Morfologia krwi

Krew jest rodzajem płynnej tkanki łącznej, krąży w naczyniach krwionośnych, które porównać można do zamkniętego układu „przewodów”. Jej głównym zadaniem jest dostarczanie tlenu, substancji odżywczych, hormonów i enzymów do każdej komórki organizmu. Stanowi również barierę dla mikroorganizmów chorobotwórczych. W składzie krwi wyróżniamy elementy morfotyczne oraz płynne osocze. Do elementów morfotycznych należą krwinki czerwone i białe oraz płytki krwi. Ich badanie nazywa się morfologią.

Krwinki czerwone (erytrocyty, RBC)

Czerwone krwinki krwi są przenośnikami tlenu. Jak nazwa wskazuje, mają czerwoną barwę, którą nadaje zawarta w nich hemoglobina – substancja, która wiąże i oddaje tlen. Erytrocytów jest najwięcej w stosunku do innych elementów morfotycznych, dlatego też krew przyjmuje kolor czerwony.

Wartości prawidłowe:

  • Kobiety: 4,2-5,4 x 1012/l
  • Mężczyźni: 4,7-6,1 x 1012/l

Zwiększona liczba erytrocytów (erytrocytoza) może być spowodowana niedotlenieniem lub wzmożoną produkcją hormonu pobudzającego wytwarzanie krwinek czerwonych we krwi. Zdarza się, że jest również wynikiem nowotworowego rozrostu krwinek czerwonych. Bardziej powszechny jest spadek poziomu erytrocytów (erytropenia). Może być on spowodowany niedoborem witaminy B12 lub kwasu foliowego (tzw. niedokrwistość megaloblastyczna). Niedokrwistość może być również wynikiem rozpadu erytrocytów (niedokrwistość hemolityczna), lub niedoboru żelaza. Do innych przyczyn wtórnych zaliczają się między innymi: ciąża, choroby nerek, choroby przewlekłe, nowotwory.

Krwinki białe (leukocyty, WBC)

Leukocyty to krwinki odpornościowe. Mają za zadanie bronić przed bakteriami, wirusami, pierwotniakami itp. Składają się z kilku podtypów - granulocytów, limfocytów i monocytów.

Wartości prawidłowe:

  • 4,0-10,8 x 109/l

Wzrost liczby krwinek białych (leukocytoza) może być spowodowany przyczynami fizjologicznymi. Należą do nich: wysoka temperatura otoczenia, opalanie się na słońcu, ciąża, wysiłek fizyczny, stres. Podwyższone wartości świadczyć mogą także o zmianach patologicznych takich jak: stany zapalne narządów, uszkodzenie tkanek, zatrucia, nowotwory.

Spadek ilości krwinek białych (leukopenia) może być wynikiem niektórych chorób zakaźnych, WZW, zakażenia wirusem HIV, uszkodzenia szpiku kostnego, ciężkich zakażeń bakteryjnych.

Płytki krwi - Trombocyty (PLT)

Trombocyty to wyspecjalizowane komórki, które biorą udział w procesie krzepnięcia krwi.

Wartości prawidłowe:

  • 130-450 x 109/l

Zwiększona liczba trombocytów występuje w przypadku różnych przewlekłych stanów zapalnych, w niedoborze żelaza, po usunięciu śledziony, niektórych procesach nowotworowych. Związana może być także z ciążą. Zdarza się też tzw. nadpłytkowość samoistna. Niskie wartości płytek krwi (trombocypenia) spowodowane są np. niedoborami witaminy B12 lub kwasu foliowego, infekcjami, przyjmowaniem niektórych leków.

Hematokryt (HCT)

Hematokryt dostarcza informacji, jaki procent krwi stanowią elementy morfotyczne, a ściślej czerwone krwinki (erytrocyty).

Wartości prawidłowe:

  • Kobiety: 37-47 % 
  • Mężczyźni: 42-52 %

Wysoki hematokryt może być spowodowany nadkrwistością pierwotną (czerwienica prawdziwa) i wtórną (przewlekłe choroby płuc, nowotwory nerek, przebywanie na wysokościach). Zwiększony poziom bywa także skutkiem odwodnienia, zapalenia otrzewnej i rozległych oparzeń. Obniżone stężenie hematokrytu może być skutkiem: przewodnienia, niedokrwistości, utraty krwi, hemolizy wewnątrznaczyniowej (reakcja potransfuzyjna), chorób szpiku kostnego.

Hemoglobina (HGB, Hb)

Wartości prawidłowe:

  • Noworodki: 14,2-19,6 g/dl (8,8-12,2 mmol/l)
  • Kobiety: 11,5-16,0 g/dl (7,2-10,0 mmol/l)
  • Mężczyźni: 12,5-18,0 g/dl (7,8-11,3 mmol/l) 

Obniżony poziom hemoglobiny jest głównie wynikiem niedokrwistości i przewodnienia organizmu. Wzrost stężenia hemoglobiny obserwuje się w nadkrwistościach i w zaburzeniach gospodarki wodno - elektrolitowej (odwodnienie).

Bazocyty - Granulocyty zasadochłonne (BASO)

Wartości prawidłowe:

  • 0-0,2 x 109/l

Liczba bazocytów zwiększa się w stanach alergicznych, białaczce szpikowej, przewlekłych stanach zapalnych przewodu pokarmowego, , niedoczynności tarczycy. Obniżone wartości mogą pojawić się w ostrych infekcjach, gorączce reumatycznej, nadczynności tarczycy, zapaleniu płuc.

Eozynocyty - Granulocyty kwasochłonne (EOS)

Wartości prawidłowe:

  • 0-0,45 x 109/l

Wzrost stężenia eozynocytów wywołują choroby alergiczne, zakaźne, hematologiczne, pasożytnicze, astma oskrzelowa, katar sienny, łuszczyca oraz zażywanie niektórych leków. Spadek spowodowany może być: zakażeniami, czerwonką, posocznicą, urazami, oparzeniami, działaniem hormonów nadnerczowych, a także wysiłkiem fizycznym.

Neutrocyty - Granulocyty obojętnochłonne (NEUT)

Wartości prawidłowe:

  • 1,8-7,7 x 109/l

Wzrost stężenia występuje w zakażeniach miejscowych i ogólnych, urazach, utracie krwi, zawale mięśnia sercowego, chorobach metabolicznych, hematologicznych, nowotworach. Zwiększoną ich wartość można zaobserwować u osób palących i kobiet w trzecim trymestrze ciąży. Spadek liczby neutrocytów spotykany jest głównie w zakażeniach bakteryjnych, wirusowych, grzybiczych i pierwotniakowych.

Limfocyty (LYMPH)

Wartości prawidłowe:

  • 1,0-4,5 x 109/l

Liczba limfocytów wzrasta w związku z procesami chorobowymi do których należą: odra, świnka, gruźlica, różyczka, krztusiec, białaczka, chłoniaki, choroby immunologiczne. Obniżone wartości może wywołać stosowanie kortykosterydów oraz poważne zakażenia wirusowe.

Monocyty (MONO)

Wartości prawidłowe:

  • 0-0,8 x 109/l

Podwyższone wartości monocytów mogą świadczyć o wielu różnych chorobach tj.: bruceloza, zapalenie wsierdzia, mononukleoza zakaźna, gruźlica, kiła, zakażenie pierwotniakami, nowotwory. Spadek ich liczby może być oznaką infekcji, a także stosowania glikosterydów.

Pozostałe oznaczenia w morfologii

 Pozostałe oznaczenia w morfologii 

Opracowanie: Opracowanie:  dr hab. n.med. Bernarda Kazanowska, prof. nadzw., Optimum Profesorskie Centrum Medyczne

Materiały mają charakter informacyjny.

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