26.2.12. What mechanisms are at the basis of leukopenia, connected with the shortering of time existence of leukocytes in peripheral blood?

1. Destruction of leukocytes, may be mediated by:

a) autoimmune mechanisms (atrophic arthritis, systemic lupus erythematosus)

b) haptene mechanisms (amydopirine acute granulocytopenia)

c) hypersplenism (increase of phagocytic activity of spleen macrophages

2. Enhanced usage of leukocytes. Accelerated exit of leukocytes from the blood to tissues is precursor in case of chronic recurrent inflammation.

3. Enhanced excretion of leukocytes from the organism. Evident chronic loss of neutrophils is observed in smokers: 0,5-2•10⁸ granulocytes and 0,8-1,6•10⁸ macrophages are lost with sputum during morning cough

26.2.13. What is agranulocytosis?

It is a clinic-hematologic syndrome characterized by full blown decrease of granulocytes, below 0,75•10⁹/l at total decrease of the number of leukocytes below 1•10⁹/l.

At the basis of it there are two mechanisms:

myelotoxic – impairments of red bone marrow;

immune – breaking of granulocytic row cells by leukocytic antibodies.

Agranulocytosis is accompanied by weakening of body’s response because of the protective disfunction of leukocytes.

26.2.14. What is the shift of leukocytic formula?

Nucleic shift is breaking of ratio between immature and mature forms of neutrophils.

On count of leukograms it is determined the existence of nucleic shift of neutrophilic granulocytes to the left or the right. This terminology is related with the particularity of location the immature neutrophilic granulocytes (myelocytes, metamyelocytes, stab neutrophils) in the left part of Arnette and Shilling’s formula, but mature segmentoneucleac neutrophils are conditionally put in the right position. The increase numbers of young forms of neutrophilic granulocytes in the blood manifestates the nucleic shift to the left, the majority of mature neutrophils with a large number of segments (5-6) on the background of disappearing of younger cells – nucleic shift to the right.

26.2.15. What are the variations of the shift of leukocytic formula to the left?

There are such variations of it:

1. Regenerative shift is the index of reactive activation of granulocytopoiesis (on the background of moderate general leukocytosis the number of stab neutrophils and metamyelocytes is increased, single myelocytes can also appear)

2. Hyperregenerative shift expresses the overhyperplasia of leukopoietic tissue with the disorders of cell maturation and evident rejuvenation of blood composition. In this case the number of stab granulocytes and myelocytes is greatly increased, myelocytes and promyelocytes appear; the total number of leukocytes may be increased unchanged or even decreased due to the development of myeloid depletion after activation.

3. Degenerative shift manifestates the inhibition and deep disorders of leukopoiesis, when of the background of general leukopenia in leukogramms the number of stab neutrophilic granulocytes with degenerative changes in their cytoplasm and nucleus increases, at the same time the number of segment-nucleus forms decreases and metamyelocytes are absent.

4. Regenerative – degenerative shift is observed at hyperproduction of pathologically changed leukocytes and disorders of their maturation in bone marrow. In this case there is leukocytosis, in blood smear the myelocytes with the signs of degeneration increases.