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660 Unit V Medical Surgical Nursing Care

oxygen content of the blood. Old red blood cells are trapped by
the liver where they are destroyed, though the iron contained in
the destroyed red blood cell is retained and used in the formation
of new red blood cells. The iron in the red blood cell is required
for the formation of hemoglobin. It allows the hemoglobin mole-
cule to transport oxygen. This makes iron critical to the oxygen-
transporting function of the red blood cell.
White blood cells or leukocytes are critical in the fight
against inflammation and infection. White blood cells are
divided into two types:
1. Granulocytes. The granulocytes are further differentiated into
neutrophils, eosinophils, and basophils. Approximately two-
thirds of all white blood cells are neutrophils. They have a very
short life span (about 10 hours), so the bone marrow is con-
stantly replacing them. The neutrophils increase in number
in response to inflammation in the body. The eosinophils and
basophils respond primarily to allergic reactions.
2. Agranulocytes. The agranulocytes are divided into mono-
cytes and lymphocytes. The monocytes kill bacteria and
respond to the presence of foreign materials in the body.
The lymphocytes are formed in lymphatic tissue and are
needed for a healthy immune system.
Platelets are elements in the blood that are necessary for
proper blood coagulation. The production of platelets is con-
trolled by thrombopoietin (a protein manufactured by the
liver, the kidney, the smooth muscle, and the bone marrow).
The release of thrombopoietin is controlled by the number of
platelets present in the blood. Table 26-1 ■ provides normal
values for a complete blood count.
Collaborative Care
LABORATORY TESTS
There are many laboratory tests that can indicate disorders of
the hematopoietic and lymphatic systems. All clients will first
have a complete blood count (CBC). This blood test measures

TABLE 26-1
Complete Blood Count with Normal Values
LABORATORY TEST NORMAL VALUES WHAT TEST MEASURES
Red Blood Cell (RBC)
RBC count Number of circulating RBCs per cubic millimeter of blood
■ Men 4.2–5.4 million/mm3
■ Women 3.6–5.0 million/mm3
Reticulocyte count 1–1.5% of total RBC Number of immature RBCs in 1 mm3 of blood
Hemoglobin (Hgb) Amount of hemoglobin in 100 mL (1 dL) of blood
■ Men 14–16.5 g/dL
■ Women 12–15 g/dL
Hematocrit (Hct) Packed volume of RBCs in 100 mL of blood; reported
as a percentage
■ Men 40–50%
■ Women 37–47%
Mean corpuscular volume 85–100 cubic micrometers Average volume of individual RBCs
(MCV) (µm3) per cell
Mean corpuscular 31–35 g/dL Weight of the hemoglobin in an average RBC
hemoglobin (MCH)
Mean corpuscular hemoglobin 33.4–35.5% Average concentration (percent) of hemoglobin
concentration (MCHC) within RBC

White Blood Cells (WBCs) and Platelets

WBC count 5,000–10,000/mm3 Number of WBCs per cubic millimeter of blood
Differential WBC count: Number of neutrophils released by bone marrow
3
■ Neutrophils 60–70% or 3,000–7,000/mm Active phagocytes; first to respond to inflammation or
infection
■ Eosinophils 1–3% or 50–400/mm3 Respond to allergic reaction and parasitic infestations
■ Basophils 0.3–0.5% or 25–200/mm3 Respond to allergic and inflammatory reactions
■ Lymphocytes 20–30% or 1,000–4,000/mm3 Involved in immune reactions
■ Monocytes 3–8% or 100–600/mm3 Active in disposing of foreign and waste material,
especially in inflammation