\n<ul>\n<li>Alfa- \u015fi beta- talasemia.<\/li>\n<li>Sindroamele de hemoglobin\u0103 E (AE, EE, E-beta-talasemia).<\/li>\n<li>Sindroamele de hemoglobin\u0103 C (AC, CC).<\/li>\n<li>Hemoglobinele instabile.<\/li>\n<\/ul>\n<p>III. Boli ale sintezei de hem \u015fi porfirin\u0103:<\/p>\n<ul>\n<li>Anemia sideroblastic\u0103 ereditar\u0103 (X-linkat\u0103, autosomal\u0103).<\/li>\n<li>Anemia sideroblastic\u0103 dob\u00e2ndit\u0103 (anemia sideroblastic\u0103 idiopatic\u0103 cu siderobla\u015fti inelari, anemia sideroblastic\u0103 asociat\u0103 cu boli mieloproliferative sau alte boli maligne).<\/li>\n<li>Anemia sideroblastic\u0103 dob\u00e2ndit\u0103 reversibil\u0103 (din alcoolism, indus\u0103 de medicamente: izoniazida, cloramfenicol, din intoxicatia cu plumb \u2013 de obicei normocitar\u0103).<\/li>\n<\/ul>\n<p>Cea mai frecvent\u0103 cauz\u0103 este deficitul de fier, anemia feripriv\u0103 fiind cea mai \u00eent\u00e2lnit\u0103 form\u0103 de anemie de pe glob<sup>7<\/sup>.<\/p>\n<p>3. VEM crescut (&gt;100 fL): anemia macrocitar\u0103. Pe baza criteriilor biochimice \u015fi morfologice anemiile macrocitare se pot \u00eemp\u0103r\u0163i \u00een dou\u0103 grupuri: anemii megaloblastice \u015fi non-megaloblastice<sup>3<\/sup>.<\/p>\n<p>In anemiile megaloblastice<sup>3<\/sup> marca morfologic\u0103 este reprezentat\u0103 de prezen\u0163a precursorilor eritroizi anormali \u00een m\u0103duva osoas\u0103, caracteriza\u0163i prin dimensiuni crescute \u015fi alter\u0103ri specifice \u00een aspectul cromatinei nucleare. Aceste celule distincte reprezint\u0103 expresia morfologic\u0103 a unei anomalii biochimice, respectiv \u00eent\u00e2rzierea sintezei de ADN. Rata sintezei hemoglobinei, respectiv sinteza ARN, nu este afectat\u0103 \u00een timp ce rata diviziunilor celulare este redus\u0103, \u00een consecin\u0163\u0103 componentele citoplasmatice, \u00een special Hb sunt sintetizate \u00een exces \u00een timpul \u00eent\u00e2rzierii \u00eentre diviziunile celulare, duc\u00e2nd la formarea unor eritrocite de dimensiuni crescute. Cele dou\u0103 modific\u0103ri caracteristice de pe frotiul de s\u00e2nge care permit diferen\u0163ierea anemiilor megaloblastice sunt prezen\u0163a macroovalocitelor \u015fi a neutrofilelor cu nucleu hipersegmentat. In anemia megaloblastic\u0103 VEM este de obicei &gt;110 fL (110 \u2013 130 fL, chiar p\u00e2n\u0103 la 160 fL).<\/p>\n<p><strong>Clasificarea patogenic\u0103 a anemiilor megaloblastice<\/strong><\/p>\n<p>I. Deficitul de vitamina B12:<\/p>\n<p>A. Dieta deficitar\u0103 (rar\u0103: vegetarianismul strict, de lung\u0103 durat\u0103, f\u0103r\u0103 ou\u0103 \u015fi produse lactate; mai frecvent\u0103 la copiii n\u0103scu\u0163i din mame strict vegetariene sau la cei cu diete restrictive \u00een fenilcetonurie).<\/p>\n<p>B. \u00a0Malabsorb\u0163ie de vitamina B12:<\/p>\n<ul>\n<li>An<a href=\"https:\/\/www.synevo.ro\/anemie-pernicioasa-deficitul-de-vitamina-b12\/\" data-wpel-link=\"internal\">emia pernicioas\u0103<\/a> (boala autoimun\u0103 caracterizat\u0103 prin atrofie gastric\u0103 \u015fi pierderea factorului intrinsec).<\/li>\n<li>Deficien\u0163\u0103 ereditar\u0103 de factor intrinsec (anemia pernicioas\u0103 ereditar\u0103).<\/li>\n<li>Malabsorb\u0163ia vitaminei B12 din alimente (chirurgia gastric\u0103, pacien\u0163i cu gastrita \u015fi aclorhidrie, infec\u0163ia cu Helicobacter pylori).<\/li>\n<li>Insuficien\u0163\u0103 pancreatic\u0103.<\/li>\n<li>Sindromul Zollinger-Ellison.<\/li>\n<li>Competi\u0163ia biologic\u0103 pentru vitamina B12: proliferarea bacterian\u0103 a intestinului sub\u0163ire (anomalii structurale: diverticuli, stricturi, fistule, ansa oarb\u0103 sau ale motilit\u0103\u0163ii: disfunc\u0163ia autonom\u0103 din diabet); infestarea cu Diphyllobothrium latum.<\/li>\n<li>Boli ileale: sprue tropical, boli intestinale inflamatorii, boala celiac\u0103, rezec\u0163ii ileale, by-pass jejuno-ileal pentru obezitate, radioterapia cu afectarea ileonului, boli ileale infiltrative (limfom, sclerodermie).<\/li>\n<li>Malabsorb\u0163ia familial\u0103 selectiv\u0103 a vitaminei B12 (Sindromul Imerslund-Gr\u00e4sbeck).<\/li>\n<li>Malabsorb\u0163ia vitaminei B12 indus\u0103 de toxice \u015fi medicamente: alcool, colchicina, metformin, neomicina, colestiramina, acid paraaminosalicilic.<\/li>\n<\/ul>\n<p>C. Defecte \u00een tranportul \u015fi metabolismul intracelular al <a href=\"https:\/\/www.synevo.ro\/shop\/vitamina-b12\/\" data-wpel-link=\"internal\">vitaminei B12<\/a>:<\/p>\n<ul>\n<li>Boli genetice: muta\u0163ii genetice care afecteaz\u0103 metabolismul intracelular al cobalaminei (aciduria metilmalonic\u0103 \u015fi hiperhomocisteinemia); deficien\u0163a de transcobalamina II.<\/li>\n<li>Toxicitatea oxidului nitros<sup>3;7<\/sup>.<\/li>\n<\/ul>\n<p>II. Deficitul de fola\u0163i:<\/p>\n<p>A. Dieta deficitar\u0103 (prematuri, diet\u0103 exclusiv lactat\u0103 la sugari f\u0103r\u0103 suplimentare cu fola\u0163i, dieta restrictiv\u0103 din fenilcetonurie, abuzul de alcool).<\/p>\n<p>B. Nevoi crescute: sarcin\u0103, al\u0103ptare, copii \u00een perioada de cre\u015ftere, anemia hemolitic\u0103 cronic\u0103, boli neoplazice, hipertiroidism.<\/p>\n<p>C. \u00a0Pierderi crescute: dializa cronic\u0103.<\/p>\n<p>D. \u00a0Malabsorb\u0163ie de fola\u0163i:<\/p>\n<ul>\n<li>Boli intestinale: sprue tropical, <a href=\"https:\/\/www.synevo.ro\/intoleranta-la-gluten-sau-boala-celiaca\/\" data-wpel-link=\"internal\">boala celiac\u0103<\/a>, boli intestinale inflamatorii, rezec\u0163ii jejunale.<\/li>\n<li>Dermatita herpetiform\u0103.<\/li>\n<li>Aclorhidria endogen\u0103 sau iatrogenic\u0103.<\/li>\n<li>Insuficien\u0163a pancreatic\u0103 in care se administreaz\u0103 terapie de substitu\u0163ie oral\u0103.<\/li>\n<\/ul>\n<p>E.\u00a0 Deficit de fola\u0163i indus toxic\/medicamentos: abuzul de alcool, sulfasalazina, anticonvulsivante (\u00een special hidantoinele; acidul valproic), antifola\u0163i (metotrexat, trimetoprim-sulfametoxazol, pirimetamina), contraceptivele orale.<\/p>\n<p>F. \u00a0Defecte mo\u015ftenite ale transportului \u015fi metabolismului:<\/p>\n<ul>\n<li>Deficitul de tetradidrofolat reductaz\u0103.<\/li>\n<li>Malabsorb\u0163ia ereditar\u0103 de folat.<\/li>\n<\/ul>\n<p>III. Boli mo\u015ftenite ale sintezei de ADN: aciduria orotic\u0103, sindromul Lesch-Nyhan, anemia megaloblastic\u0103 responsiv\u0103 la tiamina.<\/p>\n<p>IV. Defecte ale sintezei ADN induse toxic\/medicamentos:<\/p>\n<ul>\n<li>Antagonisti purinici (6-mercaptopurina, 6-tioguanina, azatioprina).<\/li>\n<li>Antagonisti pirimidinici (citozinarabinozida).<\/li>\n<li>Hidroxiuree.<\/li>\n<li>Agenti alchilan\u0163i (ciclofosfamida).<\/li>\n<li>Zidovudina (AZT).<\/li>\n<li>Arsenic.<\/li>\n<\/ul>\n<p>V. Cauze diverse: eritroleucemie, leucemie acut\u0103 mieloida, sindrom mielodisplazic<sup>3;7<\/sup>.<\/p>\n<p>Anemiile macrocitare non-megaloblastice<sup>7<\/sup> nu au un mecanism patogenic comun; ele reprezint\u0103 anemiile macrocitare \u00een care precursorii eritroizi medulari sunt normali; sinteza ADN nu este afectata; VEM este de obicei, u\u015for crescut (100 \u2013 110 fL).<\/p>\n<p><strong>Clasificarea anemiilor macrocitare non-megaloblastice<\/strong><sup>7<\/sup><strong>\u00a0<\/strong><\/p>\n<p>I. \u00a0Asociate cu eritropoieza accelerat\u0103: anemia hemolitic\u0103 \u015fi posthemoragic\u0103.<\/p>\n<p>II. Alcoolism (cre\u015fterea medie este ~5 fL, adic\u0103 5-10% peste valoarea medie a subiec\u0163ilor de control; normalizarea VEM se produce dup\u0103 3-4 s\u0103pt\u0103m\u00e2ni de abstinen\u0163\u0103); VEM reprezint\u0103 un test screening util pentru depistarea alcoolismului ocult.<\/p>\n<p>III. Boli hepatice.<\/p>\n<p>IV. Sindroame mielodisplazice.<\/p>\n<p>V. Anemia mieloftizic\u0103.<\/p>\n<p>VI. Anemia aplastic\u0103.<\/p>\n<p>VII. Anemia sideroblastic\u0103 dobandit\u0103.<\/p>\n<p>VIII. Anemia diseritropoietica ereditar\u0103 (tipurile I \u015fi III).<\/p>\n<p>IX. Anemia Diamond-Blackfan.<\/p>\n<p>X. <a href=\"https:\/\/www.synevo.ro\/hipotiroidism-tulburare-a-functiei-tiroidiene\/\" data-wpel-link=\"internal\">Hipotiroidism<\/a>.<\/p>\n<p><strong>Interferen\u0163e<\/strong><\/p>\n<p>1. Prezen\u0163a de dubl\u0103 popula\u0163ie eritrocitar\u0103 (micro- \u015fi macrocitar\u0103, c\u00e2nd se asociaz\u0103 anemia feripriv\u0103 cu anemia megaloblastic\u0103) poate determina un VEM normal. In aceast\u0103 situa\u0163ie RDW este &gt;15, pe histograma efectuat\u0103 de analizorul automat se observ\u0103 aspectul caracteristic de \u201ccurb\u0103 cu dou\u0103 cocoa\u015fe\u201d, iar confirmarea prezen\u0163ei dublei popula\u0163ii eritrocitare se face prin examinarea frotiului de s\u00e2nge. Dubla popula\u0163ie este caracteristic\u0103 pentru anemiile sideroblastice (o popula\u0163ie microcitar\u0103 hipocrom\u0103 \u015fi una relativ normocitar\u0103) \u015fi anemiei feriprive dup\u0103 \u00eenceperea terapiei de substitu\u0163ie cu fier.<\/p>\n<p>2. VEM fals crescut: reticulocitoza marcat\u0103 (&gt;50%), leucocitoza marcat\u0103 (&gt;50000\/\u00b5L) hiperglicemie marcat\u0103 (&gt;600 mg\/dl), prezen\u0163a de aglutinine la rece, intoxica\u0163ia cu metanol (\u015fi, \u00een consecin\u0163\u0103 cre\u015fte Hct, iar CHEM scade).<\/p>\n<p>3. VEM fals sc\u0103zut: hemoliza in vitro, prezen\u0163a de eritrocite fragmentate, excesul de EDTA.<\/p>\n<p>4. Dac\u0103 pragul inferior al analizorului este fixat prea sus, este calculat un VEM mai mare deoarece eritrocitele mai mici nu sunt m\u0103surate, iar dac\u0103 pragul superior este prea mare sunt m\u0103surate \u015fi leucocitele, iar VEM este crescut<sup>4;6;8;15;18<\/sup>.<\/p>\n<p><strong>Hemoglobina eritrocitar\u0103 medie <\/strong>(HEM) \u2013 este o m\u0103sur\u0103 a con\u0163inutului mediu de hemoglobin\u0103 pe eritrocit.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 HEM este calculat de analizorul automat conform formulei:<\/p>\n<p>Hb(g\/dL) x 10<\/p>\n<p>HEM =\u00a0\u00a0\u00a0 \u2014\u2014\u2014\u2014\u2014\u2014\u2013<\/p>\n<p>Nr.Er.(x10<sup>6<\/sup>\/\u03bcL)<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 HEM se exprim\u0103 \u00een picograme (pg\/10<sup>-12<\/sup>g). Valorile normale la adult sunt 26\u201334 pg sau 0.4-0.53 fmol (valori mai mari la nou-n\u0103scut; vezi anexa 7.1.1).<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong> \u2013 \u00een majoritatea anemiilor HEM se coreleaz\u0103 cu VEM, astfel anemiile microcitare sunt de obicei hipocrome (uneori hipocromia poate preceda microcitoza), cele normocitare sunt de obicei normocrome, iar condi\u0163iile care cresc HEM determin\u0103 \u00een general, dac\u0103 nu \u00eentotdeauna, VEM crescut, deoarece con\u0163inutul eritrocitar normal de Hb este ~95% din concentra\u0163ia de Hb maxim posibil\u0103 (anemiile macrocitare, anemia regenerativ\u0103 observat\u0103 de exemplu \u00een timpul substitu\u0163iei cu fier a anemiei feriprive, la nou-n\u0103scut).<\/p>\n<p><strong>Interferen\u0163e <\/strong><\/p>\n<div>1. Hiperlipidemia, leucocitoza &gt;50000\/\u03bcL determin\u0103 HEM fals crescut (Hb fals crescut\u0103).<\/div>\n<div>2. Concentra\u0163ie crescut\u0103 de heparin\u0103 determin\u0103 HEM fals crescut.<\/div>\n<div>3. Prezen\u0163a aglutininelor la rece determin\u0103 HEM fals crescut<sup>4;6;8;15;18<\/sup>.<\/div>\n<div><\/div>\n<p><strong>Concentra\u0163ia eritrocitar\u0103 medie de hemoglobin\u0103 <\/strong>(CHEM) \u2013 m\u0103soar\u0103 concentra\u0163ia medie de Hb dintr-un volum dat de eritrocite (sau raportul dintre masa de Hb \u015fi volumul de eritrocite).<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 CHEM este calculat de analizorul automat conform formulei<sup>9<\/sup>:<\/p>\n<p>Hb (g\/dL) x 100<\/p>\n<p>CHEM =\u00a0\u00a0\u00a0 \u2014\u2014\u2014\u2014\u2014\u2014\u2013<\/p>\n<p>Hct (%)<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 CHEM se exprim\u0103 \u00een g\/dL. Valorile normale la adult sunt 32-36 g\/dL (320-360 g\/L) (vezi anexa 7.1.1)<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong> \u2013 VEM este un indice extrem de valoros \u00een clasificarea anemiilor, dar HEM \u015fi CHEM, de obicei, nu aduc \u00een plus informa\u0163ii relevante clinic. Totu\u015fi, au un rol important \u00een controlul de calitate al laboratorului, deoarece ace\u015fti indici variaz\u0103 foarte pu\u0163in de la o zi la alta pentru un specimen dat, dac\u0103 pacientul nu este transfuzat.<\/p>\n<p>Datorit\u0103 comportamentului similar al volumului eritrocitar \u015fi con\u0163inutului\u00a0\u00een Hb al fiec\u0103rui eritrocit\u00a0\u00een parte, CHEM r\u0103m\u00e2ne constant\u00a0\u00een multe afec\u0163iuni hematopoietice<sup>4;6;8;16;19<\/sup>.<\/p>\n<p>1. CHEM sc\u0103zut (&lt;30g\/dL): apare \u00een anemiile hipocrome (anemia feripriv\u0103, unele talasemii).<\/p>\n<p>2. CHEM crescut: cu excep\u0163ia sferocitozei ereditare \u015fi a unor cazuri homozigote de siclemie \u015fi hemoglobina C, CHEM nu dep\u0103\u015fe\u015fte valoarea de 37 g\/dL; aceast\u0103 valoare este aproape de nivelul de solubilitate a Hb \u015fi cre\u015fterea \u00een continuare a concentra\u0163iei de Hb poate duce la cristalizarea ei. Acurate\u0163ea determin\u0103rii CHEM depinde de factorii care afecteaz\u0103 m\u0103surarea fie a Hct, fie a Hb.<\/p>\n<p><strong>Interferen\u0163e<\/strong><\/p>\n<p>1. CHEM poate fi fals crescut\u00a0\u00een hiperlipemie, prezenta de aglutinine la rece\u00a0\u00een titru mare, prezen\u0163a de rulouri.<\/p>\n<p>2. In hiperglicemia marcat\u0103 (&gt;600 mg\/dL) CHEM poate fi fals sc\u0103zut (VEM si Hct fals crescute) <sup>4;6;8;16;19<\/sup>.<\/p>\n<p><strong>L\u0103rgimea distribu\u0163iei eritrocitare <\/strong>(RDW) \u2013 este un indice eritrocitar care cuantific\u0103 heterogenitatea volumului celular (gradului de anizocitoz\u0103).<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 RDW este calculat de analizorul automat\u00a0\u00een func\u0163ie de prezen\u0163a de anomalii ale frecven\u0163ei relative la anumite niveluri de discriminare, existen\u0163a a dou\u0103 sau a mai multor \u201cpeak\u201d-uri \u015fi l\u0103rgime de distribu\u0163ie anormal\u0103. Distribu\u0163ia VEM \u00eentr-o prob\u0103 este prezentat\u0103 sub forma unui grafic\u00a0\u00een care pe abcis\u0103 se proiecteaz\u0103 volumul eritrocitar, iar pe ordonat\u0103 frecven\u0163a relativ\u0103<sup>9<\/sup>.<\/p>\n<p>Devia\u0163ia standard a m\u0103rimii eritrocitelor x 100<\/p>\n<p>RDW (CV%) =\u00a0\u00a0 \u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014-<\/p>\n<p>VEM<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 11.6-14.8 coeficient de varia\u0163ie (CV) a volumului eritrocitar<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>RDW este util\u00a0\u00een caracterizarea ini\u0163ial\u0103 a anemiilor,\u00a0\u00een particular a anemiei microcitare, de\u015fi alte teste sunt de obicei necesare pentru confirmarea diagnosticului. Astfel RDW este util\u00a0\u00een diferen\u0163ierea beta-talasemiei minore necomplicate,\u00a0\u00een care VEM este sc\u0103zut, iar RDW normal de anemia feripriv\u0103,\u00a0\u00een care VEM este sc\u0103zut, iar RDW crescut (cre\u015fterea RDW este un semn precoce\u00a0\u00een deficitul de fier)<sup>7<\/sup>. RDW este u\u015for crescut \u00een beta-talasemia minor\u0103 cu anemie u\u015foar\u0103<sup>4<\/sup>. Unele studii au ar\u0103tat c\u0103 RDW nu diferen\u0163iaz\u0103 beta-talasemia minor\u0103 de anemia feripriv\u0103 dec\u00e2t dac\u0103 este utilizat un cut-off mai mare (17%)<sup>4<\/sup>. De asemenea permite diferen\u0163ierea \u00eentre anemia din bolile cronice (VEM normal\/sc\u0103zut, RDW normal) \u015fi anemia feripriv\u0103 incipient\u0103 (VEM normal\/sc\u0103zut, RDW crescut)<sup>7;16<\/sup>.<\/p>\n<p>RDW crescut: anemia feripriv\u0103, anemia megaloblastic\u0103, diferite hemoglobinopatii (S, S-C, S-\u03b2-talasemia), anemia hemolitic\u0103 imun\u0103, reticulocitoza marcat\u0103, prezen\u0163a de fragmente eritrocitare, aglutinare, dimorfism eritrocitar (inclusiv pacien\u0163ii transfuza\u0163i sau cei trata\u0163i recent pentru deficien\u0163e nutri\u0163ionale).<\/p>\n<p>RDW normal: anemia din bolile cronice, beta-talasemia heterozigot\u0103, anemia hemoragic\u0103 acut\u0103, anemia aplastic\u0103, sferocitoza ereditar\u0103, boala cu Hb E, siclemia.<\/p>\n<p>Nu exist\u0103 o cauz\u0103 cunoscut\u0103 pentru RDW sc\u0103zut<sup>4;6;8;16;19<\/sup>.<\/p>\n<p><strong>Interferen\u0163e<\/strong>:<\/p>\n<p>1. Alcoolismul creste RDW.<\/p>\n<p>2. Prezen\u0163a aglutininelor la rece<sup>4;6;8;16<\/sup><\/p>\n<h3><strong>NUMARUL DE TROMBOCITE <\/strong>(NUMARUL DE PLACHETE) <strong>\u00a0<\/strong><\/h3>\n<p>Trombocitele sunt fragmente citoplasmatice anucleate bogate \u00een granule, rotund-ovalare, plate, \u00een form\u0103 de disc, cu diametrul de 2-4\u03bc. Trombopoieza are loc \u00een m\u0103duva osoas\u0103 \u00eencep\u00e2nd cu celula progenitoare multipotent\u0103, continu\u0103 cu megakariocitopoieza care include proliferarea megakariocitar\u0103 \u015fi maturarea megakariocitelor cu formarea de trombocite. In mod normal, dou\u0103 treimi din trombocite se g\u0103sesc \u00een circula\u0163ie, iar o treime sunt stocate \u00een splin\u0103. Trombocitele sunt implicate \u00een hemostaz\u0103 \u015fi \u00een ini\u0163ierea proceselor de reparare tisular\u0103 \u015fi vasoconstric\u0163ie dup\u0103 injuria vascular\u0103 \u015fi \u00een timpul proceselor inflamatorii, aderarea \u015fi agregarea plachetar\u0103 av\u00e2nd ca rezultat formarea trombusului plachetar care astup\u0103 rupturile din pere\u0163ii vaselor mici.<\/p>\n<div><strong>Indica\u0163ii<\/strong><\/div>\n<div>\n<ul>\n<li>investigarea unei s\u00e2nger\u0103ri neexplicate, unei boli hemoragice sau a unei boli trombotice;<\/li>\n<li>\u00een cadrul unui profil de coagulare;<\/li>\n<li>monitorizarea bolilor asociate cu insuficien\u0163\u0103 medular\u0103;<\/li>\n<li>monitorizarea \u00een timpul tratamentelor care pot induce supresie medular\u0103 (iradiere, chimioterapie etc.) <sup>4;6<\/sup><sup>;<\/sup><sup>8;10;12-14;16;17;19<\/sup>.<\/li>\n<\/ul>\n<\/div>\n<p><strong>Metoda de determinare<\/strong> \u2013 trombocitele sunt num\u0103rate de analizorul automat prin aceea\u015fi metod\u0103 ca eritrocitele, \u00een timpul direc\u0163ion\u0103rii lor \u00eentr-un singur r\u00e2nd printr-un orificiu, prin metoda de focusare hidrodinamic\u0103<sup>9<\/sup>.<\/p>\n<p>O estimare a num\u0103rului de trombocite pe un frotiu de s\u00e2nge bine efectuat constituie un control valoros al num\u0103rului de trombocite determinat prin metoda automat\u0103. In general, c\u00e2nd frotiul este examinat cu obiectivul de 100x fiecare trombocit observat\/c\u00e2mp reprezint\u0103 ~10000 Tr x10<sup>6<\/sup>\/L. In consecin\u0163\u0103, un frotiu normal trebuie s\u0103 prezinte \u00een medie cel pu\u0163in 14 Tr\/c\u00e2mp<sup>15<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong><sup>9 <\/sup>\u2013 150-450 x 10<sup>3<\/sup>\/\u03bcL.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Cre\u015fterea num\u0103rului de trombocite (trombocitoza\/trombocitemie)<\/p>\n<p>A. Trombocitoza tranzitorie \u2013 se datoreaz\u0103 mobiliz\u0103rii trombocitelor din pool-ul extravascular: efort fizic, na\u015ftere, administrare de epinefrin\u0103.<\/p>\n<p>B. Trombocitoza primar\u0103:<\/p>\n<ul>\n<li>Trombocitemia ereditar\u0103 (rar\u0103; autosomal dominant\u0103; muta\u0163ie a genei trombopoietinei de pe cromozomul 3).<\/li>\n<li>Sindroame mieloproliferative (hematopoieza clonal\u0103): trombocitemia esen\u0163ial\u0103, policitemia vera, leucemia mieloida cronic\u0103, metaplazia mieloida cu mielofibroz\u0103.<\/li>\n<\/ul>\n<p>C. Trombocitoza secundar\u0103\/reactiv\u0103 (produc\u0163ia persistent\u0103 a unuia sau mai multor factori trombopoietici, \u00een special interleukina 6, care ac\u0163ioneaz\u0103 asupra megakariocitelor):<\/p>\n<ul>\n<li>boli infec\u0163ioase;<\/li>\n<li>boli inflamatorii;<\/li>\n<li>boli maligne;<\/li>\n<li>regenerarea rapid\u0103 dup\u0103 hemoragie\/anemie hemolitic\u0103;<\/li>\n<li>rebound dup\u0103 refacerea post-trombocitopenie;<\/li>\n<li>asplenia anatomic\u0103 (splenectomie)\/func\u0163ional\u0103 (de exemplu din siclemie);<\/li>\n<li>deficitul de fier;<\/li>\n<li>postchirurgical<sup>13<\/sup>.<\/li>\n<\/ul>\n<p>In sindroamele mieloproliferative cronice trombocitoza este frecvent\u0103 \u015fi poate constitui un mecanism fiziopatologic important \u00een producerea hemoragiei \u015fi trombozei. Trombocitele circulante sunt mari, dismorfice \u015fi anormale func\u0163ional. Pacien\u0163ii cu trombocitoz\u0103 reactiv\u0103 pot avea valori ale trombocitelor la fel de mari ca\u00a0\u00een bolile mieloproliferative (de ordinul milioanelor), dar hemoragia \u015fi tromboz\u0103 sunt neobi\u015fnuite. Trombocitele circulante sunt mari, rotunde, normale func\u0163ional<sup>4;13<\/sup>.<\/p>\n<p>2. Sc\u0103derea num\u0103rului de trombocite (trombocitopenia): este cea mai frecvent\u0103 cauz\u0103 de s\u00e2ngerare. Trombocitopenia poate ap\u0103rea prin mecanisme diferite:<\/p>\n<p>A. Distruc\u0163ie accelerat\u0103 a trombocitelor: este cea mai frecvent\u0103 cauz\u0103 de trombocitopenie; aceasta determin\u0103 stimularea trombopoiezei duc\u00e2nd la cre\u015fterea num\u0103rului, m\u0103rimii \u015fi matura\u0163iei megakariocitelor medulare.<\/p>\n<ul>\n<li>Datorat\u0103 unor procese imunologice:\n<ul>\n<li>autoimune: idiopatica\/secundar\u0103 (infec\u0163ii, sarcin\u0103, boli vasculare de colagen, boli limfoproliferative, tumori solide, medicamente etc.); mecanismul este reprezentat de prezenta de autoanticorpi anti-trombocitari de tip IgG \u015fi\/sau IgA, mai rar IgM, care activeaz\u0103 complementul \u015fi determin\u0103 scurtarea duratei de via\u0163\u0103 a trombocitelor prin \u00eendep\u0103rtarea din circula\u0163ie de c\u0103tre sistemul fagocitic mononuclear splenic;<\/li>\n<li>aloimune: trombocitopenie neonatal\u0103; purpura posttransfuzional\u0103.<\/li>\n<\/ul>\n<\/li>\n<li>Datorata unor procese non-imunologice:\n<ul>\n<li>microangiopatii trombotice: coagulare intravascular\u0103 diseminat\u0103, purpura trombotic\u0103 trombocitopenic\u0103, sindrom hemolitic uremic, sindromul HELLP din sarcin\u0103 (hemoliza\/eclampsie, cre\u015fterea enzimelor hepatice \u015fi sc\u0103derea trombocitelor);<\/li>\n<li>alterarea trombocitelor prin suprafe\u0163e vasculare anormale (valvulopatii, ateroscleroza extensiv\u0103, proteze vasculare, catetere, circula\u0163ie extracorporeal\u0103 etc.);<\/li>\n<li>infec\u0163ii: virusuri (rubeol\u0103\/oreion neonatal, citomegalovirus, parvovirus B19, vaccinuri), bacterii (septicemie, meningococemie, boala Lyme), Mycoplasma pneumoniae, protozoare (malarie).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>B. Produc\u0163e sc\u0103zuta de trombocite:<\/p>\n<ul>\n<li>Hipoplazie megakariocitar\u0103: medicamente mielosupresive (agen\u0163i alchilanti, antimetaboliti, medicamente citotoxice), radia\u0163ii ionizante, anemie aplastic\u0103, boli medulare infiltrative, medicamente care produc hipoplazie medular\u0103 prin mecanism idiosincrazic (cloramfenicol), substan\u0163e care supreseaz\u0103 selectiv megakariocitele (clorotiazide, estrogeni, etanol).<\/li>\n<li>Trombopoieza ineficient\u0103: anemia megaloblastic\u0103.<\/li>\n<li>Alterarea mecanismului de reglare a trombopoiezei: deficit de trombopoietina; trombocitopenia ciclic\u0103.<\/li>\n<li>Trombocitopenii ereditare: trombocitopenia amegakariocitara congenitala, trombocitopenia cu absen\u0163a radiusului, anomalia May-Hegglin, sindromul Wiskott-Aldrich (microtrombocitopenia X-linkata), macrotrombocitopenia X-linkata cu diseritropoieza, sindromul Bernard-Soulier, sindromul plachetelor gri etc.<\/li>\n<li>Purpura trombocitopenic\u0103 amegakariocitar\u0103 pur\u0103 dobandit\u0103 (rar\u0103).<\/li>\n<\/ul>\n<p>C. Distribu\u0163ie anormal\u0103 a trombocitelor:<\/p>\n<ul>\n<li>Boli ale splinei (neoplazice, congestive, infiltrative, infec\u0163ioase); de obicei trombocitopenie u\u015foar\u0103 = 50-100\u00d710<sup>3<\/sup>\/\u03bcL.<\/li>\n<li>Hipotermia.<\/li>\n<li>Dilu\u0163ia trombocitelor prin transfuzii masive.<\/li>\n<\/ul>\n<p>Numeroase medicamente au fost asociate cu trombocitopenia imun\u0103. Cele mai comune medicamente incriminate sunt: heparina (1% din pacienti), quinidina, quinina, rifampicina, trimetoprim-sulfametoxazol, danazol, metildopa, acetaminofen, digoxin, interferon-alfa etc.<\/p>\n<p>Trombocitopenia se asociaz\u0103 clinic cu s\u00e2nger\u0103ri cutaneo-mucoase: petesii, purpur\u0103, gingivoragii, epistaxis, p\u00e2n\u0103 la s\u00e2nger\u0103ri gastrointestinale, pulmonare \u015fi genitourinare. S\u00e2nger\u0103rile spontane sunt rare la &gt;60\u00d710<sup>3<\/sup>Tr\/\u03bcL (pot ap\u0103rea s\u00e2nger\u0103ri posttraumatice, postoperatorii) <sup>12;17<\/sup>.<\/p>\n<p><strong>Valori critice<\/strong><\/p>\n<p>1. Trombocitoza <strong>&gt;1.5\u00d710<sup>9<\/sup>\/<\/strong><strong>\u03bc<\/strong><strong>L<\/strong>, precum \u015fi trombocitoza la pacien\u0163ii v\u00e2rstnici \u015fi\/sau cu boli cardiovasculare prezint\u0103 risc de tromboz\u0103, mai rar de hemoragie<sup>6<\/sup>.<\/p>\n<p>2.\u00a0 Trombocitopenia <strong>&lt;20\u00d710<sup>3<\/sup>\/<\/strong><strong>\u03bc<\/strong><strong>L<\/strong> se asociaz\u0103 cu risc de s\u00e2nger\u0103ri spontane interne\/externe (risc 1% de hemoragii intracraniene)<sup>6<\/sup>.<\/p>\n<p><strong>Interferen\u0163e <\/strong><\/p>\n<p>1. Trombocitele cresc la altitudine, \u00een timpul iernii, dup\u0103 efort fizic intens, traume.<\/p>\n<p>2. Trombocitele scad \u00eenaintea menstrua\u0163iei \u015fi \u00een sarcin\u0103.<\/p>\n<p>3. O fals\u0103 trombocitopenie poate fi indicat\u0103 de analizorul automat \u015fi se datoreaz\u0103 unei erori de num\u0103rare:<\/p>\n<ul>\n<li>formarea de agregate\/aglutinate trombocitare (pseudotrombocitopenie) induse de anticoagulantul EDTA \u2013 se datoreaz\u0103 prezentei de aglutinine (autoanticorpi), care sunt imunoglobuline de tip IgG, IgA\/IgM \u015fi care induc aglutinarea in vitro a trombocitelor dependente de anticoagulant (care induce expunerea unor situsuri antigenice la care se vor lega anticorpii); nu exist\u0103 nici o asociere cunoscut\u0103 cu vreo boal\u0103\/medicament; este cea mai frecvent\u0103 cauz\u0103 de fals\u0103 trombocitopenie. Frotiul de s\u00e2nge periferic evidentiaz\u0103 agregatele trombocitare; pentru o num\u0103r\u0103toare exact\u0103 a trombocitelor se recomand\u0103 recoltarea unei pic\u0103turi de s\u00e2nge din pulpa degetului \u015fi folosirea modulului capilar al analizorului.<\/li>\n<li>prezen\u0163a de trombocite gigante;<\/li>\n<li>satelitismul plachetar (adsorb\u0163ia trombocitelor pe suprafa\u0163a neutrofilelor segmentate);<\/li>\n<li>prezenta aglutininelor la rece care poate determina aglutinare independent\u0103 de EDTA.<\/li>\n<\/ul>\n<p>4. Prezen\u0163a de fragmente eritrocitare, microsferocite, fragmente leucocitare (fragmente nucleare \u015fi citoplasmatice limfocitare \u00een leucemia limfoida cronic\u0103) poate determina niveluri fals crescute ale trombocitelor<sup>4;6;8;16;17;19<\/sup>.<\/p>\n<p>5. Interferen\u0163e medicamentoase:<\/p>\n<ul>\n<li><strong>Cresc trombocitele<\/strong>: cefazolin, ceftriaxon, clindamicin, danazol, diltiazem, dipiridamol, epoetin alfa, eritropoietina, fludarabina, gemfibrozil, glucocorticoizi, imipenem, imunoglobuline, interferon alfa-2a, isotretinoin, lansoprazol, litiu, lomefloxacin, megestrol, meropenem, metilprednisolon, metoprolol, miconazol, moxalactam, netilmicina, ofloxacina, contraceptive orale, penicilamina, propranolol, steroizi, ticlopidina, zalcitabina, zidovudina<sup>6<\/sup>.<\/li>\n<li><strong>Scad trombocitele<\/strong>: abciximab, acetaminofen, acetazolamida, albendazol, albuterol, alemtuzumab, alopurinol, acid aminocaproic, aminoglutetimid, amiodarona, amitriptilina, amoxicilina, amfotericina B, ampicilina, amrinona, anagrelid, anticonvulsivante, antineoplazice, trioxid de arseniu, asparaginaza, aspirina, aur, azatioprina, azitromicina, barbiturice, vaccin BCG, benazepril, betaxolol, subsalicilat de bismut, bleomicina, candesartan, capecitabina, captopril, carbamazepin, carbenicilin, carmustina, carvedilol, cefaclor, cefamandol, cefazolin, cefoxitin, ceftriaxon, cefuroxim, clorambucil, cloramfenicol, clordiazepoxid, clorochina, clorotiazida, clorfeniramin, clorpromazina, clorpropamid, cimetidina, cladribina, clindamicina, clofibrat, clonazepam, clopidogrel, cotrimoxazol, codeina, colchicina, ciclofosfamida, citarabina, dacarbazina, dalteparin, danazol, diazoxid, diclofenac, didanozina, dietilstilbestrol, digitala, digoxin, diltiazem, difenhidramina, disopiramida, docetaxel, doxepin, doxorubicin, doxiciclina, enalapril, epirubicin, eprosartan, eritromicina, esomeprazol, etanercept, acid etacrinic, etosuximid, etidronat, etopozid, etretinat, factor VIIa, famotidina, fenoprofen, flecainida, fluconazol, flucitozin, fludarabina, 5-fluorouracil, flufenazin, fluvastatin, fondaparinux, furosemid, gabapentin, ganciclovir, gemcitabina, gentamicina, glimepirid, gliburid, granisetron, vaccin antihepatita B, hidralazina, hidroclorotiazida, hidroxiclorochina, hidroxiuree, ibuprofen, idarubicina, ifosfamida, imatinib, imipenem, imipramina, imunoglobulina, indinavir, indometacin, infliximab, interferon alfa-2a, interleukina-2, irinotecan, isoniazida, isosorbid, isotretinoin, itroconazol, ketoprofen, lamivudina, lansoprazol, lepirudin, levamizol, levodopa, lisinopril, lomefloxacin, lomustin, lovastatin, loxapin, vaccin antirubeolic, vaccin antirujeolic, mecloretamina, acid mefenamic, meloxicam, melfalan, meprobamat, 6-mercaptopurina, meropenem, mesalamina, metformin, metazolamida, meticilina, metotrexat, metsuximid, metildopa, metisergid, metoprolol, metronidazol, milrinona, mitoxantrona, moricizina, morfina, moxalactam, micofenolat, acid nalidixic, naproxen,\u00a0 netilmicina, nicardipina, nitrofurantoin, nitroglicerina, nizatidina, norfloxacin, nortriptilina, nistatin, ofloxacin, paclitaxel, pamidronat, penicilamina, penicilina, pentamidina, pentostatin, pentoxifilina, fenobarbital, fenotiazine, indolol, piroxicam, vaccin antipolio, pravastatin, prednison, probenecid, procainamida, procarbazina, promazina, prometazina, propafenona, propranolol, protriptilina, pirazinamida, pirimetamina, raloxifen, ramipril, rezerpina, rifampicina, vaccin antirubeolic, sargramostin, spironolactona, stavudin, streptomicin, sulfametoxazol, sulfasalazina, sulfoniluree, sulindac, tacrolimus, tamoxifen, tetraciclina, tiabendazol, tiazide, tioguanina, tioridazina, tiotepa, ticarcilina, ticlopidina, timolol, tinzaparin, tobramicina, tocainida, tolbutamid, tolmentin, topotecan, trimetoprim, vaccin antiurlian, acid valproic, vancomicina, vinblastina, vincristina, vinorelbina, zidovudina<sup>6<\/sup>.<\/li>\n<\/ul>\n<p><strong>VOLUMUL TROMBOCITAR MEDIU <\/strong>(VTM)<sup>4;6;16;17<\/sup>\u00a0 \u2013 indic\u0103 uniformitatea de m\u0103rime a popula\u0163iei trombocitare. Este util \u00een diagnosticul diferen\u0163ial al trombocitopeniei<sup>4;6;16;17<\/sup>.<\/p>\n<p><strong>Metoda de determinare<\/strong>: este calculat de analizorul automat dup\u0103 urm\u0103toarea formula:<\/p>\n<p>PCT (Plachetocrit) (%)<\/p>\n<p>VTM (fL) = \u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014\u2014- x1000<\/p>\n<p><strong>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Nr. trombocite (x10<sup>3<\/sup>\/\u03bcL)<\/p>\n<p>De asemenea, analizorul automat calculeaz\u0103 <strong>l\u0103rgimea distribu\u0163iei trombocitare <\/strong>(PDW) asem\u0103n\u0103tor cu calcularea l\u0103rgimii distribu\u0163iei eritrocitare<sup>9<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013\u00a0 VTM = 7.4-13 fL sau \u03bcm<sup>3<\/sup>.<\/p>\n<p>PDW = 8-16.5 coeficient de varia\u0163ie (CV) a volumului trombocitar<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong> \u2013 VTM poate fi utilizat \u00eempreun\u0103 cu PDW pentru distingerea condi\u0163iilor asociate cu produc\u0163ie sc\u0103zut\u0103 de trombocite de cele asociate cu distruc\u0163ie plachetar\u0103 crescut\u0103.<\/p>\n<p>1. VTM crescut:<\/p>\n<p>In general VTM variaz\u0103 invers propor\u0163ional cu num\u0103rul de trombocite, cu volume plachetare mai mari observate la pacien\u0163ii trombocitopenici la care trombocitele sunt sc\u0103zute datorit\u0103 distruc\u0163iei periferice \u015fi unui turn-over plachetar crescut (ca \u00een purpura trombocitopenic\u0103 idiopatic\u0103)<sup>16<\/sup>.<\/p>\n<p>VTM este caracteristic crescut\u00a0\u00een hipertiroidism \u015fi \u00een bolile mieloproliferative <sup>4;16<\/sup>.<\/p>\n<p>In trombocitopoieza ineficient\u0103 asociat\u0103 cu hematopoieza megaloblastic\u0103 din deficitul de vitamin\u0103 B12 \u015fi\/sau acid folic trombocitele circulante sunt anormal de mari.<\/p>\n<p>VTM poate fi crescut dup\u0103 splenectomie; este crescut \u00een pre-eclampsie, la fum\u0103torii aterosclerotici (cre\u015fterea VTM la fum\u0103tori a fost propus\u0103 ca factor de risc pentru ateroscleroz\u0103)<sup>4<\/sup>.<\/p>\n<p>Plachete mari sunt prezente \u00een faza de recuperare dup\u0103 trombocitopenia indus\u0103 de alcool<sup>4<\/sup>. Exist\u0103 cateva forme de trombocitopenie ereditar\u0103 caracterizate prin prezen\u0163a de trombocite gigante (VTM = 16-30 fL): sindromul Bernard-Soulier \u015fi macrotrombocitopeniile ereditare cu transmitere autosomal dominanat\u0103 (sindroamele Fechtner, Sebastian, May-Hegglin si Epstein)<sup>16;19<\/sup>.<\/p>\n<p>In trombocitoz\u0103, VTM este de obicei crescut \u00een bolile mieloproliferative (asociat cu morfologie anormal\u0103) \u015fi normal\u00a0\u00een trombocitozele reactive (infec\u0163ii, tumori, boli inflamatorii etc.)<sup>13<\/sup>.<\/p>\n<p>2. VTM sc\u0103zut:<\/p>\n<p>Num\u0103rul de trombocite \u015fi VTM sunt de obicei sc\u0103zute \u00een condi\u0163iile asociate cu alterarea produc\u0163iei de trombocite: hipoplazia megakariocitar\u0103, anemia aplastic\u0103, chimioterapie, de asemenea \u00een trombocitopenia septic\u0103<sup>4;16;17<\/sup>. Odat\u0103 cu ameliorarea tabloului clinic \u015fi refacerea dup\u0103 chimioterapie, VTM cre\u015fte \u00eenaintea cre\u015fterii num\u0103rului de trombocite.<\/p>\n<p>Pacien\u0163ii cu hipersplenism au trombocite mai mici decat cei cu PTI, astfel m\u0103rimea trombocitelor poate servi ca mijloc pentru diferen\u0163ierea \u00eentre trombocitopenia cauzat\u0103 de distruc\u0163ia imunologic\u0103 a plachetelor fat\u0103 de sindroamele cu splenomegalie<sup>4;16<\/sup>.<\/p>\n<p>Prezen\u0163a de fragmente trombocitare (de ex. \u00een leucemie) se poate asocia cu VTM sc\u0103zut<sup>4<\/sup>.<\/p>\n<p>Dintre trombocitopeniile ereditare sindromul Wiskott-Aldrich \u015fi trombocitopenia X-linkat\u0103 se asociaz\u0103 cu microcitoza trombocitar\u0103 (VTM ~jum\u0103tate fa\u0163\u0103 de valorile normale)<sup>10;19<\/sup>.<\/p>\n<p>Exist\u0103 dovezi ca VTM se coreleaz\u0103 cu tendin\u0163a de s\u00e2ngerare la pacien\u0163ii trombocitopenici: la VTM &gt;6.4 fL scade semnificativ frecven\u0163a s\u00e2ngerarilor; astfel VTM ar putea fi util \u00een aprecierea oportunit\u0103\u0163ii administr\u0103rii de transfuzii de trombocite<sup>4<\/sup>.<\/p>\n<p><strong>Interferen\u0163e<\/strong><\/p>\n<p>Plachetele tind s\u0103 se m\u0103reasca \u00een primele dou\u0103 ore\u00a0\u00een EDTA, mic\u015for\u00e2ndu-se din nou o dat\u0103 cu prelungirea stoc\u0103rii probei, f\u0103c\u00e2nd dificil\u0103 standardizarea m\u0103sur\u0103torilor. De aceea interpretarea VTM \u015fi PDW trebuie f\u0103cut\u0103 cu precau\u0163ie<sup>16<\/sup>. VTM \u015fi PDW pot avea valori false dac\u0103 num\u0103rul de Tr este &lt;10000\/\u00b5L<sup>4<\/sup>.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<h3><strong>NUMARUL DE LEUCOCITE (NUMARUL DE CELULE ALBE) SI<\/strong> <strong>FORMULA LEUCOCITARA<\/strong><strong>\u00a0<\/strong><\/h3>\n<p>Leucocitele se \u00eempart \u00een dou\u0103 grupe principale: granulocite \u015fi a-\/non-granulocite. Granulocitele sunt denumite astfel datorit\u0103 prezen\u0163ei\u00a0\u00een citoplasm\u0103 de granula\u0163ii distincte \u015fi se identific\u0103 trei tipuri de granulocite\u00a0\u00een func\u0163ie de afinit\u0103\u0163ile de colorare pe frotiul de s\u00e2nge colorat Wright: neutrofile, eozinofile \u015fi bazofile. De asemenea, aceste celule sunt denumite \u015fi leucocite polimorfonucleare datorit\u0103 nucleului multilobulat. Nongranulocitele care constau din limfocite \u015fi monocite nu con\u0163in\u00a0\u00een general granula\u0163ii citoplasmatice distincte \u015fi au nucleul nonlobulat, fiind denumite \u015fi leucocite mononucleare<sup>2;4;6;8;12;16;18-20<\/sup>.<\/p>\n<p><strong>Indica\u0163ii<\/strong> \u2013 evaluarea infec\u0163iilor, inflama\u0163iilor, necrozelor tisulare, intoxica\u0163iilor, alergiilor, bolilor mieloproliferative \u015fi limfoproliferative acute \u015fi cronice, tumorilor maligne, depresiei medulare (iradiere, medicamente citotoxice, imunosupresoare, antitiroidiene etc.)<sup>6;8;12<\/sup>.<\/p>\n<p><strong>Metoda de determinare<\/strong> \u2013 leucocitele sunt determinate de analizorul automat (dup\u0103 ce hematiile sunt lizate, iar leucocitele sunt colorate cu o substan\u0163\u0103 fluorescent\u0103 cu afinitate pentru acizii nucleici) prin metoda de citometrie \u00een flux cu fluorescent\u0103 utiliz\u00e2nd LASER semiconductor.<\/p>\n<p>De asemenea, sunt efectuate dou\u0103 scatergrame bidimensionale. In scatergrama 4 DIFF axa x reprezint\u0103 intensitatea luminii dispersate lateral (respectiv complexitatea intern\u0103 a celulelor), iar axa y intensitatea fluorescentei laterale (respectiv con\u0163inutul de acizi nucleici), sunt proiectate cele cinci clase leucocitare \u015fi grupul de umbre eritrocitare, precum \u015fi anumite semnale de avertizare. In scatergrama WBC\/BASO axa x reprezint\u0103 intensitatea luminii dispersate lateral, iar axa y intensitatea luminii dispersate frontal (respectiv m\u0103rimea celulelor) \u015fi sunt proiectate trei grupuri, respectiv grupul de umbre eritrocitare, grupul de bazofile \u015fi grupul de alte leucocite<sup>9<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 la adult = 4000-10000\/\u00b5L sau 4-10\u00d710<sup>9<\/sup>\/L;<\/p>\n<p>\u2013 la copii valori mai mari, diferite \u00een func\u0163ie de v\u00e2rst\u0103 (vezi anexa7.1.1).<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1.Varia\u0163ii fiziologice ale leucocitelor<\/p>\n<ul>\n<li>cre\u015fterea \u015fi dezvoltarea: la nou-n\u0103scu\u0163i \u015fi copii num\u0103rul de leucocite este crescut, cu sc\u0103derea treptat\u0103 a valorilor, cu atingerea valorilor de la adult \u00eentre 18-21 ani;<\/li>\n<li>varia\u0163ii rasiale: la negrii din Africa num\u0103rul de neutrofile \u015fi monocite este mai mic, iar num\u0103rul de eozinofile mai mare;<\/li>\n<li>fluctua\u0163ii diurne \u015fi de la o zi la alta: influen\u0163ate de lumin\u0103; de asemenea activitatea obi\u015fnuit\u0103 determin\u0103 valori mai mari ale leucocitelor dup\u0103-amiaz\u0103, dar care tind s\u0103 r\u0103m\u00e2n\u0103 \u00een limite normale;<\/li>\n<li>varia\u0163ii climatice \u015fi sezoniere: c\u0103ldura \u015fi radia\u0163iile solare intense ar determina leucocitoza, iar reziden\u0163a prelungit\u0103 \u00een Antarctica determina leucopenie; lumina artificial\u0103 \u015fi ultraviolet\u0103 determin\u0103 limfocitoza;<\/li>\n<li>anoxia acut\u0103 determin\u0103 neutrofilie;<\/li>\n<li>\u00een primele zile de reziden\u0163\u0103 la altitudine crescut\u0103 apare leucocitoza asociat\u0103 cu limfopenie \u015fi eozinopenie, urmate de limfocitoz\u0103 \u015fi eozinofilie usoare;<\/li>\n<li>exerci\u0163iile fizice intense determin\u0103 leucocitoza marcat\u0103, de obicei pe seama neutrofilelor segmentate (se datoreaz\u0103 trecerii neutrofilelor marginate \u00een circula\u0163ie), dar poate fi prezent\u0103 \u015fi limfocitoza; normalizarea survine \u00een mai pu\u0163in de o or\u0103; gradul leucocitozei se coreleaz\u0103 cu intensitatea efortului fizic \u015fi nu cu durata sa;<\/li>\n<li>crizele convulsive determin\u0103 cre\u015fterea num\u0103rului de leucocite;<\/li>\n<li>injec\u0163iile cu epinefrin\u0103 determin\u0103 leucocitoza, \u00een special neutrofilie;<\/li>\n<li>atacurile de tahicardie paroxistic\u0103 pot determina leucocitoza;<\/li>\n<li>durerea, grea\u0163a, v\u0103rs\u0103turile, anxietatea pot determina leucocitoza \u00een absen\u0163a infec\u0163iei, prin redistribuirea celulelor marginate spre circula\u0163ie;<\/li>\n<li>anestezia cu eter determin\u0103 leucocitoza, iar narcoza cu compu\u015fi barbiturici de obicei scade num\u0103rul de leucocite;<\/li>\n<li>\u00een\u00a0 perioada ovulatorie poate ap\u0103rea leucocitoza u\u015foar\u0103 \u015fi eozinopenie;<\/li>\n<li>\u00een sarcin\u0103 apare leucocitoza u\u015foar\u0103, iar neutrofilia se accentueaz\u0103 odat\u0103 cu apropierea termenului; de asemenea, \u00een timpul travaliului apare neutrofilie uneori pronuntat\u0103, cu normalizarea valorilor dup\u0103 4-5 zile \u015fi asociat\u0103 cu eozinopenie.<\/li>\n<\/ul>\n<p>Majoritatea varia\u0163iilor fiziologice se explic\u0103 prin stimularea cortexului adrenal. Administrarea de cortizon \u015fi hidrocortizon se asociaz\u0103 cu neutrofilie (datorat\u0103 probabil sc\u0103derii fluxului din s\u00e2nge \u015fi cre\u015fterii eliber\u0103rii medulare), urmat\u0103 de eozinopenie \u015fi limfopenie<sup>18<\/sup>.<\/p>\n<p>2. Leucocitoza:<strong> L &gt;10000\/\u00b5L sau &gt;10\u00d710<sup>9<\/sup>\/L <\/strong>\u2013 se datoreaz\u0103 de obicei unei cre\u015fteri a num\u0103rului de neutrofile sau limfocite; mai rar celelalte clase de leucocite determin\u0103 cre\u015fterea num\u0103rului absolut de leucocite. O cre\u015ftere propor\u0163ional\u0103 a tuturor tipurilor de leucocite se datoreaz\u0103 hemoconcentra\u0163iei.<\/p>\n<ul>\n<li>\u00a0 a. Infec\u0163iile reprezint\u0103 cauza major\u0103 de leucocitoz\u0103. O infec\u0163ie acut\u0103 tipic\u0103 se caracterizeaz\u0103 printr-o faz\u0103 de atac neutrofilic\u0103, o faz\u0103 reactiv\u0103 monocitic\u0103 \u015fi o faz\u0103 de recuperare limfocitico-eozinofilic\u0103. In infec\u0163iile cronice poate persista oricare din aceste trei faze. Infec\u0163iile virale \u015fi unele infec\u0163ii bacteriene (febra tifoid\u0103) nu urmeaz\u0103 \u00een mod normal acest curs. Gradul leucocitozei depinde de severitatea infec\u0163iei, v\u00e2rsta \u015fi rezisten\u0163a pacientului, precum \u015fi de rezerva medular\u0103.<\/li>\n<li>\u00a0 b. Alte cauze de leucocitoz\u0103:\n<ul>\n<li>hemopatii maligne;<\/li>\n<li>traumatisme\/injurii tisulare, de exemplu interven\u0163ii chirurgicale, necroze tisulare;<\/li>\n<li>tumori maligne (in special carcinomul bronsic);<\/li>\n<li>toxine, uremie, eclampsie, com\u0103, tireotoxicoz\u0103;<\/li>\n<li>medicamente: cloroform, chinin\u0103, factori de crestere etc.;<\/li>\n<li>hemoliza acut\u0103;<\/li>\n<li>hemoragie acut\u0103;<\/li>\n<li>postsplenectomie<sup>18<\/sup>.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>3. Leucopenie:<strong> &lt;4000\/\u00b5L sau &lt;4\u00d710<sup>9<\/sup>\/L <\/strong>(valorile cuprinse \u00eentre 2500-4000\/\u00b5L sunt considerate borderline, \u00een timp ce valorile &lt;2500\/\u00b5L sunt cert anormale)\u00a0 se poate datora urm\u0103toarelor cauze:<\/p>\n<ul>\n<li>infec\u0163ii virale, unele infec\u0163ii bacteriene, infec\u0163ii bacteriene severe;<\/li>\n<li>hipersplenism;<\/li>\n<li>depresie medular\u0103 produs\u0103 de intoxica\u0163ie cu metale grele, benzen, radia\u0163ii ionizante, medicamente: chimioterapice, barbiturice, antibiotice, antihistaminice, anticonvulsivante, antitiroidiene, arsenic, diuretice, analgezice \u015fi antiinflamatorii;<\/li>\n<li>boli medulare primitive: leucemie (aleucemic\u0103), anemie megaloblastic\u0103, sindroame mielodisplazice, anemie aplastic\u0103, boli congenitale (anemia Fanconi, discheratoza congenital\u0103);<\/li>\n<li>boli medulare secundare: granuloame, metastaze<sup>18<\/sup>.<\/li>\n<\/ul>\n<p><strong>Interferen\u0163e<\/strong><\/p>\n<p>1. Num\u0103r fals crescut de leucocite: prezen\u0163a de eritrocite rezistente la liza (la nou-n\u0103scu\u0163i, reticulocitoza), prezen\u0163a de eritroblasti circulan\u0163i \u00een num\u0103r mare, trombocitele gigante (pot fi num\u0103rate ca leucocite), prezen\u0163a de crioglobuline (la temperatura camerei se formeaz\u0103 cristale proteice care sunt num\u0103rate ca leucocite; dispar dup\u0103 \u00eenc\u0103lzirea probei la 37\u00b0C), paraproteinemia, prezen\u0163a de aglutinine la rece.<\/p>\n<p>2. Num\u0103r fals sc\u0103zut de leucocite: prezen\u0163a de leucocite alterate (chimioterapie, sepsis) \u2013 nu sunt incluse \u00een num\u0103r\u0103toare<sup>4;6;8;19<\/sup>.<\/p>\n<p><strong>Valori critice<\/strong> -num\u0103r de leucocite <strong>&lt;500\/\u00b5L<\/strong>, respectiv <strong>&gt;30000\/\u00b5L<\/strong><sup>6<\/sup>.<\/p>\n<p><strong>Formula leucocitar\u0103<\/strong> const\u0103 \u00een diferen\u0163ierea num\u0103rului total de leucocite circulante\u00a0\u00een cele cinci tipuri de leucocite, exprimate procentual \u015fi respectiv\u00a0\u00een num\u0103r absolut, fiecare dintre acestea \u00eendeplinind o func\u0163ie specific\u0103. Actualmente este de preferat raportarea fiec\u0103rui tip de leucocite\u00a0\u00een valori absolute. Formula leucocitar\u0103 este efectuat\u0103 automat de c\u0103tre analizor.<\/p>\n<p>Exist\u0103 anumite situa\u0163ii \u00eens\u0103\u00a0\u00een care este necesar\u0103 efectuarea manual\u0103 a formulei leucocitare: num\u0103r de leucocite prea mic\/prea mare, prezen\u0163a de celule anormale semnalizat\u0103 de analizor prin anumite mesaje de avertizare\/chiar e\u015fecul analizorului de a indica formula leucocitar\u0103. In aceste cazuri se efectueaz\u0103 num\u0103r\u0103toarea microscopic\u0103: frotiu de s\u00e2nge venos (recoltat pe EDTA; heparina poate produce deform\u0103ri ale leucocitelor) sau frotiu de s\u00e2nge capilar<sup>9<\/sup>.<\/p>\n<p><strong>\u00a0<\/strong><strong>Neutrofilele (granulocitele polimorfonucleare neutrofile) <\/strong>\u2013 cel mai numeros tip de leucocite, joac\u0103 un rol major \u00een ap\u0103rarea antiinfec\u0163ioas\u0103 primar\u0103 a organismului prin fagocitarea \u015fi digestia microorganismelor, iar activarea lor necorespunz\u0103toare poate duce la lezarea \u0163esuturilor normale ale organismului prin eliberarea de enzime \u015fi agen\u0163i piogeni.<\/p>\n<p>In momentul apari\u0163iei infec\u0163iei sunt produ\u015fi agen\u0163i chemotactici care determin\u0103 migrarea neutrofilelor la locul infec\u0163iei \u015fi activarea func\u0163iilor defensive ale acestora, cu fagocitarea agentului respectiv, urmat\u0103 de eliberarea granulelor \u00een vezicula de fagocitoz\u0103 \u015fi distrugerea agentului infec\u0163ios. Acest efect este adesea asociat cu cre\u015fterea produc\u0163iei \u015fi eliber\u0103rii neutrofilelor din m\u0103duva osoas\u0103.<\/p>\n<p>Granulopoieza are loc la nivelul m\u0103duvei osoase, consider\u00e2ndu-se c\u0103 granulocitele neutrofile, eozinofile \u015fi bazofile urmeaz\u0103 acela\u015fi model de proliferare, diferen\u0163iere, maturare \u015fi eliberare \u00een s\u00e2nge. Mielobla\u015ftii, promielocitele \u015fi mielocitele reprezint\u0103 compartimentul mitotic, celulele fiind capabile de replicare, iar metamielocitele, neutrofilele nesegmentate \u015fi neutrofilele segmentate reprezint\u0103 compartimentul postmitotic\/de diferen\u0163iere.<\/p>\n<p>In afara m\u0103duvei osoase, granulocitele neutrofile se g\u0103sesc\u00a0\u00een \u0163esuturi, circulante la nivelul vaselor de s\u00e2nge \u015fi marginate care ader\u0103 la endoteliul vascular. Cre\u015fterea neutrofilelor circulante se datoreaz\u0103 fie eliber\u0103rii din m\u0103duva osoas\u0103, fie mobiliz\u0103rii neutrofilelor marginate. In cazul unei stimul\u0103ri puternice metamielocitele \u015fi mielocitele pot ajunge\u00a0\u00een s\u00e2ngele periferic<sup>18<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong>: \u2013\u00a0 la adult = 2000-8000\/\u00b5L sau 2-8\u00d710<sup>9<\/sup>\/L; 45-80% din leucocite;<\/p>\n<p>\u2013\u00a0 la copii valori mai mici \u00een func\u0163ie de v\u00e2rst\u0103<sup>9<\/sup> (vezi anexa 7.1.1).<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Neutrofilia:<strong>\u00a0 &gt;8000\/\u00b5L sau 8\u00d710<sup>9<\/sup>\/L:<\/strong><\/p>\n<ul>\n<li>Pseudoneutrofilia (cre\u015fterea num\u0103rului de neutrofile circulante pe seama neutrofilelor marginate): efort fizic intens, stres (plansul la copii), travaliu, menstrua\u0163ie.<\/li>\n<li>Infec\u0163ii bacteriene acute localizate \u015fi generalizate: neutrofilie p\u00e2n\u0103 la 15000-20000\/\u00b5L, foarte rar chiar p\u00e2n\u0103 la 50000\/\u00b5L; pot ap\u0103rea granula\u0163ii toxice\u00a0\u015fi devierea la st\u00e2nga a formulei leucocitare, cu cre\u015fterea procentului de neutrofile nesegmentate (normal 1-4% din neutrofile), iar \u00een cazul unui stimul puternic cu eliberarea de precursori medulari (metamielocite, mielocite). In infec\u0163ii foarte severe poate ap\u0103rea deviere la st\u00e2nga degenerativ\u0103 cu cre\u015fterea formelor imature f\u0103r\u0103 leucocitoz\u0103 (prognostic nefavorabil) sau reac\u0163ie leucemoid\u0103 (leucocite &gt;25000\/\u00b5L, devierea formulei leucocitare, uneori p\u00e2n\u0103 la mieloblast).<\/li>\n<li>Infec\u0163ii virale, fungice \u015fi parazitare: de obicei, neutrofilia este u\u015foar\u0103 \u015fi este prezent\u0103 doar \u00een faza ini\u0163ial\u0103.<\/li>\n<li>Sepsis neonatal.<\/li>\n<li>Boli inflamatorii cronice: vasculite, artrit\u0103 reumatoid\u0103, bron\u015fit\u0103, colit\u0103, dermatit\u0103, <a href=\"https:\/\/www.synevo.ro\/pielonefrita-o-afectiune-cu-simtome-severe-inca-de-la-debut\/\" data-wpel-link=\"internal\">pielonefrit\u0103<\/a>, <a href=\"https:\/\/www.synevo.ro\/pancreatita-diagnostic-predispozitia-genetica\/\" data-wpel-link=\"internal\">pancreatit\u0103<\/a>.<\/li>\n<li>Boli metabolice: com\u0103 diabetic\u0103, com\u0103 uremic\u0103, com\u0103 hepatic\u0103, atacul acut de gut\u0103, eclampsia, tireotoxicoza.<\/li>\n<li>Necroz\u0103 tisular\u0103: arsuri, infarct miocardic.<\/li>\n<li>Toxice \u015fi medicamente: corticosteroizi, plumb, mercur, monoxid de carbon, digital\u0103 veninuri.<\/li>\n<li>Hemoragia acut\u0103 (neutrofilie p\u00e2n\u0103 la 25000\/\u00b5L in a 3<sup>a<\/sup>-a 5<sup>a<\/sup> zi), proceduri chirurgicale majore, anemia hemolitic\u0103, postsplenectomie.<\/li>\n<li>Tumori maligne, \u00een special carcinoame (gastrointestinal, pulmonar): neutrofilia apare ca urmare a reac\u0163iei inflamatorii, necrozei tumorale, producerii de factori de cre\u015ftere granulopoietici de c\u0103tre tumor\u0103.<\/li>\n<li>Boli mieloproliferative cronice (leucemia mieloida cronic\u0103, policitemia vera, trombocitemia esen\u0163ial\u0103, metaplazia mieloida cu mielofibroz\u0103)<sup>4<\/sup><sup>,<\/sup><sup>6;8;18;19<\/sup>.<\/li>\n<\/ul>\n<p>2. Neutropenia: se clasific\u0103 \u00een u\u015foar\u0103 (1000-1500\/\u00b5L), moderat\u0103 (500-1000\/\u00b5L) \u015fi sever\u0103 (&lt;500\/\u00b5L); agranulocitoza reprezint\u0103 o form\u0103 sever\u0103 de neutropenie cu absen\u0163a total\u0103 a neutrofilelor circulante. Neutropenia sever\u0103 se asociaz\u0103 cu risc crescut de infec\u0163ii cu localizare oral\u0103 (ulcere, periodontita), cutaneo-mucoas\u0103 (piele, perirectal, genital), iar \u00een neutropenia prelungit\u0103 infec\u0163ii sistemice (pulmonare, gastrointestinale, hematogene). Cauze de neutropenie:<\/p>\n<p><strong>\u00a0 <\/strong>A. Pseudoneutropenia: efectuarea hemogramei dup\u0103 un timp \u00eendelungat de la recoltare, prezen\u0163a paraproteinemiei care produce aglutinarea neutrofilelor, marginarea neutrofilelor.<\/p>\n<p>B. \u00a0Neutropenia dob\u00e2ndit\u0103:<\/p>\n<ul>\n<li>Infec\u0163ii bacteriene severe, septicemie \u00een special cu bacterii Gram negative; infec\u0163ii virale: neutropenia survine \u00een primele 1-2 zile \u015fi persist\u0103 3-7 zile, de obicei f\u0103r\u0103 semnifica\u0163ie clinic\u0103; neutropenie prelungit\u0103 poate ap\u0103rea \u00een infec\u0163ii cu virusul hepatitic B, virusul Epstein-Barr, HIV; infec\u0163ii cu protozoare (malarie), fungi, rickettsii.<\/li>\n<li>Substan\u0163e chimice, toxice \u015fi medicamente:\n<ul>\n<li>Neutropenie indus\u0103 imun: aminopirina, penicilina, antitiroidiene, aur, quinidina.<\/li>\n<li>Inhibi\u0163ia granulopoiezei dependent\u0103 de doza: antibiotice \u03b2-lactamice, carbamazepina, acid valproic.<\/li>\n<li>Lezarea direct\u0103 a micromediului medular sau a precursorilor mieloizi de c\u0103tre medicament sau metaboli\u0163ii acestuia.<\/li>\n<\/ul>\n<\/li>\n<li>Medicamente care pot produce neutropenie:\n<ul>\n<li>Metale grele: aur, arseniu, mercur.<\/li>\n<li>Analgezice \u015fi antiinflamatorii: aminopirina, fenilbutazona, indometacin, ibuprofen, acid acetilsalicilic, barbiturice, mesalazina, quinina.<\/li>\n<li>Antipsihotice \u015fi antidepresive: fenotiazine, imipramin, desipramin, diazepam, clordiazepoxid, meprobamat, haloperidol.<\/li>\n<li>Anticonvulsivante: acid valproic, fenitoin, etosuximid, carbamazepin, lamotrigin.<\/li>\n<li>Antitiroidiene: tiouracil, propiltiouracil, metimazol, carbimazol, perclorat de potasiu, tiocianat.<\/li>\n<li>Medicamente cardiovasculare: procainamida, captopril, propranolol, hidralazina, metildopa, diazoxid, nifedipin, propafenona, ticlopidina, enalapril, amiodarona, quinidina.<\/li>\n<li>Antihistaminice: cimetidina, ranitidina, famotidina.<\/li>\n<li>Antimicrobiene: peniciline, cefalosporine, vancomicina, cloramfenicol, gentamicina, clindamicina, doxiciclina, flucitozina, nitrofurantoin, griseofulvin, metronidazol, rifampicina, izoniazida, streptomicina, mebendazol, pirimetamina, levamisol, sulfonamide, etambutol, ciprofloxacin, trimetoprim, imipenem.<\/li>\n<li>Antimalarice: clorochin, hidroxiclorochin, quinacrin, dapsona.<\/li>\n<li>Antivirale: zidovudina, aciclovir, ganciclovir, terbinafin.<\/li>\n<li>Antidiabetice: clorpropamid, tolbutamid.<\/li>\n<li>Diuretice: acid etacrinic, acetazolamida, tiazide, spironolactona.<\/li>\n<li>Diverse: alopurinol, colchicina, bezafibrat, tamoxifen, penicilamina, acid retinoic, metoclopramid, Rauwolfia, etanol, imunoglobuline intravenoase, omeprazol, levodopa.<\/li>\n<\/ul>\n<\/li>\n<li>Neutropenia nutri\u0163ional\u0103: casexie, st\u0103ri debilitante, anorexie nervoas\u0103, deficit de vitamina B12 \u015fi folat, deficit de cupru.<\/li>\n<li>Neutropenia imun\u0103 (prezen\u0163a de anticorpi anti-neutrofile):<\/li>\n<li>Neutropenia autoimun\u0103 primar\u0103 (80% din cazuri apar la copii &lt;1an; neutropenia autoimun\u0103 cronic\u0103 idiopatic\u0103) sau secundar\u0103 (lupus eritematos sistemic, granulomatoza Wegener, artrit\u0103 reumatoid\u0103, hepatit\u0103 cronic\u0103, limfocitoza T-\u03b3, transplant medular, transfuzii);<\/li>\n<li>Neutropenia isoimuna neonatal\u0103.<\/li>\n<li>Sindromul Felty: artrita reumatoid\u0103, splenomegalie \u015fi neutropenie.<\/li>\n<li>Neutropenia asociat\u0103 cu activarea complementului: expunerea s\u00e2ngelui la membrane artificiale (dializ\u0103, afereza, by-pass cardiopulmonar), anafilaxie. Are loc agregarea \u015fi aderarea neutrofilelor la endoteliul vascular, in special pulmonar.<\/li>\n<li>Hipersplenism.<\/li>\n<li>Chimioterapia \u00een cancer, tratamentul cu metotrexat \u00een artrit\u0103 reumatoid\u0103.<\/li>\n<li>Radia\u0163ii ionizante.<\/li>\n<li>Boli hematopoietice: leucemia (aleucemica), anemi\u0103 aplastic\u0103.<\/li>\n<\/ul>\n<p>C. Neutropenia congenital\u0103 \u015fi cronic\u0103:<\/p>\n<ul>\n<li>Neutropenia congenital\u0103 sever\u0103 (sindromul Kostmann).<\/li>\n<li>Neutropenia ciclic\u0103 (oscila\u0163ii periodice ale num\u0103rului de neutrofile de la neutropenie sever\u0103 &lt;200\/\u00b5L la niveluri aproape normale): ereditar\u0103 sau dob\u00e2ndit\u0103.<\/li>\n<li>Neutropenia benigna cronic\u0103: familial\u0103 \u015fi nonfamilial\u0103.<\/li>\n<li>Neutropenia idiopatic\u0103 cronic\u0103 sever\u0103.<\/li>\n<li>Neutropenia asociat\u0103 cu defecte imune congenitale: agamaglobulinemia X-linkat\u0103, sindromul de hiper-IgM, dis-gamaglobulinemia tip I, deficienta de IgA, hipo-gamaglobulinemia familial\u0103.<\/li>\n<li>Disgeneza reticular\u0103 (neutropenie sever\u0103, limfopenie, agamaglobulinemie \u015fi absen\u0163a imunit\u0103\u0163ii mediate celular).<\/li>\n<li>Neutropenia asociat\u0103 cu anomalii fenotipice: sindromul Shwachman, hipoplazia cartilaj-p\u0103r, diskeratoza congenital\u0103, sindromul Barth, sindromul Ch\u00e9diak-Higashi.<\/li>\n<li>Mielokathexis.<\/li>\n<li>Sindromul leucocitelor \u201clenese\u201d.<\/li>\n<li>Boli metabolice: glicogenoza tip Ib, metilmalonic acidemia<sup>1<\/sup>.<\/li>\n<\/ul>\n<p><strong>Interferen\u0163e<\/strong> \u2013 vezi varia\u0163ii fiziologice ale leucocitelor, pseudoneutrofilia \u015fi pseudoneutropenia.<\/p>\n<p><strong>Valori critice<\/strong> \u2013 num\u0103r de neutrofile <strong>&lt;200\/\u00b5L<\/strong> sau agranulocitoza \u2013 risc de infec\u0163ii sistemice fatale.<\/p>\n<p><strong>\u00a0<\/strong><strong>Limfocitele <\/strong>\u2013 reprezint\u0103 o popula\u0163ie celular\u0103 heterogen\u0103 care difer\u0103 \u00een func\u0163ie de origine, durata de via\u0163\u0103, localizare la nivelul organelor limfoide \u015fi func\u0163ie. De\u015fi unele caracteristici morfologice ca: m\u0103rimea, granularitatea, raportul nucleo-citoplasmatic diferen\u0163iaz\u0103 popula\u0163iile limfocitare una de cealalt\u0103, ele nu ofer\u0103 indicii privind tipul \u015fi func\u0163ia lor. Majoritatea limfocitelor din sange sunt mici, de\u015fi sunt comune \u015fi forme mai mari, cum ar fi limfocitele mari granulare care con\u0163in granula\u0163ii azurofile \u00een citoplasm\u0103.<\/p>\n<p>65-80% din limfocite sunt celule T, 8-15% sunt celule B, iar ~10% sunt celule natural killer (NK) (celulele NK sunt morfologic distincte, unele dintre acestea fiind identice cu limfocitele mari granulare). Numai 2% din limfocite sunt prezente \u00een sange. Limfopoieza are loc la nivelul organelor limfoide.<\/p>\n<p>Organele limfoide primare sunt m\u0103duva osoas\u0103 \u015fi timusul, unde are loc diferen\u0163ierea antigen-independent\u0103 a limfocitelor din precursorii imaturi (limfocitele B se matureaz\u0103 \u00een m\u0103duva, iar limfocitele T \u00een timus unde migreaz\u0103 de la nivel medular). Dup\u0103 acest stadiu precoce de diferen\u0163iere, limfocitele imunocompetente sunt eliberate \u015fi se localizeaz\u0103 \u00een arii specifice din organele limfoide secundare: splin\u0103, ganglionii limfatici, placile Peyer de la nivelul intestinului \u015fi inelul Waldeyer, unde are loc stadiul final, antigen-dependent al diferen\u0163ierii limfocitare \u015fi distribuirea de celule efectoare complet diferen\u0163iate a produsilor acestora spre alte zone ale organismului.<\/p>\n<p>Plasmocitele reprezint\u0103 celule B complet diferen\u0163iate, cu citoplasma abundent\u0103, intens bazofil\u0103, uneori granular\u0103 \u015fi nucleu excentric, rotund-ovalar, cu cromatin\u0103 dens\u0103 cu aspect de \u201cspi\u0163e de roat\u0103\u201d. Plasmocitele nu sunt prezente in mod normal in sange. Frecvent sunt intalnite celule intermediare (limfoplasmocite), ca in infec\u0163iile virale, inclusiv mononucleoz\u0103 infec\u0163ioas\u0103 sau in bolile imunologice cu hipergamaglobulinemie.<\/p>\n<p>Celulele B controleaz\u0103 r\u0103spunsul imun umoral mediat de anticorpi specifici antigenului ofensator. Celulele B cu memorie au durat\u0103 lung\u0103 de via\u0163\u0103 \u015fi nu produc anticorpi pan\u0103 in momentul restimul\u0103rii antigenice, cand r\u0103spund la doze mult mai mici de antigen, prolifereaz\u0103 clonal \u015fi produc o cantitate de anticorpi de 7-10 ori mai mare decat celule B neexperimentate antigenic.<\/p>\n<p>Celulele T sunt implicate in r\u0103spunsul imun mediat celular \u015fi includ celulele T helper CD4<sup>+<\/sup>, celulele T supresor CD8<sup>+<\/sup> \u015fi celulele T citotoxice<sup>6;15;19<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 adult: 1000-4000\/\u00b5L sau 1-4\u00d710<sup>9<\/sup>\/L; 20-55% din leucocite;<\/p>\n<p>\u2013 la copii valori mai mari in func\u0163ie de varst\u0103<sup>9<\/sup> (vezi anexa7.1.1).<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Limfocitoza:<strong> &gt;4000\/\u00b5L:<\/strong><\/p>\n<p><strong>\u00a0 <\/strong>A. Cauze benigne:<\/p>\n<ul>\n<li>Infec\u0163ii virale:<\/li>\n<li>Limfocitoza infec\u0163ioas\u0103 (apare in special la copii).<\/li>\n<li>Mononucleoza infec\u0163ioas\u0103: produs\u0103 de virusul Epstein-Barr, afecteaz\u0103 in special adolescen\u0163ii \u015fi adul\u0163ii tineri, produce un tablou hematologic caracteristic cu limfo-monocitoz\u0103 \u015fi prezen\u0163a pe frotiul de sange de limfocite atipice, activate (celulele Downey).<\/li>\n<li>Alte infec\u0163ii virale: infec\u0163ii virale ale tractului respirator superior, infec\u0163ii cu citomegalovirus, rujeol\u0103, oreion, varicel\u0103, hepatit\u0103 acut\u0103 viral\u0103, infec\u0163ie acut\u0103 cu HIV.<\/li>\n<li>Alte infec\u0163ii: infec\u0163ii cronice (tuberculoz\u0103, sifilis), tuse convulsiv\u0103, toxoplasmoza, febra tifoid\u0103, bruceloza.<\/li>\n<li>Num\u0103rul de limfocite poate dep\u0103\u015fi 15000\/\u00b5L in limfocitoza infec\u0163ioas\u0103, mononucleoza infec\u0163ioas\u0103, tusea convulsiv\u0103.<\/li>\n<li>Boala Crohn, colita ulcerativ\u0103.<\/li>\n<li>Boala Addison.<\/li>\n<li>Boala serului, hipersensibitate medicamentoas\u0103.<\/li>\n<li>Vasculite.<\/li>\n<li>Limfocitoza policlonala persistent\u0103 (condi\u0163ie benigna rar\u0103, care afecteaz\u0103 tipic femei\u00a0 fum\u0103toare de varsta mijlocie, cu tendin\u0163\u0103 familiala, cu prezen\u0163a de limfocite binucleate cu citoplasm\u0103 abundent\u0103).<\/li>\n<li>Sindromul de splenomegalie hiperreactiv\u0103 din malarie.<\/li>\n<\/ul>\n<p>B. Cauze maligne:<\/p>\n<ul>\n<li>Cu celula B: leucemia limfocitar\u0103 cronic\u0103, leucemia prolimfocitar\u0103 cu celula B, leucemia cu celule p\u0103roase, faza leucemic\u0103 din limfoamele nonhodgkin, macroglobulinemia Waldenstr\u00f6m.<\/li>\n<li>Cu celula T: leucemia prolimfocitar\u0103 cu celula T, leucemia\/limfomul cu celula T al adultului, sindromul S\u00e9zary, leucemia cu limfocite mari granulare.<\/li>\n<\/ul>\n<p>2. Limfopenie:<strong> &lt;1000\/\u00b5L:<\/strong><\/p>\n<ul>\n<li>Imunodeficien\u0163e congenitale: sindroame de imunodeficien\u0163\u0103 combinat\u0103.<strong>\u00a0<\/strong><\/li>\n<li>Infec\u0163ia HIV (sc\u0103derea selectiv\u0103 a celulelor CD4<sup>+<\/sup>).<strong>\u00a0<\/strong><\/li>\n<li>Chimioterapia (in special analogii nucleozidici: fludarabina, cladribina \u2013 produc sc\u0103derea marcat\u0103 a celulelor CD4<sup>+<\/sup>, care poate persista ani de zile), radioterapia, medica\u0163ia imunosupresoare.<strong>\u00a0<\/strong><\/li>\n<li>Lupus eritematos sistemic (sunt prezen\u0163i anticorpi anti-limfocitari care produc liza complement mediat\u0103 a limfocitelor); boala mixt\u0103 de \u0163esut conjuctiv; dermatomiozit\u0103.<strong>\u00a0<\/strong><\/li>\n<li>Tuberculoza avansat\u0103 (miliar\u0103): sc\u0103derea marcata a celulelor CD4<sup>+<\/sup>.<strong>\u00a0<\/strong><\/li>\n<li>Virusul gripal (limfopenia apare tipic dup\u0103 rezolvarea infec\u0163iei).<strong>\u00a0<\/strong><\/li>\n<li>Boala Hodgkin \u015fi alte malignita\u0163i.<strong>\u00a0<\/strong><\/li>\n<li>Anemia aplastic\u0103.<strong>\u00a0<\/strong><\/li>\n<li>Administrarea de ACTH\/corticosteroizi; tumori hipofizare secretoare de ACTH; boala Cushing.<strong>\u00a0<\/strong><\/li>\n<li>Pierderi crescute la nivelul tractului intestinal prin obstruc\u0163ia drenajului limfatic: tumori, boala Whipple, limfangiectazie intestinala; boli inflamatorii intestinale.<strong>\u00a0<\/strong><\/li>\n<li>Uremia.<strong>\u00a0<\/strong><\/li>\n<li>Diverse: sarcoidoza, insuficien\u0163a cardiac\u0103 congestiv\u0103, boli debilitante severe, mu\u015fc\u0103turi de \u015farpe, arsuri, anestezie, proceduri chirurgicale, by-pass cardiopulmonar.<\/li>\n<\/ul>\n<p>3. Plasmocitele: nu sunt prezente in mod normal in sange; sunt crescute in:<\/p>\n<ul>\n<li>Mielom multiplu, leucemia cu plasmocite.<\/li>\n<li>Cancer: ficat, san, prostat\u0103.<\/li>\n<li>Ciroz\u0103.<\/li>\n<li>Artrita reumatoid\u0103, lupusul eritematos sistemic.<\/li>\n<li>Boala serului.<\/li>\n<li>Unele infec\u0163ii bacteriene, virale, parazitare<sup>4;6;8;15;19<\/sup>.<\/li>\n<\/ul>\n<p><strong>Interferen\u0163e<\/strong> \u2013 vezi varia\u0163ii fiziologice ale leucocitelor; efortul fizic, stresul, menstrua\u0163ia pot produce limfocitoza.<\/p>\n<p>Interferen\u0163e medicamentoase<sup>6<\/sup>:<\/p>\n<ul>\n<li><strong>Cresc limfocitele:<\/strong> acid aminosalicilic, cefaclor, ceftazidim, clorambucil, clorpropamid,\u00a0dexametazona, gabapentin, G-CSF, griseofulvin, haloperidol, levodopa, narcotice,\u00a0ofloxacin, propiltiouracil, quazepam, spironolactona, triazolam, acid valproic.<\/li>\n<li><strong>Scad limfocitele:<\/strong> alprazolam, asparaginaza, benzodiazepine, ceftriaxon, clorambucil,\u00a0ciclosporina, dexametazona, eprosartan, fludarabina, acid folic, furosemid, hidrocortizon,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ibuprofen, irinotecan, levofloxacin, litiu, mecloretamina, mirtazepina, muromonab-CD3,\u00a0nelfinavir, ofloxacin, olsalazina, pamidronat, pentostatin, fenitoin, quazepam, terbinafina,\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 tiamina, trastuzumab, triazolam.<\/li>\n<\/ul>\n<p><strong>Valori critice<\/strong> \u2013 num\u0103r de limfocite <strong>&lt;500\/\u00b5L<\/strong> cre\u015fte riscul de infec\u0163ii, in special virale<sup>6<\/sup>.<\/p>\n<p>Num\u0103r de celule CD4<sup>+<\/sup> sever sc\u0103zut este cel mai bun indicator unic de infec\u0163ii oportuniste<sup>18<\/sup>.<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>Monocitele<\/strong> \u2013 sunt cele mai mari celule din s\u00e2nge; fac parte din sistemul fagocitic mononuclear\/reticuloendotelial compus din monocite, macrofage \u015fi precursorii lor medulari. Monocitele sunt eliberate in s\u00e2nge \u015fi, dup\u0103 un scurt timp in circula\u0163ie, migreaz\u0103 in diferite \u0163esuturi, int\u00e2mpl\u0103tor sau specific, ca r\u0103spuns la diferi\u0163i factori chemotactici.<\/p>\n<p>In \u0163esuturi, ca r\u0103spuns la diferi\u0163i stimuli solubili, ele se diferen\u0163iaz\u0103 in macrofage tisulare, cu calit\u0103\u0163i morfologice \u015fi func\u0163ionale caracteristice, proces care a fost denumit \u201cactivare\u201d \u015fi care este reversibil (\u201cdezactivare\u201d). Celulele sistemului fagocitic mononuclear sunt foarte primitive filogenetic, nici un animal neputand tr\u0103i f\u0103r\u0103 ele. Indeplinesc o varietate larg\u0103 de func\u0163ii importante in organism, incluz\u00e2nd indep\u0103rtarea particulelor str\u0103ine \u015fi celulelor senescente, moarte sau alterate, reglarea func\u0163iilor altor celule, procesarea \u015fi prezentarea de antigene in reac\u0163iile imune, participarea in diferite reac\u0163ii inflamatorii, distrugerea bacteriilor \u015fi celulelor tumorale.<\/p>\n<p>Monocitele \u015fi macrofagele produc numero\u015fi factori bioactivi: enzime, factori ai complementului, factori de coagulare, specii reactive de oxigen \u015fi azot, factori angiogenetici, proteine de legare (transferina, transcobalamina II, fibronectina, apolipoproteina E), lipide bioactive (deriva\u0163i ai acidului arahidonic), factori chemotactici, citokine \u015fi factori de cre\u015ftere (IFN \u03b1 \u015fi \u03b3, IL 1,3,6,8,10,12, FGF, PDGF, TNF, M-CSF) <sup>1;6;16<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 0-1000\/\u00b5L sau 0-1\u00d710<sup>9<\/sup>\/L; 0-15% din leucocite<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Monocitoza:<strong> &gt;1000\/\u00b5L:<\/strong><\/p>\n<ul>\n<li>Cele mai frecvente cauze sunt infec\u0163iile bacteriene, tuberculoza, endocardita bacterian\u0103 subacut\u0103, sifilisul, bruceloza.<\/li>\n<li>Leucemia mielomonocitara cronic\u0103, leucemia monoblastic\u0103 acut\u0103, boli mieloproliferative cronice.<\/li>\n<li>Carcinoame: stomac, s\u00e2n, ovar.<\/li>\n<li>Boala Hodgkin, limfoame.<\/li>\n<li>Recuperarea dup\u0103 neutropenie, chimioterapie, transplant medular (semn favorabil).<\/li>\n<li>Tezaurismoze (boala Gaucher).<\/li>\n<li>Boli parazitare (malarie, Kala-azar, tripanosomiaza), rickettsioze, infec\u0163ii micotice.<\/li>\n<li>Boli gastrointestinale: colita ulcerativ\u0103, enterita regional\u0103, sprue, ciroza hepatic\u0103.<\/li>\n<li>Boli de colagen, sarcoidoza.<\/li>\n<li>Postchirurgical, postsplenectomie.<\/li>\n<li>Reac\u0163ii medicamentoase.<\/li>\n<li>Intoxica\u0163ie cu tetracloretan.<\/li>\n<li>Tratament cu factori de cre\u015ftere granulo-monocitari.<\/li>\n<\/ul>\n<p>2. Monocitopenie:<strong> &lt;100\/\u00b5L <\/strong>(condi\u0163ie extrem de rar\u0103)<strong>:<\/strong><\/p>\n<ul>\n<li>Tratament cu prednison (tranzitoriu).<strong>\u00a0<\/strong><\/li>\n<li>Leucemia cu celule p\u0103roase.<strong>\u00a0<\/strong><\/li>\n<li>Infec\u0163ii severe care determin\u0103 \u015fi neutropenie.<strong>\u00a0<\/strong><\/li>\n<li>Infec\u0163ie HIV.<strong>\u00a0<\/strong><\/li>\n<li>Anemie aplastic\u0103<sup>1;4;8;19<\/sup>.<strong>\u00a0<\/strong><\/li>\n<\/ul>\n<p><strong>Interferen\u0163e<\/strong> \u2013 vezi varia\u0163ii fiziologice ale leucocitelor.<\/p>\n<p>Interferen\u0163e medicamentoase:<\/p>\n<p><strong>Cresc monocitele:<\/strong> alprazolam, ampicilina, carbenicilina, clorpromazina, griseofulvin, haloperidol, lomefloxacin, metsuximid, penicilamina, piperacilina, prednison, propiltiouracil, quazepam.<\/p>\n<p><strong>Scad monocitele:<\/strong> alprazolam, triazolam<sup>6<\/sup>.<strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><strong>\u00a0<\/strong><strong>Eozinofilele (granulocitele eozinofile)<\/strong><sup>6;9;18<\/sup>\u2013 au fost ini\u0163ial descrise pentru granula\u0163iile lor intracitoplasmatice caracteristice care manifest\u0103 afinitate crescut\u0103 pentru coloran\u0163ii acizi, cum ar fi eozina, \u015fi care apar colorate ro\u015fu-str\u0103lucitor \u00een microscopia optic\u0103. Eozinofilele sunt celule mobile, cu originea \u00een m\u0103duva osoas\u0103, urm\u00e2nd acela\u015fi model de proliferare, diferen\u0163iere, maturare \u015fi eliberare \u00een s\u00e2nge ca \u015fi granulocitele neutrofile; nucleul lor este de obicei bilobat, dar sunt adesea observa\u0163i \u015fi trei sau mai mul\u0163i lobi.<\/p>\n<p>La indivizii s\u0103n\u0103to\u015fi se g\u0103sesc \u00een num\u0103r mic \u00een s\u00e2nge, dar devin predominante \u00een s\u00e2nge \u015fi \u0163esuturi \u00een asociere cu diferite boli alergice, parazitare sau boli maligne. Prezen\u0163a eozinofilelor \u00een c\u0103ile respiratorii \u015fi mucoasa intestinal\u0103, num\u0103rul c\u00e2t \u015fi starea lor de activare, a fost asociat\u0103 at\u00e2t cu maifest\u0103rile IgE-dependente c\u00e2t \u015fi IgE-independente ale bolilor alergice.<\/p>\n<p>Totu\u015fi, rolul imunologic \u015fi importan\u0163a eozinofilului \u00een patogeneza astmului nu sunt pe deplin clarificate. Eozinofilele con\u0163in cel pu\u0163in cinci tipuri diferite de granula\u0163ii intracitoplasmatice; granula\u0163iile cristaloide con\u0163in cea mai mare parte a proteinelor cationice cu \u00eenc\u0103rc\u0103tura mare, incluz\u00e2nd proteina bazic\u0103 major\u0103, peroxidaza, proteina cationica eozinofilic\u0103 \u015fi neurotoxina derivat\u0103 din eozinofil, implicate \u00een alter\u0103rile tisulare observate \u00een astm \u015fi alte boli alergice.<\/p>\n<p>Eozinofilia indus\u0103 de alergeni sau parazi\u0163i este dependent\u0103 de celula T \u015fi este mediat\u0103 de citokine eliberate de limfocitele sensibilizate. Eozinofilul produce \u015fi stocheaz\u0103 p\u00e2n\u0103 la 29 de mediatori cunoscu\u0163i, citokine, chemokine \u015fi factori de cre\u015ftere, importante \u00een reac\u0163iile inflamatorii \u00een care este implicat\u0103 aceast\u0103 celul\u0103 (produ\u015fi ai acidului arahidonic, interleukine 1\u03b1-6, 8, 9-13, 16, IFN\u03b3, TNF, TGF\u03b1, TGF\u03b21, NGF, PDGF-B,SCF, GM-CSF, eotaxina, MIP-1\u03b1, RANTES).<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong>: 0-700\/\u00b5L sau 0-0.7\u00d710<sup>9<\/sup>\/L (0-7% din leucocite); valori mai mici la copiii p\u00e2n\u0103 la 1 an (vezi anexa 1).<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong> <sup>4;6;8;9;18<\/sup><\/p>\n<p><strong>1. Eozinofilia &gt;700\/\u00b5L:<\/strong><\/p>\n<ul>\n<li>Boli alergice:\n<ul>\n<li>Astmul bronsic: exist\u0103 o corela\u0163ie \u00eentre hiperreactivitatea bronsic\u0103 \u015fi gradul eozinofiliei; biopsia bron\u015fic\u0103 identific\u0103 prezen\u0163a eozinofilelor \u00een c\u0103ile respiratorii; \u00een astmul intrinsec\/nonatopic \u00een care lipse\u015fte dependen\u0163a de un r\u0103spuns imun dependent de IgE, exist\u0103 o cre\u015ftere similar\u0103 a eozinofilelor \u00een c\u0103ile aeriene.<\/li>\n<li>Dermatita atopic\u0103, urticaria, edemul angioneurotic, sensibilizarea la aspirin\u0103, alergii medicamentoase (trimetoprim-sulfametoxazol, penicilin\u0103, tetraciclin\u0103, nitrofurantoin), febra f\u00e2nului.<\/li>\n<li>Esofagita eozinofilic\u0103 (posibil asociat\u0103 cu alergie la alimente), gastroenterita eozinofilic\u0103, proctocolita eozinofilic\u0103 (asociat\u0103 cu alergia la laptele de vac\u0103, de\u015fi poate ap\u0103rea \u015fi la copii hr\u0103ni\u0163i cu formule de soia sau alimenta\u0163i la s\u00e2n).<\/li>\n<\/ul>\n<\/li>\n<li>Asocierea dintre infiltrate pulmonare \u015fi eozinofilie apare \u00een:\n<ul>\n<li>Sindromul L\u00f6ffler (infiltrat eozinofilic pulmonar tranzitoriu) \u2013 se poate asocia cu infestarea cu specii de Ascaris.<\/li>\n<li>Angeita alergic\u0103 \u015fi granulomatoas\u0103 (sindromul Churg-Strauss \u2013 tablou astmatiform, eozinofilie \u015fi vasculit\u0103 sistemic\u0103).<\/li>\n<li>Vasculita de hipersensibilizare.<\/li>\n<li>Aspergiloza bronho-pulmonar\u0103 alergic\u0103 (se caracterizeaz\u0103 printr-un tablou de astm, test cutanat pozitiv la aspergilus \u015fi prezen\u0163a de anticorpi precipitan\u0163i anti-aspergilus).<\/li>\n<li>Eozinofilia tropical\u0103 (infestare parazitar\u0103 pulmonar\u0103: filariaza).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>In plus, reac\u0163iile medicamentoase, sindromul hipereozinofilic \u015fi infesta\u0163iile parazitare se pot asocia cu eozinofilie \u015fi infiltrate pulmonare.<\/p>\n<ul>\n<li>Boli neoplazice:\n<ul>\n<li>Sindromul hipereozinofilic idiopatic: rar, mai frecvent la b\u0103rba\u0163i (B:F=9:1), eozinofilie p\u00e2n\u0103 la 50000\/\u00b5L, diferen\u0163iat de leucemia eozinofilic\u0103 prin absen\u0163a blastilor, determin\u0103 afectare organic\u0103 multipl\u0103, alterare nervoas\u0103 central\u0103 \u015fi deces de obicei prin disfunc\u0163ie cardiac\u0103.<\/li>\n<li>Leucemia eozinofilic\u0103.<\/li>\n<li>Boala Hodgkin \u015fi limfoamele maligne.<\/li>\n<li>Bolile mieloproliferative cronice.<\/li>\n<li>Carcinomul bron\u015fic (prin produc\u0163ie excesiv\u0103 de IL5).<\/li>\n<\/ul>\n<\/li>\n<li>Boli gastrointestinale: <a href=\"https:\/\/www.synevo.ro\/boala-crohn-si-investigatiile-de-laborator\/\" data-wpel-link=\"internal\">boala Crohn<\/a>, colita ulcerativ\u0103.<\/li>\n<li><a href=\"https:\/\/www.synevo.ro\/infectia-cu-hiv-problema-sanatate-publica\/\" data-wpel-link=\"internal\">Infec\u0163ia HIV:<\/a> se poate datora infesta\u0163iilor parazitare intercurente, reac\u0163iei la trimetoprim-sulfametoxazol utilizat pentru tratamentul infec\u0163iei cu Pneumocystis carinii.<\/li>\n<li>Infest\u0103ri parazitare \u00een special helmintice (trichineloza, chist hidatic, schistosomiaza, fascioloza, toxocaroza \u2013 \u201clarva migrans\u201d viscerala, cisticercoza, scabie), \u00een special \u00een timpul fazei de migrare tisular\u0103.<\/li>\n<li>Boli cutanate: pemfigus vulgaris, dermatita herpetiform\u0103, eritem exsudativ multiform.<\/li>\n<li>Boli infec\u0163ioase (febra ro\u015fie), \u00een convalescent\u0103 dup\u0103 alte infec\u0163ii.<\/li>\n<li>Eozinofilia familial\u0103 (rar\u0103).<\/li>\n<li>Eozinofilie iatrogena: tratamentul bolilor maligne cu IL-2, administrarea de GM-CSF, rejetul alogrefei.<\/li>\n<li>Sindromul eozinofilie-mialgie: produs de ingestia de L-triptofan, poten\u0163ial fatal (polineuropatie ascendenta Guillain-Barr\u00e9-like).<\/li>\n<li>Rinita eozinofilic\u0103 nonalergic\u0103.<\/li>\n<\/ul>\n<p>!Cele mai mari valori ale num\u0103rului de eozinofile (&gt;1500\/\u00b5L) apar \u00een sindromul hipereozinofilic idiopatic, leucemia cu eozinofile, trichineloza \u015fi dermatita herpetiform\u0103<sup>6;18<\/sup>.<\/p>\n<p><strong>2. Eozinopenia <\/strong>se datoreaz\u0103 \u00een general unei produc\u0163ii crescute de steroizi, care acompaniaz\u0103 majoritatea condi\u0163iilor de stres \u015fi se asociaz\u0103 cu:<\/p>\n<ul>\n<li>Sindromul Cushing.<\/li>\n<li>Medicamente: ACTH, corticosteroizi, epinefrina, tiroxina, prostaglandine.<\/li>\n<li>Infec\u0163ii acute.<\/li>\n<\/ul>\n<p><strong>Interferen\u0163e <\/strong><sup>4;6;8<\/sup>: vezi varia\u0163ii fiziologice ale leucocitelor.<\/p>\n<p>1. Ritmul circadian: num\u0103rul de eozinofile este minim diminea\u0163a \u015fi cre\u015fte de la pr\u00e2nz p\u00e2n\u0103 dup\u0103 miezul nop\u0163ii.<\/p>\n<p>2. Condi\u0163iile de stres scad num\u0103rul de eozinofile.<\/p>\n<p>3. Interferen\u0163e medicamentoase:<\/p>\n<ul>\n<li><strong>Cresc eozinofilele:<\/strong> alopurinol, alprazolam, acid aminosalicilic, amoxicilina, amfotericina B, ampicilina, aztreonam, benazepril, captopril, carbamazepin, carbenicilina, cefoperazon, cefotaxim, ceftazidim, ceftriaxon, cefalexin, cloramfenicol, clorpromazina, ciprofloxacin, clindamicina, clofibrat, clonazepam, danazol, dapsona, desipramina, diazoxid, diclofenac, doxepin, doxorubicina, doxiciclina, enalapril, etosuximid, flucitozina, fluorouracil, flufenazina, furazolidon, famciclovir, gemfibrozil, gentamicina, haloperidol, vaccin anti-hepatita A, ibuprofen, imipenem, isoniazida, lamotrigin, lansoprazol, levodopa, acid mefenamic, mefenitoin, metsuximid, metisergid, moxalactam, naproxen, nitrofurantoin, nizatidina, norfloxacina, ofloxacina, penicilinamina, pentazocin, perfenazina, piperacilina, piroxicam, procarbazina, propafenona, ramipril, ranitidina, rifampicina spironolactona, streptomicina, sulfametoxazol, sulfasalazina, tetraciclina, tioridazina, ticarcilina, ticlopidina, tobramicina, triazolam, trifluoperazina, trimipramina, trovafloxacin, acid valproic, zalcitabina<sup>6<\/sup>.<\/li>\n<li><strong>Scad eozinofilele:<\/strong> amitriptilina, aspirina, captopril, clozapin, corticotropin, desipramina, etosuximid, indometacin, nortriptilina, olsalazina, procainamida, rifampicina, sulfametoxazol, triazolam<sup>6<\/sup>.<\/li>\n<\/ul>\n<p><strong>Bazofilele (granulocitele bazofile)<\/strong> <strong>\u015fi<\/strong> <strong>mastocitele <\/strong>\u2013 sunt\u00a0dou\u0103 popula\u0163ii de leucocite bazofile care prezint\u0103 multe asem\u0103n\u0103ri, dar \u015fi unele diferen\u0163e. Ambele tipuri de celule con\u0163in granula\u0163ii intracitoplasmatice care se coloreaz\u0103 metacromatic cu coloran\u0163i bazici. De asemenea, ambele exprim\u0103 pe suprafa\u0163a lor o isoform\u0103 tetrameric\u0103 (\u03b1\u03b2\u03b32) a receptorului cu afinitate mare pentru IgE. C\u00e2nd acest receptor cu afinitate mare este legat de alergenul sensibilizant sau de anticorpii anti-IgE, at\u00e2t bazofilele, c\u00e2t \u015fi mastocitele sunt activate, fiind indus\u0103 sinteza \u015fi secre\u0163ia de mediatori. Prin aceste mecanisme bazofilele \u015fi mastocitele sunt factori importan\u0163i \u00een inflama\u0163iile alergice \u015fi alte fenomene imune \u015fi inflamatorii.<\/p>\n<p>Bazofilele sunt celule av\u00e2nd kinetica \u015fi istoria natural\u0103 a granulocitelor, care se matureaz\u0103 \u00een m\u0103duv\u0103, circul\u0103 \u00een s\u00e2nge \u015fi re\u0163in anumite tr\u0103s\u0103turi ultrastructurale caracteristice dup\u0103 migrarea \u00een \u0163esuturi \u00een timpul proceselor inflamatorii \u015fi imunologice (hipersensibilitate cutanat\u0103 bazofilic\u0103, astm). Nu exist\u0103 eviden\u0163e conving\u0103toare c\u0103 bazofilele se metamorfozeaz\u0103 \u00een mastocite dup\u0103 migrarea \u00een \u0163esuturi.<\/p>\n<p>Mastocitele se matureaz\u0103 \u00een mod obi\u015fnuit \u00een afara m\u0103duvei osoase sau circula\u0163iei \u2013 \u00een general \u00een \u0163esutul conjunctiv \u015fi cavit\u0103\u0163ile seroase. Exist\u0103 anumite condi\u0163ii \u00een care num\u0103rul de progenitori mastocitari din circula\u0163ie poate fi crescut.<\/p>\n<p>Bazofilele \u015fi mastocitele difer\u0103 semnificativ \u00een ceea ce prive\u015fte fenotipul de suprafa\u0163\u0103, forma \u015fi structura nucleului; bazofilele au \u00een general mai pu\u0163ine granule \u015fi o morfologie mai omogen\u0103 dec\u00e2t mastocitele. Exist\u0103, de asemenea, diferen\u0163e \u00een ceea ce prive\u015fte mediatorii stoca\u0163i \u015fi cei nou sintetiza\u0163i dup\u0103 activare. Ambele celule con\u0163in histamin\u0103, PAF \u015fi metaboli\u0163i ai acidului arahidonic, considerate importante \u00een patogeneza bolilor inflamatorii, cum ar fi astmul. O distinc\u0163ie major\u0103 const\u0103 \u00een proteinazele care sunt con\u0163inute \u00een cantitate abundent\u0103 \u00een mastocite. Ambele celule produc citokine, spre exemplu bazofilele produc cantit\u0103\u0163i mari de IL-4 \u015fi IL-13, \u00een timp ce repertoriul mastocitelor include un spectru larg de citokine, asociate cu fenotipurile Th1 si Th2 (cum ar fi TNF).<\/p>\n<p>De asemenea, rolul bazofilelor \u015fi mastocitelor \u00een inflama\u0163iile alergice difer\u0103 \u00een func\u0163ie de stimulii care activeaz\u0103 fiecare celul\u0103. C\u00e2teva popula\u0163ii mastocitare r\u0103spund la unele neuropeptide, iar asocierea anatomic\u0103 str\u00e2ns\u0103 dintre mastocite \u015fi nervi constituie eviden\u0163a componentei neurogenice-dependente de mastocite a reac\u0163iilor alergice.<\/p>\n<p>Degranularea anafilactic\u0103 survine dup\u0103 stimularea receptorului pentru IgE sau prin alti stimuli cum ar fi componente ale complementului. Degranularea anafilactic\u0103 poate fi extensiv\u0103 implic\u00e2nd majoritatea granulelor. Dar,\u00a0\u00een numeroase reac\u0163ii inflamatorii,\u00a0\u00een care apare infiltrare mastocitar\u0103 \u015fi bazofilic\u0103, cum ar fi hipersensibilitatea cutanat\u0103 \u00eent\u00e2rziat\u0103, poate ap\u0103rea o degranulare \u015fi secre\u0163ie de mediatori mult mai pu\u0163in exploziv\u0103 (\u201cpiecemeal degranulation\u201d). Dup\u0103 degranulare, celule sunt capabile s\u0103 se refac\u0103 \u015fi s\u0103 func\u0163ioneze din nou<sup>2<\/sup>.<\/p>\n<p><strong>Valori de referin\u0163\u0103<\/strong> \u2013 bazofile = 0-200\/\u00b5L sau 0-0.2\u00d710<sup>9<\/sup>\/L (0-2% din leucocite)<sup>9<\/sup>.<\/p>\n<p><strong>Semnifica\u0163ie clinic\u0103<\/strong><\/p>\n<p>1. Bazofilia:<strong> &gt;200\/\u00b5L:<\/strong><\/p>\n<ul>\n<li>Num\u0103rul de bazofile \u015fi precursori mastocitari este crescut \u00een boli alergice: rinita alergic\u0103, polipoza nazal\u0103, sinuzita cronic\u0103, astm, dermatita atopic\u0103, alergii medicamentoase.<\/li>\n<li>In leucemia megakarioblastica din sindromul Down (trisomia 21) exist\u0103 diferen\u0163iere bazofilic\u0103 (care poate include mastocitele) din progenitorii leucemici.<\/li>\n<li>Leucemia mieloid\u0103 cronic\u0103 \u015fi alte sindroame mieloproliferative cronice (policitemia vera, metaplazia mieloida cu mielofibroza). Nivelul bazofiliei are valoare prognostic\u0103, iar criza bazofilic\u0103 anun\u0163\u0103 faza blastic\u0103 terminal\u0103 din leucemia mieloid\u0103 cronic\u0103. Hiperhistaminemia din leucemia mieloid\u0103 cronic\u0103 \u015fi celelalte sindroame mieloproliferative se coreleaz\u0103 cu num\u0103rul \u015fi turn-overul bazofilelor (\u015fi posibil \u015fi al mastocitelor).<\/li>\n<li>Mastocitoza sistemic\u0103, urticaria pigmentos\u0103 (o form\u0103 pediatric\u0103 de proliferare mastocitar\u0103 limitat\u0103, cu localizare cutanat\u0103) \u2013 num\u0103r crescut de bazofile \u015fi precursori mastocitari \u00een s\u00e2nge.<\/li>\n<li>Leucemie bazofilic\u0103.<\/li>\n<li>Boala Hodgkin.<\/li>\n<li>Anemie hemolitic\u0103 cronic\u0103, postsplenectomie.<\/li>\n<li>Postradia\u0163ii ionizante.<\/li>\n<li>Infec\u0163ii: tuberculoza, <a href=\"https:\/\/www.synevo.ro\/varicela-o-boala-contagioasa-a-copilariei\/\" data-wpel-link=\"internal\">varicela<\/a>, gripa.<\/li>\n<li>Injectarea de particule str\u0103ine.<\/li>\n<li>Hipotiroidism.<\/li>\n<\/ul>\n<p>2. Bazopenia:<strong> &lt;20\/\u00b5L:<\/strong><\/p>\n<ul>\n<li>Infec\u0163ii \u00een faz\u0103 acut\u0103.<\/li>\n<li>Reac\u0163ii de stres (sarcin\u0103, infarct miocardic).<\/li>\n<li>Dup\u0103 tratament prelungit cu steroizi, chimioterapie, iradiere.<\/li>\n<li>Absen\u0163a ereditar\u0103 a bazofilelor.<\/li>\n<li>Febra reumatic\u0103 acut\u0103 la copii.<\/li>\n<li>Hipertiroidism.<\/li>\n<\/ul>\n<p>3. Prezen\u0163a de precursori mastocitari \u00een sange:<\/p>\n<ul>\n<li>Urticarie, astm.<\/li>\n<li>Soc anafilactic.<\/li>\n<li>Mastocitoz\u0103 sistemic\u0103, urticaria pigmentoas\u0103, leucemia cu mastocite.<\/li>\n<li>Macroglobulinemie, limfoame cu invazie medular\u0103.<\/li>\n<li>Insuficien\u0163a corticosuprarenaliana.<\/li>\n<li>Boli hepatice \u015fi renale cronice.<\/li>\n<li><a href=\"https:\/\/www.synevo.ro\/osteoporoza-boala-usor-de-diagnosticat\/\" data-wpel-link=\"internal\">Osteoporoza<\/a> <sup>4;6;8;19<\/sup>.<\/li>\n<\/ul>\n<p>Interferen\u0163e medicamentoase:<\/p>\n<ul>\n<li><strong>Cre\u015fteri ale bazofilelor<\/strong>: desipramina, paroxetin, tretinoin, triazolam.<\/li>\n<li><strong>Sc\u0103deri ale bazofilelor:<\/strong> procainamida, tiopental<sup>6<\/sup>.<\/li>\n<\/ul>\n<p>Anexa 7.1.1<\/p>\n<div>\n<table class=\"wp-block-table w-100\" width=\"1017\">\n<tbody>\n<tr>\n<td colspan=\"2\" rowspan=\"4\" width=\"68\"><strong>V<\/strong><strong>\u00e2rst\u0103<\/strong><\/td>\n<td rowspan=\"4\" width=\"78\"><strong>Nr. eritro-<\/strong>&nbsp;<\/p>\n<p><strong>cite<\/strong><\/p>\n<p><strong>(x10<sup>6<\/sup>\/\u00b5L)<\/strong><\/td>\n<td rowspan=\"4\" width=\"59\"><strong>Hb<\/strong>&nbsp;<\/p>\n<p><strong>(g\/dL)<\/strong><\/td>\n<td rowspan=\"4\" width=\"59\"><strong>Ht<\/strong>&nbsp;<\/p>\n<p><strong>(%)<\/strong><\/td>\n<td rowspan=\"4\" width=\"59\"><strong>VEM<\/strong>&nbsp;<\/p>\n<p><strong>(fL)<\/strong><\/td>\n<td rowspan=\"4\" width=\"59\"><strong>HEM<\/strong>&nbsp;<\/p>\n<p><strong>(pg)<\/strong><\/td>\n<td rowspan=\"4\" width=\"64\"><strong>CHEM<\/strong>&nbsp;<\/p>\n<p><strong>(g\/dL)<\/strong><\/td>\n<td rowspan=\"4\" width=\"78\"><strong>Nr.<\/strong>&nbsp;<\/p>\n<p><strong>leuco-<\/strong><\/p>\n<p><strong>cite<\/strong><\/p>\n<p><strong>(x10<sup>3<\/sup>\/\u00b5L)<\/strong><\/td>\n<td colspan=\"3\" width=\"189\"><strong>Nr. neutrofile<\/strong><\/td>\n<td rowspan=\"2\" width=\"62\"><strong>Limfo-<\/strong>&nbsp;<\/p>\n<p><strong>cite<\/strong><\/td>\n<td rowspan=\"2\" width=\"60\"><strong>Mono-<\/strong>&nbsp;<\/p>\n<p><strong>cite<\/strong><\/td>\n<td rowspan=\"2\" width=\"67\"><strong>Eozino-<\/strong>&nbsp;<\/p>\n<p><strong>file<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>Bazo-file<\/strong><\/td>\n<td rowspan=\"4\" width=\"59\"><strong>Trombocite (x10<sup>3<\/sup>\/<\/strong><strong> \u00b5L)<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>Total<\/strong><\/td>\n<td width=\"72\"><strong>Nesegm.<\/strong><\/td>\n<td width=\"59\"><strong>Segm.<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>%<\/strong><\/td>\n<td width=\"72\"><strong>%<\/strong><\/td>\n<td width=\"59\"><strong>%<\/strong><\/td>\n<td width=\"62\"><strong>%<\/strong><\/td>\n<td width=\"60\"><strong>%<\/strong><\/td>\n<td width=\"67\"><strong>%<\/strong><\/td>\n<td width=\"59\"><strong>%<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>#<\/strong><\/td>\n<td width=\"72\"><strong>#<\/strong><\/td>\n<td width=\"59\"><strong>#<\/strong><\/td>\n<td width=\"62\"><strong>#<\/strong><\/td>\n<td width=\"60\"><strong>#<\/strong><\/td>\n<td width=\"67\"><strong>#<\/strong><\/td>\n<td width=\"59\"><strong>#<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>&lt;1 luna<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.9-5.9<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>13.4-19.8<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>41-65<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>85-120<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>30-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>28-35<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>5.0-20.0<\/strong><\/td>\n<td width=\"59\"><strong>20-40<\/strong><\/td>\n<td width=\"72\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>20-35<\/strong><\/td>\n<td width=\"62\"><strong>35-65<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<td rowspan=\"32\" width=\"59\"><strong>\u00a0<\/strong>&nbsp;<\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>150 -450<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-9.5<\/strong><\/td>\n<td width=\"72\"><strong>0-0.5<\/strong><\/td>\n<td width=\"59\"><strong>1.0-9.0<\/strong><\/td>\n<td width=\"62\"><strong>2.0-17.0<\/strong><\/td>\n<td width=\"60\"><strong>0-1.7<\/strong><\/td>\n<td width=\"67\"><strong>0-0.85<\/strong><\/td>\n<td width=\"59\"><strong>0-0.6<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>1 luna<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.3-5.3<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>10.7-17.1<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>33-55<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>85-110<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>29-36<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>28-35<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>5.0-20.0<\/strong><\/td>\n<td width=\"59\"><strong>20-40<\/strong><\/td>\n<td width=\"72\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>20-35<\/strong><\/td>\n<td width=\"62\"><strong>40-70<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-9.5<\/strong><\/td>\n<td width=\"72\"><strong>0-0.5<\/strong><\/td>\n<td width=\"59\"><strong>1.0-9.0<\/strong><\/td>\n<td width=\"62\"><strong>2.0-17.0<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.85<\/strong><\/td>\n<td width=\"59\"><strong>0-0.6<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>2-3 luni<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.3-5.3<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>9.4-13.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>28-42<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>84-106<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>27-34<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>28-35<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.5<\/strong><\/td>\n<td width=\"59\"><strong>15-50<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>15-40<\/strong><\/td>\n<td width=\"62\"><strong>40-70<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.0-7.5<\/strong><\/td>\n<td width=\"62\"><strong>4.0-13.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.6<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>4-5 luni<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.5-5.1<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>10.3-14.1<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>32-44<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>76-97<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-32<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>29-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.5<\/strong><\/td>\n<td width=\"59\"><strong>15-50<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>15-40<\/strong><\/td>\n<td width=\"62\"><strong>40-70<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.0-7.5<\/strong><\/td>\n<td width=\"62\"><strong>4.0-13.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.6<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>6-8 luni<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.9-5.5<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.4-14.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>33-41<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>70-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-30<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.5<\/strong><\/td>\n<td width=\"59\"><strong>15-50<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>15-40<\/strong><\/td>\n<td width=\"62\"><strong>40-70<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.5<\/strong><\/td>\n<td width=\"62\"><strong>4.0-13.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>9-11 luni<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.0-5.3<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.4-14.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>33-41<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>70-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-30<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.5<\/strong><\/td>\n<td width=\"59\"><strong>15-50<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>15-40<\/strong><\/td>\n<td width=\"62\"><strong>40-65<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.0-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.5<\/strong><\/td>\n<td width=\"62\"><strong>4.0-10.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>1 an<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.1-5.3<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.3-14.1<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>32-40<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>70-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>22-30<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-38<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.5<\/strong><\/td>\n<td width=\"59\"><strong>20-65<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>20-55<\/strong><\/td>\n<td width=\"62\"><strong>40-65<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-5<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.5-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.5<\/strong><\/td>\n<td width=\"62\"><strong>4.0-10.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>2-3 ani<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.7-4.9<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.0-14.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>32-42<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>73-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-31<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>6.0-17.0<\/strong><\/td>\n<td width=\"59\"><strong>30-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>30-65<\/strong><\/td>\n<td width=\"62\"><strong>30-55<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.5-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.5<\/strong><\/td>\n<td width=\"62\"><strong>3.0-9.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>4-5 ani<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.7-4.9<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.0-14.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>32-42<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>73-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-31<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>5.5-15.5<\/strong><\/td>\n<td width=\"59\"><strong>30-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>30-65<\/strong><\/td>\n<td width=\"62\"><strong>25-55<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.5-8.5<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.5<\/strong><\/td>\n<td width=\"62\"><strong>2.0-8.0<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>6-8 ani<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.8-4.9<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>11.5-14.5<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>33-41<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>75-89<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>25-31<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>5.0-14.5<\/strong><\/td>\n<td width=\"59\"><strong>30-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>30-65<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-10<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.5-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.5-7.0<\/strong><\/td>\n<td width=\"62\"><strong>1.5-7.0<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td colspan=\"2\" rowspan=\"2\" width=\"68\"><strong>9-11 ani<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>3.9-5.1<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>12.0-15.0<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>34-43<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>76-90<\/strong><\/td>\n<td rowspan=\"2\" width=\"59\"><strong>26-32<\/strong><\/td>\n<td rowspan=\"2\" width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.5-13.5<\/strong><\/td>\n<td width=\"59\"><strong>35-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>35-65<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"59\"><strong>1.8-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.8-7.0<\/strong><\/td>\n<td width=\"62\"><strong>1.5-6.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"43\"><strong>12-14 ani<\/strong><\/td>\n<td width=\"25\"><strong>B<\/strong><\/td>\n<td width=\"78\"><strong>4.1-5.2<\/strong><\/td>\n<td width=\"59\"><strong>12.0-16.0<\/strong><\/td>\n<td width=\"59\"><strong>35-45<\/strong><\/td>\n<td width=\"59\"><strong>77-94<\/strong><\/td>\n<td width=\"59\"><strong>26-32<\/strong><\/td>\n<td width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.5-13.5<\/strong><\/td>\n<td width=\"59\"><strong>40-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>40-65<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"25\"><strong>F<\/strong><\/td>\n<td width=\"78\"><strong>3.8-5.0<\/strong><\/td>\n<td width=\"59\"><strong>11.5-15.0<\/strong><\/td>\n<td width=\"59\"><strong>34-44<\/strong><\/td>\n<td width=\"59\"><strong>76-95<\/strong><\/td>\n<td width=\"59\"><strong>26-32<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td width=\"59\"><strong>1.8-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.8-7.0<\/strong><\/td>\n<td width=\"62\"><strong>1.5-6.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"43\"><strong>15-17 ani<\/strong><\/td>\n<td width=\"25\"><strong>B<\/strong><\/td>\n<td width=\"78\"><strong>4.2-5.6<\/strong><\/td>\n<td width=\"59\"><strong>11.7-16.6<\/strong><\/td>\n<td width=\"59\"><strong>37-48<\/strong><\/td>\n<td width=\"59\"><strong>79-95<\/strong><\/td>\n<td width=\"59\"><strong>27-32<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.5-13.0<\/strong><\/td>\n<td width=\"59\"><strong>40-75<\/strong><\/td>\n<td width=\"72\"><strong>0-10<\/strong><\/td>\n<td width=\"59\"><strong>40-65<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"25\"><strong>F<\/strong><\/td>\n<td width=\"78\"><strong>3.9-5.1<\/strong><\/td>\n<td width=\"59\"><strong>11.7-15.3<\/strong><\/td>\n<td width=\"59\"><strong>34-44<\/strong><\/td>\n<td width=\"59\"><strong>78-98<\/strong><\/td>\n<td width=\"59\"><strong>26-34<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td width=\"59\"><strong>1.8-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-1.0<\/strong><\/td>\n<td width=\"59\"><strong>1.8-7.0<\/strong><\/td>\n<td width=\"62\"><strong>1.5-6.5<\/strong><\/td>\n<td width=\"60\"><strong>0-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"43\"><strong>18-44 ani<\/strong><\/td>\n<td width=\"25\"><strong>B<\/strong><\/td>\n<td width=\"78\"><strong>4.3-5.7<\/strong><\/td>\n<td width=\"59\"><strong>13.2-17.3<\/strong><\/td>\n<td width=\"59\"><strong>39-49<\/strong><\/td>\n<td width=\"59\"><strong>80-99<\/strong><\/td>\n<td width=\"59\"><strong>27-34<\/strong><\/td>\n<td width=\"64\"><strong>32-37<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.0-10.0<\/strong><\/td>\n<td width=\"59\"><strong>45-80<\/strong><\/td>\n<td width=\"72\"><strong>0-4<\/strong><\/td>\n<td width=\"59\"><strong>45-76<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"25\"><strong>F<\/strong><\/td>\n<td width=\"78\"><strong>3.8-5.1<\/strong><\/td>\n<td width=\"59\"><strong>11.7-15.5<\/strong><\/td>\n<td width=\"59\"><strong>35-45<\/strong><\/td>\n<td width=\"59\"><strong>81-100<\/strong><\/td>\n<td width=\"59\"><strong>27-34<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td width=\"59\"><strong>2.0-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-0.4<\/strong><\/td>\n<td width=\"59\"><strong>2.0-7.6<\/strong><\/td>\n<td width=\"62\"><strong>1.0-4.0<\/strong><\/td>\n<td width=\"60\"><strong>0.3-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0.05-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"43\"><strong>45-64 ani<\/strong><\/td>\n<td width=\"25\"><strong>B<\/strong><\/td>\n<td width=\"78\"><strong>4.2-5.6<\/strong><\/td>\n<td width=\"59\"><strong>13.1-17.2<\/strong><\/td>\n<td width=\"59\"><strong>39-50<\/strong><\/td>\n<td width=\"59\"><strong>81-101<\/strong><\/td>\n<td width=\"59\"><strong>27-35<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.0-10.0<\/strong><\/td>\n<td width=\"59\"><strong>45-80<\/strong><\/td>\n<td width=\"72\"><strong>0-4<\/strong><\/td>\n<td width=\"59\"><strong>45-76<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"25\"><strong>F<\/strong><\/td>\n<td width=\"78\"><strong>3.8-5.3<\/strong><\/td>\n<td width=\"59\"><strong>11.7-16.0<\/strong><\/td>\n<td width=\"59\"><strong>35-47<\/strong><\/td>\n<td width=\"59\"><strong>81-101<\/strong><\/td>\n<td width=\"59\"><strong>27-34<\/strong><\/td>\n<td width=\"64\"><strong>31-36<\/strong><\/td>\n<td width=\"59\"><strong>2.0-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-0.4<\/strong><\/td>\n<td width=\"59\"><strong>2.0-7.6<\/strong><\/td>\n<td width=\"62\"><strong>1.0-4.0<\/strong><\/td>\n<td width=\"60\"><strong>0.3-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0.05-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<tr>\n<td rowspan=\"2\" width=\"43\"><strong>65-74 ani<\/strong><\/td>\n<td width=\"25\"><strong>B<\/strong><\/td>\n<td width=\"78\"><strong>3.8-5.8<\/strong><\/td>\n<td width=\"59\"><strong>12.6-17.4<\/strong><\/td>\n<td width=\"59\"><strong>37-51<\/strong><\/td>\n<td width=\"59\"><strong>81-103<\/strong><\/td>\n<td width=\"59\"><strong>27-34<\/strong><\/td>\n<td width=\"64\"><strong>31-36<\/strong><\/td>\n<td rowspan=\"2\" width=\"78\"><strong>4.0-10.0<\/strong><\/td>\n<td width=\"59\"><strong>45-80<\/strong><\/td>\n<td width=\"72\"><strong>0-4<\/strong><\/td>\n<td width=\"59\"><strong>45-76<\/strong><\/td>\n<td width=\"62\"><strong>20-55<\/strong><\/td>\n<td width=\"60\"><strong>0-15<\/strong><\/td>\n<td width=\"67\"><strong>0-7<\/strong><\/td>\n<td width=\"59\"><strong>0-2<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"25\"><strong>F<\/strong><\/td>\n<td width=\"78\"><strong>3.8-5.2<\/strong><\/td>\n<td width=\"59\"><strong>11.7-16.1<\/strong><\/td>\n<td width=\"59\"><strong>35-47<\/strong><\/td>\n<td width=\"59\"><strong>81-102<\/strong><\/td>\n<td width=\"59\"><strong>27-35<\/strong><\/td>\n<td width=\"64\"><strong>32-36<\/strong><\/td>\n<td width=\"59\"><strong>2.0-8.0<\/strong><\/td>\n<td width=\"72\"><strong>0-0.4<\/strong><\/td>\n<td width=\"59\"><strong>2.0-7.6<\/strong><\/td>\n<td width=\"62\"><strong>1.0-4.0<\/strong><\/td>\n<td width=\"60\"><strong>0.3-1.0<\/strong><\/td>\n<td width=\"67\"><strong>0.05-0.7<\/strong><\/td>\n<td width=\"59\"><strong>0-0.2<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>&nbsp;<\/p>\n<h2><strong>Bibliografie<\/strong><\/h2>\n<div>1. B Weinberg. Monunuclear Phagocytes. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 349-377.<\/div>\n<div>2. Befus D, Denburg J. Basophilic Leukocytes: Mast Cells and Basophils. In Wintrobe\u2019s Clinical Hematology. Lippincott, Williams, and Wilkins, Philadelphia, 11 ed. ed. 2004, 336-345.<\/div>\n<div>3. Carmel L. Megaloblastic Anemias: Disorders of Impaired DNA Synthesis. In Wintrobe\u2019s Clinical Hematology. Lippincott, Williams, and Wilkins, Philadelphia, 11 ed. 2004, 1367-1413.<\/div>\n<div>4. DeMott W, Tilzer L. Hematology. In Laboratory Test Handbook. Hudson (Cleveland) ed. 1994, 517-617.<\/div>\n<div>5. Desai S. Complete Blood Count. In Clinicians\u2019s Guide to Laboratory Medicine. Hudson (Cleveland) ed. 2004, 13-18.<\/div>\n<div>6. Fischbach F. Blood Studies: Hematology and Coagulation; Appendix J: Effects of the Most Commonly Used Drugs on Frequently Ordered Laboratory Tests. In A Manual of Laboratory and Diagnostic Tests. Lippincott Williams &amp; Wilkins, Philadelphia, 8 ed. 2009, 67-110, 1227-1247.<\/div>\n<div>7. Glader B. Anemia: General Considerations. In Wintrobe\u2019s Clinical Hematology, Philadelphia. 2004, 948-975.<\/div>\n<div>8. J Wallach. Hematologic Diseases. In Interpretation of Diagnostic Tests. Philadelphia ed. 1996, 293-316.<\/div>\n<div>9. Laborator Synevo. Referintele specifice tehnologiei de lucru utilizate. 2010. Ref Type: Catalog<\/div>\n<div>10. Lacy P, Becker A, Moqbel R. The Human Eosinophil. In Wintrobe\u2019s Clinical Hematology. Philadelphia, ed. 2004, 311-329.<\/div>\n<div>11. Levine S. Miscellaneous Causes of Thrombocytopenia. In Wintrobe\u2019s Clinical Hematology, Philadelphia. Philadelphia ed. 2004, 1565-1570.<\/div>\n<div>12. Levine S. Thrombocytopenia: Pathophysiology and Classification. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 1529-1531.<\/div>\n<div>13. Levine S. Thrombocytosis. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 1591-1597.<\/div>\n<div>14. Means R. Erythrocytosis. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 1495-1505.<\/div>\n<div>15. Paraskevas F. Lymphocytes and Lymphatic Organs. In Wintrobe\u2019s Clinical Hematology. Philadelphia, ed. 2004, 409-433.<\/div>\n<div>16. Perkins S. Examination of the Blood and Bone Marrow. In Wintrobe\u2019s Clinical Hematology. Philadelphia, ed. 2004, 3-21.<\/div>\n<div>17. Rodgers G. Diagnostic Approach of the Bleeding Disorders. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 1511-1526.<\/div>\n<div>18. Skubitz K. Neutrofilic Leukocytes. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 268-303.<\/div>\n<div>19. Thomas L, Bartl R. Hematology. In Clinical Laboratory Diagnostics. 1998, 463-547.<\/div>\n<div>20. Watts R. Neutropenia. In Wintrobe\u2019s Clinical Hematology. Philadelphia ed. 2004, 1777-1795.<\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Informa\u021bii generale Hemogram\u0103 cu formul\u0103 leucocitar\u0103 cu Hb, Ht \u0219i indici Hemograma const\u0103 din m\u0103surarea urm\u0103torilor parametrii: num\u0103r de leucocite; num\u0103r de eritrocite; concentra\u0163ia de hemoglobin\u0103; hematocrit; indici eritrocitari: volumul eritrocitar mediu (VEM), hemoglobina eritrocitar\u0103 medie (HEM), concentra\u0163ia medie de hemoglobin\u0103 (CHEM) \u015fi l\u0103rgimea distribu\u0163iei eritrocitare (RDW); num\u0103r de trombocite \u015fi indici trombocitari: volumul trombocitar [&hellip;]<\/p>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false},"product_brand":[],"product_cat":[53,34],"product_tag":[],"class_list":["post-192","product","type-product","status-publish","product_cat-morfofiziologie","product_cat-teste-de-hematologie","first","instock","shipping-taxable","purchasable","product-type-simple"],"acf":[],"_links":{"self":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product\/192","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product"}],"about":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/types\/product"}],"wp:attachment":[{"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/media?parent=192"}],"wp:term":[{"taxonomy":"product_brand","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_brand?post=192"},{"taxonomy":"product_cat","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_cat?post=192"},{"taxonomy":"product_tag","embeddable":true,"href":"https:\/\/analizesanocare.ro\/en\/wp-json\/wp\/v2\/product_tag?post=192"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}