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989_neutro

989_neutro

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CAMLT Distance Learning Course DL-989 1© California Association for Medical Laboratory Technology
California Association forMedical Laboratory TechnologyDistance Learning Program
NEUTROPHILIA
 
byHelen M. Sowers, MA, CLSDept. of Biological Science (retired)California State University, East BayHayward, CADora W. Goto, MS, CLS, MT(ASCP)Laboratory ManagerBay Valley Medical GroupHayward, CA
 
Course DL-9891.0 CE/Contact HourLevel: Basic
© California Association for Medical Laboratory Technology.Permission to reprint any part of these materials, other than for credit from CAMLT,must be obtained in writing from the CAMLT Executive Office.CAMLT is approved by the California Department of Health Services as aCA CLS Accrediting Agency (#0021)and this course is approved by ASCLS for the P.A.C.E.® Program (#519)1895 Mowry Ave - Suite 112, Fremont, CA 94538Phone 510-792-4441 Fax 510-792-3045
Notification of Distance Learning Deadline
 All continuing education units required to renew your license must be earned no later than theexpiration date printed on your license. If some of your units are made up of DistanceLearning courses, please allow yourself enough time to retake the test in the event you do notpass on the first attempt. CAMLT urges you to earn your CE units early!
 
CAMLT Distance Learning Course DL-989 2© California Association for Medical Laboratory Technology
NEUTROPHILIAABSTRACT:
The production and distribution of normally functioning neutrophils is vital to hostdefenses. In order to understand the normal condition compared to changes that occur indisease states, the development, structure, function, and kinetics of neutrophils will bediscussed.There are a number of causes for increase in neutrophils. In this course we presenttwo cases of neutrophilia and compare the etiology, laboratory findings, and microscopicmorphology for each. Other causes of neutrophilia will be discussed.
OBJECTIVES:
After completing this course the participant will be able to:1.
 
Outline the maturation stages of neutrophils.2.
 
Discuss how neutrophils protect the body against foreign invaders.3.
 
Explain the difference between shift neutrophilia and absolute neutrophilia.4.
 
Compare the microscopic morphology of neutrophils in infections to those in chronicmyelocytic leukemia.5.
 
Discuss the other findings and causes of neutrophilia in infections compared tochronic myelocytic leukemia.6.
 
List other causes of neutrophilia.
Case #1
: A 59-year-old patient with high fever and chills
Reference interval Reference interval
WBC 27.2 x 10
3
 /µL
4.1 – 11.0 x 10
3
 /µL
 
RBC 5.03 x 10
6
 /µL
4.20 – 6.30 x 10
6
 /µL
Lym 9.3 %
13.0 – 48.5 %
HGB 15.2 g/dL
12.0 – 18.0 g/dL
MID 2.7 %
0.1 – 11.0 %
HCT 45.5 %
37.0 – 51.0 %
Gran 88.0 %
46.5 – 82.0 %
MCV 90.5 fL
80.0 – 97 fL
MCH 30.2 pg
26.0 – 32.0 pg
PLT 222 x 10
3
 /µL
140 – 440 x 10
3
 /µL
MCHC 33.4 g/dL
31.0 – 36.0 g/dL
RDW 11.6 %
11.5 – 14.5 %
 
MID cells may include less frequentlyoccurring and rare cells correlating to Performed on Abbott Cell-Dyn 1800monocytes, eosinophils, basophils,blasts, and other precursor white cells.
1. What is abnormal about the CBC?2. Which parameters can be reported?3. What procedures can be done regarding abnormal result(s)?
 
CAMLT Distance Learning Course DL-989 3© California Association for Medical Laboratory Technology
Case #2
: A 35-year-old male complaining of fatigue
Reference interval Reference interval
WBC >>> 10
3
 /µL
4.1 – 11.0 x 10
3
 /µL
 
RBC 4.33 x 10
6
 /µL
4.20 – 6.30 x 10
6
 /µL
Lym 5.8 %
13.0 – 48.5 %
HGB 13.5 g/dL
12.0 – 18.0 g/dL
MID 7.1 %
0.1 – 11.0 %
HCT 38.9 %
37.0 – 51.0 %
Gran 87.1 %
46.5 – 82.0 %
MCV 89.9 fL
80.0 – 97 fL
MCH 31.2 pg
26.0 – 32.0 pg
PLT 189 x 10
3
 /µL
140 – 440 x 10
3
 /µL
MCHC 34.7 g/dL
31.0 – 36.0 g/dL
RDW 13.6 %
11.5 – 14.5 %
 
MID cells may include less frequentlyoccurring and rare cells correlating to Performed on Abbott Cell-Dyn 1700monocytes, eosinophils, basophils,blasts, and other precursor white cells.
1. What is abnormal about the CBC?2. Which parameters can be reported?3. What procedures can be done regarding abnormal result(s)?
DISCUSSION:
Neutrophils are one of the three granulocyte types (eosinophils, basophils, andneutrophils) found in peripheral blood. Neutrophils are the most numerous leukocyte, (whiteblood cell [WBC]), normally 55% to 75% of the leukocytes in the adult. The neutrophil is sonamed because the granules in mature neutrophils stain with the neutral dyes in Wright’sstain, appearing faint pink-lavender.
Development of Neutrophils:
 Neutrophils are produced in the bone marrow from pluripotential hematopoietic stemcells. These hematopoietic stem cells can differentiate into all the blood cell types. One lineof differentiation begins with a stem cell (CFU-GEMM) capable of developing intogranulocytes, erythrocytes, monocytes, and megakaryocytes. The next differentiation is theCFU-GM (colony forming unit granulocyte, monocyte). This in turn differentiates intoCFU-G, the neutrophil cell line. This neutrophil stem cell is no longer capable of producingother blood cell types. Myeloblasts are the first morphologically recognizable cells in theneutrophil cell line. Neutrophils go through six morphologic stages before release into theperipheral blood: myeloblast, promyelocyte, myelocyte, metamyelocyte, band, andpolymorphonuclear (PMN) neutrophil. The first three of these stages are capable of replication as well as differentiation (maturation). The last three stages are only able tomature. The maturation stages and morphology of immature neutrophils are shown in thefollowing sequence:

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