Clinical tests provide a doctor with enormous information about the patient’s health status, and their importance for medical practice can hardly be overestimated. These research methods are quite simple, require minimal equipment and can be performed in the laboratory of almost anyone. medical institution. For this reason, clinical examinations of blood, urine and stool are routine and should be performed on all people admitted for treatment to a hospital, hospital or clinic, as well as on most patients undergoing outpatient examination for various diseases.
1.1. General clinical blood test
Blood is a liquid tissue that continuously circulates through the vascular system and delivers oxygen and nutrients to all parts of the human body, and also removes “waste” waste products from them. The total amount of blood makes up 7-8% of a person's weight. Blood consists of a liquid part - plasma and formed elements: red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (platelets).
How is blood obtained for clinical research?
To conduct a clinical analysis, capillary blood is used, which is obtained from the finger of the hand (usually the ring finger, less often the middle and index finger) by puncturing the lateral surface of the soft tissue of the terminal phalanx with a special disposable lancet. This procedure is usually performed by a laboratory assistant.
Before taking blood, the skin is treated with a 70% alcohol solution, the first drop of blood is blotted with a cotton ball, and the subsequent ones are used to prepare blood smears, collected in a special glass capillary to determine the erythrocyte sedimentation rate, as well as assess other indicators, which will be discussed below. .Basic rules for taking blood from a finger
To avoid mistakes when performing a clinical blood test, you need to follow some rules. A finger prick blood test should be taken in the morning after an overnight fast, i.e. 8-12 hours after the last meal. The exception is cases when the doctor suspects the development of a serious acute illness, for example, acute appendicitis, pancreatitis, myocardial infarction, etc. In such situations, blood is taken regardless of the time of day or meal.
Before visiting the laboratory, moderate consumption of drinking water is allowed. If you drank alcohol the day before, it is better to get your blood tested no earlier than 2-3 days later.
In addition, before taking blood for testing, it is advisable to avoid excessive physical activity (cross country, lifting weights, etc.) or other intense effects on the body (visiting a steam room, sauna, swimming in cold water, etc.). In other words, the physical activity regimen before donating blood should be as normal as possible.
You should not stretch or rub your fingers before drawing blood, as this can lead to an increase in the level of leukocytes in the blood, as well as a change in the ratio of the liquid and dense parts of the blood.
The main indicators of a clinical blood test and what their changes may indicate
The most important indicators for assessing the health status of the subject are such indicators as the ratio of the volume of liquid and cellular parts of blood, the number of cellular elements of blood and the leukocyte formula, as well as the content of hemoglobin in erythrocytes and the erythrocyte sedimentation rate.
1.1. 1. Hemoglobin
Hemoglobin is a special protein that is found in red blood cells and has the ability to attach oxygen and transfer it to various human organs and tissues. Hemoglobin is red, which determines the characteristic color of blood. The hemoglobin molecule consists of a small non-protein part called heme, which contains iron, and a protein called globin.
A decrease in hemoglobin below the lower limit of normal is called anemia and can be caused for various reasons, among which the most common are iron deficiency in the body, acute or chronic blood loss, lack of vitamin B 12 and folic acid. Anemia is often detected in patients with cancer. It should be remembered that anemia is always a serious symptom and requires an in-depth examination to determine the causes of its development.
With anemia, the supply of oxygen to the body's tissues sharply decreases, while oxygen deficiency primarily affects those organs in which metabolism occurs most intensively: the brain, heart, liver and kidneys.
The more pronounced the decrease in hemoglobin, the more severe the anemia. A decrease in hemoglobin below 60 g/l is considered life-threatening for the patient and requires an urgent blood or red blood cell transfusion.
The level of hemoglobin in the blood increases with some severe blood diseases - leukemia, with “thickening” of the blood, for example due to dehydration, as well as compensatory in healthy people in high altitude conditions or in pilots after flying at high altitude.
1.1.2. Red blood cells
Red blood cells, or red blood cells, are small, flat, round cells with a diameter of about 7.5 microns. Since the red blood cell is slightly thicker at the edges than in the center, “in profile” it looks like a biconcave lens. This form is the most optimal and makes it possible for red blood cells to be maximally saturated with oxygen and carbon dioxide as they pass through the pulmonary capillaries or vessels of internal organs and tissues, respectively. Healthy men have 4.0-5.0 x 10 12 /l in their blood, and healthy women have 3.7-4.7 x 10 12 /l.
A decrease in the content of red blood cells in the blood, as well as hemoglobin, indicates the development of anemia in a person. With different forms of anemia, the number of red blood cells and the level of hemoglobin may decrease disproportionately, and the amount of hemoglobin in the red blood cell may vary. In this regard, when conducting a clinical blood test, the color indicator or the average hemoglobin content in a red blood cell must be determined (see below). In many cases, this helps the doctor quickly and correctly diagnose one or another form of anemia.
A sharp increase in the number of red blood cells (erythrocytosis), sometimes up to 8.0-12.0 x 10 12 / l or more, almost always indicates the development of one of the forms of leukemia - erythremia. Less commonly, in individuals with such changes in the blood, so-called compensatory erythrocytosis is detected, when the number of red blood cells in the blood increases in response to a person’s presence in an atmosphere thinned by oxygen (in the mountains, when flying at high altitude). But compensatory erythrocytosis occurs not only in healthy people. Thus, it was noticed that if a person has severe lung diseases with respiratory failure (pulmonary emphysema, pneumosclerosis, chronic bronchitis, etc.), as well as pathology of the heart and blood vessels that occurs with heart failure (heart defects, cardiosclerosis, etc.), the body compensatory increases the formation of red blood cells in the blood.
Finally, the so-called paraneoplastic (Greek para - near, at; neo... + Greek. plasis- formations) erythrocytosis, which develops in some forms of cancer (kidney, pancreas, etc.). It should be noted that red blood cells may have unusual sizes and shapes in various pathological processes, which has important diagnostic significance. The presence of red blood cells of various sizes in the blood is called anisocytosis and is observed in anemia. Red blood cells of normal size (about 7.5 microns) are called normocytes, reduced ones - microcytes and enlarged ones - macrocytes. Microcytosis, when small red blood cells predominate in the blood, is observed in hemolytic anemia, anemia after chronic blood loss, and often in malignant diseases. The size of red blood cells increases (macrocytosis) with B12-, folate-deficiency anemia, with malaria, with liver and lung diseases. The largest red blood cells, the size of which is more than 9.5 microns, are called megalocytes and are found in B12-, folate-deficiency anemia and, less commonly, in acute leukemia. The appearance of erythrocytes of irregular shape (elongated, worm-shaped, pear-shaped, etc.) is called poikilocytosis and is considered a sign of inadequate regeneration of erythrocytes in the bone marrow. Poikilocytosis is observed in various anemias, but is especially pronounced in B 12 -deficiency anemia.
Some forms of congenital diseases are characterized by other specific changes in the shape of red blood cells. Thus, sickle-shaped red blood cells are observed in sickle cell anemia, and target-like red blood cells (with a colored area in the center) are detected in thalassemia and lead poisoning.
Young forms of red blood cells called reticulocytes can also be detected in the blood. Normally, they are contained in the blood at 0.2-1.2% of the total number of red blood cells.
The importance of this indicator is mainly due to the fact that it characterizes the ability of the bone marrow to quickly restore the number of red blood cells during anemia. Thus, an increase in the content of reticulocytes in the blood (reticulocytosis) in the treatment of anemia caused by a lack of vitamin Bx2 in the body is an early sign of recovery. In this case, the maximum increase in the level of reticulocytes in the blood is called a reticulocyte crisis.
On the contrary, an insufficiently high level of reticulocytes in long-term anemia indicates a decrease in the regenerative capacity of the bone marrow and is an unfavorable sign.
It should be borne in mind that reticulocytosis in the absence of anemia always requires further examination, as it can be observed with cancer metastases to the bone marrow and some forms of leukemia.
Normally, the color index is 0.86-1.05. An increase in the color index above 1.05 indicates hyperchromia (Greek hyper - above, over, on the other side; chroma - color) and is observed in people with Bxr-deficiency anemia.
A decrease in color index of less than 0.8 indicates hypochromia (Greek hypo - below, under), which is most often observed in iron deficiency anemia. In some cases, hypochromic anemia develops with malignant neoplasms, more often with stomach cancer.
If the level of red blood cells and hemoglobin is reduced, and the color indicator is within the normal range, then we speak of normochromic anemia, which includes hemolytic anemia- a disease in which rapid destruction of red blood cells occurs, as well as aplastic anemia - a disease in which an insufficient number of red blood cells are produced in the bone marrow.
Hematocrit number, or hematocrit- this is the ratio of the volume of red blood cells to the volume of plasma, also characterizing the degree of deficiency or excess of red blood cells in a person’s blood. In healthy men this figure is 0.40-0.48, in women - 0.36-0.42.
An increase in hematocrit occurs with erythremia - a severe oncological blood disease and compensatory erythrocytosis (see above).
Hematocrit decreases with anemia and blood dilution, when the patient receives a large amount of medicinal solutions or takes an excessive amount of liquid orally.
1.1.3. Erythrocyte sedimentation rate
Erythrocyte sedimentation rate (ESR) is perhaps the most well-known laboratory indicator, the meaning of which they know something about, or, in any case, they guess that “a high ESR is bad sign", most people who undergo regular medical examinations.
The erythrocyte sedimentation rate refers to the rate of separation of uncoagulated blood placed in a special capillary into 2 layers: the lower one, consisting of settled erythrocytes, and the upper one, made of transparent plasma. This indicator is measured in millimeters per hour.
Like many other laboratory parameters, the ESR value depends on the gender of the person and normally ranges from 1 to 10 mm/hour in men, and from 2 to 15 mm/hour in women.
Increasing ESR- always a warning sign and, as a rule, indicates some kind of trouble in the body.
It is assumed that one of the main reasons for the increase in ESR is an increase in the ratio of protein particles in the blood plasma large sizes(globulins) and small sizes (albumins). Protective antibodies belong to the class of globulins, so their number in response to viruses, bacteria, fungi, etc., increases sharply in the body, which is accompanied by a change in the ratio of blood proteins.
For this reason, the most common cause of increased ESR is various inflammatory processes occurring in the human body. Therefore, when someone gets a sore throat, pneumonia, arthritis (inflammation of the joints) or other infectious and non-infectious diseases, the ESR always increases. The more pronounced the inflammation, the more clearly this indicator increases. Thus, in mild forms of inflammation, ESR can increase to 15-20 mm/hour, and in some severe diseases - up to 60-80 mm/hour. On the other hand, a decrease in this indicator during treatment indicates a favorable course of the disease and recovery of the patient.
At the same time, we must remember that an increase in ESR does not always indicate any kind of inflammation. The value of this laboratory indicator may be influenced by other factors: a change in the ratio of the liquid and dense parts of the blood, a decrease or increase in the number of red blood cells, loss of protein in the urine or a violation of protein synthesis in the liver and in some other cases.
The following are the groups of non-inflammatory diseases that usually lead to an increase in ESR:
Severe kidney and liver diseases;
Malignant formations;
Some severe blood diseases (myeloma, Waldenström's disease);
Myocardial infarction, pulmonary infarction, stroke;
Frequent blood transfusions, vaccine therapy.
It is also necessary to take into account the physiological reasons for the increase in ESR. Thus, an increase in this indicator is observed in women during pregnancy and can be observed during menstruation.
It should be borne in mind that a natural increase in ESR in the diseases described above does not occur if the patient has such concomitant pathology, such as chronic heart and cardiopulmonary failure; conditions and diseases in which the number of red blood cells in the blood increases (compensatory erythrocytosis, erythremia); acute viral hepatitis and obstructive jaundice; increase in protein in the blood. In addition, taking medications such as calcium chloride and aspirin can influence the ESR value in the direction of reducing this indicator.
1.1 .4. Leukocytes
Leukocytes, or white blood cells, are colorless cells of varying sizes (from 6 to 20 microns), round or irregular in shape. These cells have a nucleus and are capable of independently moving like single-celled organism- amoeba. The number of these cells in the blood is significantly less than erythrocytes and in a healthy person is 4.0-8.8 x 109/l. Leukocytes are the main protective factor in the human body’s fight against various diseases. These cells are “armed” with special enzymes that are capable of “digesting” microorganisms, binding and breaking down foreign protein substances and breakdown products formed in the body during vital activity. In addition, some forms of leukocytes produce antibodies - protein particles that attack any foreign microorganisms that enter the blood, mucous membranes and other organs and tissues of the human body.
There are two main types of white blood cells. In cells of one type, the cytoplasm has granularity, and they are called granular leukocytes - granulocytes. There are 3 forms of granulocytes: neutrophils, which, depending on their appearance the nuclei are divided into band and segmented, as well as basophils and eosinophils.
In the cells of other leukocytes, the cytoplasm does not contain granules, and among them there are two forms - lymphocytes and monocytes. These types of leukocytes have specific functions and change differently when various diseases(see below), so their quantitative analysis— a serious help to the doctor in determining the causes of the development of various forms of pathology.
An increase in the number of leukocytes in the blood is called leukocytosis, and a decrease is called leukopenia.
Leukocytosis can be physiological, i.e. occurs in healthy people in some quite ordinary situations, and pathological when it indicates some kind of disease.
Physiological leukocytosis is observed in the following cases:
2-3 hours after eating - digestive leukocytosis;
After intense physical work;
After hot or cold baths;
After psycho-emotional stress;
In the second half of pregnancy and before menstruation.
For this reason, the number of leukocytes is examined in the morning on an empty stomach. calm state the subject, without previous physical activity, stressful situations, or water procedures.
The most common causes of pathological leukocytosis include the following:
Various infectious diseases: pneumonia, otitis media, erysipelas, meningitis, pneumonia, etc.;
Suppuration and inflammatory processes various localizations: pleura (pleurisy, empyema), abdominal cavity(pancreatitis, appendicitis, peritonitis), subcutaneous tissue (felon, abscess, phlegmon), etc.;
Quite large burns;
Infarctions of the heart, lungs, spleen, kidneys;
Conditions after severe blood loss;
Leukemia;
Chronic renal failure;
Diabetic coma.
It must be remembered that in patients with weakened immunity (senile people, exhausted people, alcoholics and drug addicts), leukocytosis may not be observed during these processes. The absence of leukocytosis during infectious and inflammatory processes indicates a weak immune system and is an unfavorable sign.
Leukopenia- a decrease in the number of leukocytes in the blood below 4.0 H 10 9 /l in most cases indicates inhibition of the formation of leukocytes in the bone marrow. More rare mechanisms for the development of leukopenia are increased destruction of leukocytes in the vascular bed and redistribution of leukocytes with their retention in depot organs, for example, during shock and collapse.
Most often, leukopenia is observed due to the following diseases and pathological conditions:
Exposure to ionizing radiation;
Taking certain medications: anti-inflammatory drugs (amidopyrine, butadione, pyra-butol, reopirin, analgin); antibacterial agents(sulfonamides, synthomycin, chloramphenicol); drugs that inhibit function thyroid gland(mercazolyl, propicyl, potassium perchlorate); drugs used to treat cancer - cytostatics (methotrexate, vincristine, cyclophosphamide, etc.);
Hypoplastic or aplastic diseases, in which, for unknown reasons, the formation of leukocytes or other blood cells in the bone marrow is sharply reduced;
Some forms of diseases in which the function of the spleen increases (hypersplenism), liver cirrhosis, lymphogranulomatosis, tuberculosis and syphilis, occurring with damage to the spleen;
Selected infectious diseases: malaria, brucellosis, typhoid fever, measles, rubella, influenza, viral hepatitis;
Systemic lupus erythematosus;
Anemia associated with vitamin B12 deficiency;
In case of oncopathology with metastases to the bone marrow;
In the initial stages of development of leukemia.
Leukocyte formula is the ratio of different forms of leukocytes in the blood, expressed as a percentage. Standard values of the leukocyte formula are presented in table. 1.
Table 1
Leukocyte formula of blood and the content of various types of leukocytes in healthy people
The name of the condition in which an increase in the percentage of one or another type of leukocyte is detected is formed by adding the ending “-iya”, “-oz” or “-ez” to the name of this type of leukocyte
(neutrophilia, monocytosis, eosinophilia, basophilia, lymphocytosis).
A decrease in the percentage of various types of leukocytes is indicated by adding the ending “-singing” to the name of this type of leukocyte (neutropenia, monocytopenia, eosinopenia, basopenia, lymphopenia).
To avoid diagnostic errors when examining a patient, it is very important for the doctor to determine not only the percentage of different types of leukocytes, but also their absolute number in the blood. For example, if the number of lymphocytes in the leukoformula is 12%, which is significantly lower than normal, and the total number of leukocytes is 13.0 x 10 9 / l, then the absolute number of lymphocytes in the blood is 1.56 x 10 9 / l, i.e. “ fits" into the normative meaning.
For this reason, a distinction is made between absolute and relative changes in the content of one or another form of leukocytes. Cases when there is a percentage increase or decrease in various types of leukocytes with their normal absolute content in the blood are designated as absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc. In those situations where both the relative (in %) and the absolute number of certain forms of leukocytes speaks of absolute neutrophilia (neutropenia), lymphocytosis (lymphopenia), etc.
Different types of white blood cells "specialize" in different defensive reactions body, and therefore analysis of changes in the leukocyte formula can tell a lot about the character pathological process, developed in the body of a sick person, and help the doctor make a correct diagnosis.
Neutrophilia, as a rule, indicates an acute inflammatory process and is most pronounced when purulent diseases. Since inflammation of one or another organ in medical terms is indicated by adding the ending “-itis” to the Latin or Greek name of the organ, then neutrophilia appears with pleurisy, meningitis, appendicitis, peritonitis, pancreatitis, cholecystitis, otitis, etc., as well as acute pneumonia, phlegmon and abscesses of various locations, erysipelas .
In addition, an increase in the number of neutrophils in the blood is detected in many infectious diseases, myocardial infarction, stroke, diabetic coma and severe renal failure, after bleeding.
It should be remembered that neutrophilia can be caused by taking glucocorticoid hormonal drugs (dexamethasone, prednisolone, triamcinolone, cortisone, etc.).
Band leukocytes react most to acute inflammation and purulent process. A condition in which the number of leukocytes of this type in the blood increases is called a band shift, or a shift of the leukocyte formula to the left. Band shift always accompanies severe acute inflammatory (especially suppurative) processes.
Neutropenia is observed in some infectious (typhoid fever, malaria) and viral diseases (influenza, polio, viral hepatitis A). A low level of neutrophils often accompanies severe inflammatory and purulent processes (for example, in acute or chronic sepsis - a serious disease when pathogenic microorganisms enter the blood and freely settle in internal organs and tissues, forming numerous purulent foci) and is a sign that worsens the prognosis of severe sick.
Neutropenia can develop when bone marrow function is suppressed (aplastic and hypoplastic processes), with B 12 deficiency anemia, exposure to ionizing radiation, as a result of a number of intoxications, including when taking drugs such as amidopyrine, analgin, butadione, reopirin, sulfadimethoxine , biseptol, chloramphenicol, cefazolin, glibenclamide, mercazolil, cytostatics, etc.
If you noticed, the factors leading to the development of leukopenia simultaneously reduce the number of neutrophils in the blood.
Lymphocytosis is characteristic of a number of infections: brucellosis, typhoid and relapsing endemic typhus, tuberculosis.
In patients with tuberculosis, lymphocytosis is a positive sign and indicates a favorable course of the disease and subsequent recovery, while lymphopenia worsens the prognosis in this category of patients.
In addition, an increase in the number of lymphocytes is often detected in patients with reduced thyroid function - hypothyroidism, subacute thyroiditis, chronic radiation sickness, bronchial asthma, In 12-deficiency anemia, during fasting. An increase in the number of lymphocytes has been described when taking certain drugs.
Lymphopenia indicates immunodeficiency and is most often detected in persons with severe and long-term infectious and inflammatory processes, the most severe forms of tuberculosis, acquired immunodeficiency syndrome, with certain forms of leukemia and lymphogranulomatosis, prolonged fasting leading to the development of dystrophy, as well as in persons with chronic alcohol abusers, substance abusers and drug addicts.
Monocytosis is the most characteristic feature infectious mononucleosis, and can also occur with some viral diseases - mumps, rubella. An increase in the number of monocytes in the blood is one of the laboratory signs of severe infectious processes - sepsis, tuberculosis, subacute endocarditis, some forms of leukemia (acute monocytic leukemia), as well as malignant diseases of the lymphatic system - lymphogranulomatosis, lymphoma.
Monocytopenia is detected with bone marrow damage - aplastic anemia and hairy cell leukemia.
Eosinopenia can be observed at the height of the development of infectious diseases, B 12 deficiency anemia and bone marrow damage with a decrease in its function (aplastic processes).
Basophilia is usually detected in chronic myeloid leukemia, decreased thyroid function (hypothyroidism), and a physiological increase in basophils in the premenstrual period in women has been described.
Basopenia develops with increased function of the thyroid gland (thyrotoxicosis), pregnancy, stress, Itsenko-Cushing syndrome - a disease of the pituitary gland or adrenal glands, in which the level of adrenal hormones - glucocorticoids - is increased in the blood.
1.1.5. Platelets
Platelets, or blood platelets, are the smallest among the cellular elements of blood, the size of which is 1.5-2.5 microns. Platelets perform the most important function of preventing and stopping bleeding. With a lack of platelets in the blood, the bleeding time increases sharply, and the vessels become brittle and bleed more easily.
Thrombocytopenia is always an alarming symptom, as it creates a threat of increased bleeding and increases the duration of bleeding. A decrease in the number of platelets in the blood accompanies the following diseases and conditions:
. autoimmune (idiopathic) thrombocytopenic purpura (Purpura is a medical symptom characteristic of the pathology of one or more parts of hemostasis) (Werlhof’s disease), in which a decrease in the number of platelets is due to their increased destruction under the influence of special antibodies, the mechanism of formation of which has not yet been established;
. acute and chronic leukemia;
. decreased platelet formation in the bone marrow in aplastic and hypoplastic conditions of unknown cause, B 12, folate deficiency anemia, as well as in cancer metastases to the bone marrow;
. conditions associated with increased activity of the spleen in liver cirrhosis, chronic and, less commonly, acute viral hepatitis;
. systemic connective tissue diseases: systemic lupus erythematosus, scleroderma, dermatomyositis;
. dysfunction of the thyroid gland (thyrotoxicosis, hypothyroidism);
. viral diseases (measles, rubella, chickenpox, influenza);
. disseminated intravascular coagulation syndrome (DIC);
. taking a number of medications that cause toxic or immune damage to the bone marrow: cytostatics (vinblastine, vincristine, mercaptopurine, etc.); chloramphenicol; sulfonamide drugs (biseptol, sulfadimethoxine), aspirin, butadione, reopirin, analgin, etc.
Because low platelet counts can be serious complications, bone marrow puncture and antiplatelet antibody testing are usually performed to determine the cause of thrombocytopenia.
Platelet count, although it does not pose a threat of bleeding, is no less a serious laboratory sign than thrombocytopenia, since it often accompanies diseases that are very serious in terms of consequences.
The most common causes of thrombocytosis are:
. malignant neoplasms: stomach cancer and kidney cancer (hypernephroma), lymphogranulomatosis;
. oncological blood diseases - leukemia (megacarytic leukemia, polycythemia, chronic myeloid leukemia, etc.).
It should be noted that in leukemia, thrombocytopenia is an early sign, and as the disease progresses, thrombocytopenia develops.
It is important to emphasize (all experienced doctors know this) that in the cases listed above, thrombocytosis may be one of the early laboratory signs and its identification requires a thorough medical examination.
Other causes of thrombocytosis that are of less practical importance include:
. condition after massive (more than 0.5 l) blood loss, including after major surgical operations;
. condition after removal of the spleen (thrombocytosis usually persists for 2 months after surgery);
. in sepsis, when the platelet count can reach 1000 x 10 9 / l.
1.2. General clinical examination of urine
Urine is produced in the kidneys. Blood plasma is filtered in the capillaries of the renal glomeruli. This glomerular filtrate is the primary urine, containing all the components of blood plasma except proteins. Then, in the renal tubules, epithelial cells carry out reabsorption into the blood (reabsorption) of up to 98% of the renal filtrate with the formation of final urine. Urine is 96% water, contains the end products of metabolism (urea, uric acid, pigments, etc.) mineral salts in dissolved form, as well as a small amount of cellular elements of the blood and epithelium of the urinary tract.
Clinical examination of urine gives an idea, first of all, about the condition and function of the genitourinary system. In addition, certain changes in urine can be used to diagnose certain endocrine diseases (diabetes mellitus and diabetes insipidus), identify certain metabolic disorders, and in some cases suspect a number of other diseases of internal organs. Like many other tests, repeated urine testing helps to judge the effectiveness of the treatment.
Conducting a clinical analysis of urine includes an assessment of its general properties (color, transparency, odor), as well as physicochemical qualities (volume, relative density, acidity) and microscopic examination urinary sediment.
A urine test is one of the few that is collected by the patient independently. In order for the urine analysis to be reliable, that is, to avoid artifacts and technical errors, it is necessary to follow a number of rules when collecting it.
Basic rules for collecting urine for analysis, its transportation and storage.
There are no restrictions on the diet, but you should not “lean” on mineral water - the acidity of the urine may change. If a woman is menstruating, collecting urine for analysis should be postponed until the end of the period. The day before and immediately before submitting your urine for analysis, you should avoid intense physical activity, as in some people this can lead to the appearance of protein in the urine. The use of medications is also undesirable, since some of them (vitamins, antipyretics and painkillers) can affect the results of biochemical studies. On the eve of the test, you need to limit yourself in eating sweets and brightly colored foods.
For general analysis, “morning” urine is usually used, which is collected in the urine during the night. bladder; this reduces the influence of natural daily fluctuations in urine parameters and characterizes the studied parameters more objectively. The required volume of urine to perform a full examination is approximately 100 ml.
Urine should be collected after thorough toileting of the external genitalia, especially in women. Failure to comply with this rule may result in the detection of an increased number of white blood cells, mucus, and other contaminants in the urine, which may complicate the test and distort the result.
Women need to use a soap solution (followed by washing with boiled water) or weak solutions of potassium permanganate (0.02 - 0.1%) or furatsilin (0.02%). Antiseptic solutions should not be used when submitting urine for bacteriological analysis!
Urine is collected in a dry, clean, well-washed small jar with a volume of 100-200 ml, well washed from cleaning agents and disinfectants, or in a special disposable container.
Due to the fact that inflammatory elements may enter the urine urethra and external genitalia, you first need to release a small portion of urine and only then place a jar under the stream and fill it to the required level. The container with urine is tightly closed with a lid and transferred to the laboratory with the necessary direction, where the surname and initials of the subject, as well as the date of the analysis, must be indicated.
It must be remembered that a urine test must be performed no later than 2 hours after receiving the material. Urine that is stored longer may be contaminated with foreign bacterial flora. In this case, the urine pH will shift to the alkaline side due to ammonia released into the urine by bacteria. In addition, microorganisms feed on glucose, so negative or low urine sugar results may be obtained. Storing urine for a longer period of time also leads to the destruction of red blood cells and other cellular elements in it, and, in daylight, bile pigments.
IN winter time It is necessary to avoid freezing urine during its transportation, since the salts that precipitate during this process can be interpreted as a manifestation of renal pathology and complicate the research process.
1.2.1. General properties of urine
As is known, ancient doctors did not have such instruments as a microscope, a spectrophotometer, and, of course, did not have modern diagnostic strips for express analysis, but they could skillfully use their senses: vision, smell and taste.
Indeed, the presence of a sweet taste in the urine of a patient with complaints of thirst and weight loss allowed the ancient healer to very confidently diagnose diabetes mellitus, and urine the color of “meat slop” indicated severe kidney disease.
Although currently no doctor would think of tasting urine, assessing the visual properties and smell of urine still have not lost their diagnostic value.
Color. In healthy people, urine has a straw-yellow color, due to the content of urinary pigment - urochrome.
The more concentrated the urine, the darker the color. Therefore, during intense heat or intense physical activity with profuse sweating, less urine is released and it is more intensely colored.
In pathological cases, the intensity of the color of urine increases with an increase in edema associated with kidney and heart diseases, with loss of fluid associated with vomiting, diarrhea or extensive burns.
Urine becomes dark yellow (the color of dark beer) sometimes with a greenish tint when the excretion of bile pigments in the urine increases, which is observed with parenchymal (hepatitis, cirrhosis) or mechanical (clogging of the bile duct with cholelithiasis) jaundice.
Red or reddish color of urine may be due to the consumption of large quantities of beets, strawberries, carrots, as well as some antipyretic drugs: antipyrine, amidopyrine. Large doses of aspirin can turn the urine pink.
A more serious cause of red urine is hematuria - blood in the urine, which may be associated with renal or extrarenal diseases.
Thus, the appearance of blood in the urine can be due to inflammatory diseases of the kidneys - nephritis, but in such cases the urine, as a rule, becomes cloudy, since it contains an increased amount of protein, and resembles the color of “meat slop”, i.e. the color of water, in which the meat was washed.
Hematuria may be caused by damage to the urinary tract when a kidney stone passes, as occurs during attacks of renal colic in people with urolithiasis. More rarely, blood in the urine is observed with cystitis.
Finally, the appearance of blood in the urine may be associated with the disintegration of a kidney or bladder tumor, injuries to the kidneys, bladder, ureters or urethra.
The greenish-yellow color of urine may be due to an admixture of pus, which occurs when a kidney abscess is opened, as well as with purulent urethritis and cystitis. The presence of pus in the urine during alkaline reaction results in dirty brown or gray colored urine.
A dark, almost black color occurs when hemoglobin enters the urine due to massive destruction of red blood cells in the blood (acute hemolysis), when taking certain toxic substances - hemolytic poisons, transfusion of incompatible blood, etc. A black tint that appears when urine stands is observed in patients with alkaptonuria , in which homogentisic acid is excreted in the urine, which darkens in air.
Transparency. Healthy people have clear urine. Cloud-like turbidity of urine, which occurs during prolonged standing, has no diagnostic value. Pathological turbidity of urine may be caused by secretion large quantity salts (urates, phosphates, oxalates) or an admixture of pus.
Smell. Fresh urine from a healthy person does not have any sharp or unpleasant odor. The appearance of a fruity smell (the smell of soaked apples) occurs in patients with diabetes mellitus who have high blood glucose levels (usually exceeding 14 mmol/l for a long time), when a large amount of special products of fat metabolism - ketone acids - are formed in the blood and urine. Urine acquires a sharp unpleasant odor when consuming large amounts of garlic, horseradish, and asparagus.
When assessing physical and chemical properties urine is examined for its daily amount, relative density, acid-base reaction, protein, glucose, and the content of bile pigments.
1.2.2. Daily amount of urine
The amount of urine that a healthy person excretes per day, or daily diuresis, can vary significantly, as it depends on the influence of a number of factors: the amount of fluid drunk, the intensity of sweating, breathing rate, and the amount of fluid excreted in feces.
Under normal conditions, the average daily diuresis is 1.5-2.0 liters and corresponds to approximately 3/4 of the volume of fluid drunk.
A decrease in urine output occurs when there is excessive sweating, for example when working in high temperatures, with diarrhea and vomiting. Also, low diuresis is facilitated by fluid retention (increasing edema in renal and heart failure) in the body, while the patient’s body weight increases.
A decrease in urine output of less than 500 ml per day is called oliguria, and less than 100 ml/day is called anuria.
Anuria is a very serious symptom and always indicates a serious condition:
. a sharp decrease in blood volume and a fall blood pressure associated with heavy bleeding, shock, uncontrollable vomiting, severe diarrhea;
. severe impairment of the filtration capacity of the kidneys - acute renal failure, which can be observed in acute nephritis, renal necrosis, acute massive hemolysis;
. blockage of both ureters with stones or their compression by a nearby large tumor (cancer of the uterus, bladder, metastases).
Ischuria should be distinguished from anuria - urinary retention due to a mechanical obstruction to urination, for example, with the development of a tumor or inflammation of the prostate gland, narrowing of the urethra, compression by a tumor or blockage of the outlet in the bladder, dysfunction of the bladder due to damage to the nervous system.
An increase in daily diuresis (polyuria) is observed when edema resolves in people with renal or heart failure, which is combined with a decrease in the patient’s body weight. In addition, polyuria can be observed in diabetes mellitus and diabetes insipidus, chronic pyelonephritis, with prolapsed kidneys - nephroptosis, aldosterome (Conn's syndrome) - an adrenal tumor that produces an increased amount of mineralocorticoids, in hysterical states due to excessive fluid intake.
1.2.3. Relative density of urine
The relative density (specific gravity) of urine depends on the content of dense substances in it (urea, mineral salts, etc., and in cases of pathology - glucose, protein) and is normally 1.010-1.025 (the density of water is taken as 1). An increase or decrease in this indicator can be a consequence of both physiological changes and can occur in certain diseases.
An increase in the relative density of urine leads to:
. low fluid intake;A decrease in the relative density of urine is caused by:
. large loss of fluid with sweating, vomiting, diarrhea;
. diabetes;
. fluid retention in the body in the form of edema in cardiac or acute renal failure.
. drinking plenty of fluids;
. convergence of edema during therapy with diuretics;
. chronic renal failure with chronic glomerulonephritis x and pyelonephritis, nephrosclerosis, etc.;
. diabetes insipidus (usually below 1.007).
A single study of relative density allows only a rough estimate of the state of the concentration function of the kidneys, therefore, to clarify the diagnosis, daily fluctuations of this indicator in the Zimnitsky test are usually assessed (see below).
1.2.4. Chemical examination of urine
Urine reaction. With a normal diet (a combination of meat and plant foods), the urine of a healthy person has a slightly acidic or acidic reaction and its pH is 5-7. The more meat a person eats, the more acidic his urine is, while plant foods help shift the pH of urine to the alkaline side.
A decrease in pH, i.e., a shift in the reaction of urine to the acidic side, occurs with heavy physical work, fasting, a sharp increase in body temperature, diabetes mellitus, and impaired renal function.
On the contrary, an increase in urine pH (a shift in acidity to the alkaline side) is observed when taking a large amount mineral water, after vomiting, swelling, inflammation of the bladder, blood in the urine.
The clinical significance of determining the pH of urine is limited by the fact that a change in the acidity of urine towards the alkaline side contributes to a more rapid destruction of the formed elements in the urine sample during its storage, which must be taken into account by the laboratory assistant conducting the analysis. In addition, changes in urine acidity are important to know for people with urolithiasis. So, if the stones are urates, then the patient should strive to maintain the alkaline acidity of the urine, which will facilitate the dissolution of such stones. On the other hand, if the kidney stones are tripel phosphates, then an alkaline urine reaction is undesirable, as it will promote the formation of such stones.
Protein. In a healthy person, urine contains a small amount of protein, not exceeding 0.002 g/l or 0.003 g in daily urine.
Increased secretion protein in the urine is called proteinuria and is the most common laboratory sign of kidney damage.
For patients with diabetes mellitus, a “border zone” of proteinuria was identified, which was called microalbuminuria. The fact is that microalbumin is the smallest protein in the blood and, in the case of kidney disease, enters the urine earlier than others, being an early marker of nephropathy in diabetes mellitus. The importance of this indicator lies in the fact that the appearance of microalbumin in the urine of patients with diabetes mellitus characterizes the reversible stage of kidney damage, in which, by prescribing special medications and following the patient’s certain doctor’s recommendations, it is possible to restore damaged kidneys. Therefore, for diabetic patients upper limit The norm for protein content in urine is 0.0002 g/l (20 μg/l) and 0.0003 g/day. (30 mcg/day).
The appearance of protein in the urine can be associated with both kidney disease and pathology of the urinary tract (ureters, bladder, urethra).
Proteinuria associated with urinary tract lesions is characterized by a relatively low level of protein (usually less than 1 g/l) in combination with a large number of leukocytes or red blood cells in the urine, as well as the absence of casts in the urine (see below).
Renal proteinuria can be physiological, i.e. observed in a completely healthy person, and can be pathological - as a consequence of some disease.
The causes of physiological renal proteinuria are:
. eating large amounts of protein without digestion heat treatment(unboiled milk, raw eggs);
. intense muscle load;
. long stay in an upright position;
. swimming in cold water;
. severe emotional stress;
. epileptic seizure.
Pathological renal proteinuria is observed in the following cases:
. kidney diseases (acute and chronic inflammatory kidney diseases - glomerulonephritis, pyelonephritis, amyloidosis, nephrosis, tuberculosis, toxic kidney damage);
. nephropathy of pregnancy;
. increased body temperature in various diseases;
. hemorrhagic vasculitis;
. severe anemia;
. arterial hypertension;
. severe heart failure;
. hemorrhagic fevers;
. leptospirosis.
In most cases, it is true that the more pronounced the proteinuria, the stronger the kidney damage and the worse the prognosis for recovery. In order to more accurately assess the severity of proteinuria, the protein content in the urine collected by the patient per day is assessed. Based on this, the following degrees of gradation of proteinuria by severity are distinguished:
. mild proteinuria - 0.1-0.3 g/l;
. moderate proteinuria - less than 1 g/day;
. severe proteinuria - 3 g/day. and more.
Urobilin.
Fresh urine contains urobilinogen, which turns into urobilin when the urine stands. Urobilinogen bodies are substances that are formed from bilirubin, a liver pigment, during its transformation in the bile ducts and intestines.
It is urobilin that causes darkening of urine in jaundice.
In healthy people with a normally functioning liver, so little urobilin enters the urine that routine laboratory tests give a negative result.
The increase in this indicator from weak positive reaction(+) to sharply positive (+++) occurs in various diseases of the liver and biliary tract:
Determining urobilin in urine is a simple and quick way to identify signs of liver damage and subsequently clarify the diagnosis using biochemical, immunological and other tests. On the other hand, a negative reaction to urobilin allows the doctor to exclude the diagnosis of acute hepatitis.
Bile acids. Bile acids never appear in the urine of a person without liver pathology. The detection of bile acids of varying degrees of severity in the urine: weakly positive (+), positive (++) or strongly positive (+++) always indicates severe damage to the liver tissue, in which the bile formed in the liver cells, along with its entry into biliary tract and the intestines directly enter the blood.
The reasons for a positive urine reaction to bile acids are acute and chronic hepatitis, liver cirrhosis, obstructive jaundice caused by blockage of the bile ducts.
At the same time, it should be said that with the most severe liver damage due to the cessation of production of bile acids, the latter may not be detected in the urine.
Unlike urobilin, bile acids do not appear in the urine of patients with hemolytic anemia, so this indicator is used as an important differential sign for distinguishing between jaundice associated with liver damage and jaundice caused by increased destruction of red blood cells.
Bile acids in urine can also be detected in persons with liver damage without external signs jaundice, so this test is important for those who suspect liver disease, but do not have jaundice of the skin.
1.2.5. Urine sediment examination
The study of urinary sediment is the final stage of clinical urine analysis and characterizes the composition of cellular elements (erythrocytes, leukocytes, casts, epithelial cells), as well as salts in urine analysis. In order to conduct this study, urine is poured into a test tube and centrifuged, while dense particles settle to the bottom of the test tube: blood cells, epithelium, and salts. After this, the laboratory assistant, using a special pipette, transfers part of the sediment from the test tube onto a glass slide and prepares a preparation, which is dried, stained and examined by a doctor under a microscope.
To quantify the cellular elements found in urine, special units of measurement are used: the number of certain cells of the urinary sediment in the field of view under microscopy. For example: “1-2 red blood cells per field of view” or “single epithelial cells per field of view” and “leukocytes cover the entire field of view.”
Red blood cells. If in a healthy person red blood cells are not detected in the urine sediment or they are present in “single copies” (no more than 3 in the field of view), their appearance in the urine in larger quantities always indicates some kind of pathology in the kidneys or urinary tract.
It should be said that even the presence of 2-3 red blood cells in the urine should alert the doctor and the patient and require at least repeated urine testing or special tests (see below). Single red blood cells may appear in a healthy person after heavy physical exertion or prolonged standing.
When the admixture of blood in the urine is determined visually, i.e. the urine has a red color or tint (macrohematuria), then there is no great need to evaluate the number of red blood cells during microscopy of the urinary sediment, since the result is known in advance - red blood cells will cover the entire field of view, i.e. Their number will be many times higher than the standard values. To turn urine red, only 5 drops of blood (containing approximately 1 x 10 12 red blood cells) per 0.5 liter of urine is enough.
A smaller admixture of blood, which is invisible to the naked eye, is called microhematuria and is detected only by microscopy of urinary sediment.
The appearance of blood in the urine may be associated with any disease of the kidneys, urinary tract (ureters, bladder, urethra), prostate gland, as well as some other diseases not related to the genitourinary system:
. glomerulonephritis (acute and chronic);
. pyelonephritis (acute and chronic);
. malignant kidney tumors;
. cystitis;
. prostate adenoma;
. urolithiasis disease;
. kidney infarction;
. kidney amyloid;
. nephrosis;
. toxic kidney damage (for example, when taking analgin);
. kidney tuberculosis;
. kidney injuries;
. hemorrhagic diathesis;
. hemorrhagic fever;
. severe circulatory failure;
. hypertonic disease.
For practice, it is important to know how to roughly determine where blood gets into the urine using laboratory methods.
The main sign presumably indicating the entry of red blood cells into the urine from the kidneys is the concomitant appearance of protein and casts in the urine. In addition, the three-glass test continues to be widely used for these purposes, especially in urological practice.
This test consists of the patient, after holding urine for 4-5 hours or in the morning after sleep, collecting urine sequentially into 3 jars (containers): the first one is released into the 1st, the intermediate one into the 2nd, and the intermediate one into the 3rd. the last (final!) portion of urine. If red blood cells are found in the greatest quantity in the 1st portion, then the source of bleeding is in the urethra; in the 3rd portion, the source is more likely in the bladder. Finally, if the number of red blood cells is approximately the same in all three portions of urine, then the source of bleeding is the kidneys or ureters.
Leukocytes. Normally, in the urinary sediment of a healthy woman, up to 5, and in a healthy man, up to 3 leukocytes per field of view are found.
An increased content of leukocytes in the urine is called leukocyturia. Too pronounced leukocyturia, when the number of these cells exceeds 60 in the field of view, is called pyuria.
As already indicated, the main function of leukocytes is protective, so their appearance in the urine, as a rule, indicates some kind of inflammatory process in the kidneys or urinary tract. In this situation, the rule “the more leukocytes in the urine, the more pronounced the inflammation and the more acute the process” remains valid. However, the degree of leukocyturia does not always reflect the severity of the disease. Thus, there may be a very moderate increase in the number of leukocytes in the urinary sediment in people with severe glomerulonephritis and reach the level of pyuria in people with acute inflammation of the urethra - urethritis.
The main causes of leukocyturia are inflammatory diseases of the kidneys (acute and chronic pyelonephritis) and urinary tract (cystitis, urethritis, prostatitis). In more rare cases, an increase in the number of leukocytes in the urine can lead to kidney damage due to tuberculosis, acute and chronic glomerulonephritis, and amyloidosis.
For a doctor, and even more so for a patient, it is very important to establish the cause of leukocyturia, that is, to approximately determine the location of development of the inflammatory process of the genitourinary system. By analogy with the story about the causes of hematuria, laboratory signs indicating inflammatory process in the kidneys as the cause of leukocyturia, is the concomitant appearance of protein and casts in the urine. In addition, a three-glass test is also used for these purposes, the results of which are evaluated similarly to the results of this test when determining the source of blood in the urine. So, if leukocyturia is detected in the 1st portion, this indicates that the patient has an inflammatory process in the urethra (urethritis). If the highest number of leukocytes is in the 3rd portion, then it is most likely that the patient has inflammation of the bladder - cystitis or prostate gland - prostatitis. With approximately the same number of leukocytes in the urine of different portions, one can think of inflammatory damage to the kidneys, ureters, and bladder.
In some cases, a three-glass test is carried out more quickly - without microscopy of the urinary sediment and is guided by such signs as turbidity, as well as the presence of threads and flakes in each portion of urine, which to a certain extent are equivalent to leukocyturia.
In clinical practice, to accurately assess the number of red and white blood cells in urine, the simple and informative Nechiporenko test is widely used, which allows you to calculate how many of these cells are contained in 1 ml of urine. Normally, 1 ml of urine contains no more than 1000 red blood cells and 400 thousand leukocytes.
The cylinders are formed from protein in the kidney tubules under the influence of the acidic reaction of urine, being, in fact, their cast. In other words, if there is no protein in the urine, then there cannot be casts, and if they are, then you can be sure that the amount of protein in the urine is increased. On the other hand, since the process of formation of casts is influenced by the acidity of urine, if it is alkaline, despite proteinuria, casts may not be detected.
Depending on whether the cylinders contain cellular elements from urine and which ones, hyaline, epithelial, granular, waxy, erythrocyte and leukocyte, as well as cylinders are distinguished.
The reasons for the appearance of casts in the urine are the same as for the appearance of protein, with the only difference being that protein is detected more often, since the formation of casts, as already indicated, requires an acidic environment.
Most often in practice, hyaline cylinders are encountered, the presence of which may indicate acute and chronic diseases kidneys, but they can also be found in people without pathology of the urinary system in cases of prolonged stay in an upright position, severe cooling or, conversely, overheating, heavy physical activity.
Epithelial casts always indicate involvement of renal tubules in the pathological process, which most often occurs with pyelonephritis and nephrosis.
Waxy casts usually indicate severe kidney damage, and detection of red blood cell casts in the urine strongly suggests that hematuria is due to kidney disease.
Epithelial cells line the mucous membrane of the urinary tract and enter the urine in large quantities during inflammatory processes. Depending on what type of epithelium lines a particular section of the urinary tract during various inflammatory processes, different types of epithelium appear in the urine.
Normally, in urinary sediment, squamous epithelial cells are found in very small numbers - from single ones in the preparation to single ones in the field of view. The number of these cells increases significantly with urethritis (inflammation of the urinary tract) and prostatitis (inflammation of the prostate gland).
Transitional epithelial cells appear in the urine during acute inflammation in the bladder and renal pelvis, urolithiasis, and tumors of the urinary tract.
Cells of the renal epithelium (urinary tubules) enter the urine during nephritis (inflammation of the kidneys), poisoning with poisons that damage the kidneys, and heart failure.
Bacteria in urine is tested in a sample taken immediately after urination. Particular importance in this type of analysis is given to the correct treatment of the external genitalia before taking the analysis (see above). Detection of bacteria in urine is not always a sign of an inflammatory process in genitourinary system. An increased number of bacteria is of primary importance for diagnosis. Thus, in healthy people no more than 2 thousand microbes are found in 1 ml of urine, while patients with inflammation in the urinary organs are characterized by 100 thousand bacteria in 1 ml. If an infectious process in the urinary tract is suspected, doctors supplement the determination of microbial bodies in the urine with a bacteriological study, during which they inoculate the urine under sterile conditions on special nutrient media and, based on a number of signs of the grown colony of microorganisms, determine the identity of the latter, as well as their sensitivity to certain antibiotics to choose the right treatment.
In addition to the above components of urinary sediment, unorganized urine sediments or various inorganic compounds are isolated.
The loss of various inorganic sediments depends, first of all, on the acidity of the urine, which is characterized by pH. With an acidic reaction of urine (pH less than 5), salts of uric and hippuric acids, calcium phosphate, etc. are determined in the sediment. With an alkaline reaction of urine (pH more than 7), amorphous phosphates, tripel phosphates, calcium carbonate, etc. appear in the sediment.
At the same time, by the nature of a particular urine sediment, one can also tell about the possible illness of the person being examined. Thus, uric acid crystals appear in large quantities in the urine during renal failure, dehydration, and in conditions accompanied by large tissue breakdown (malignant blood diseases, massive, disintegrating tumors, resolving massive pneumonia).
Oxalates (salts of oxalic acid) appear due to the abuse of foods containing oxalic acid (tomatoes, sorrel, spinach, lingonberries, apples, etc.). If a person has not consumed these products, then the presence of oxalates in the urinary sediment indicates a metabolic disorder in the form of oxalo-acetic diathesis. In some rare cases of poisoning, the appearance of oxalates in the urine makes it possible to accurately confirm the victim’s consumption of a toxic substance - ethylene glycol.
1.2.6. Tests characterizing kidney function
The work of the kidneys as a whole consists of their performing various functions, called partial: concentration of urine (concentration function), excretion of urine (glomerular filtration) and the ability of the kidney tubules to return substances useful to the body that have entered the urine: protein, glucose, potassium, etc. (tubular reabsorption) or, on the contrary, to secrete some metabolic products in the urine (tubular secretion). A similar disruption of these functions can be observed with various forms kidney diseases, therefore, their examination is necessary for the doctor not so much for correct setting diagnosis, in order to determine the degree and severity of kidney disease, and also helps to assess the effectiveness of treatment and determine the prognosis of the patient’s condition.
The most widely used tests in practice are the Zimnitsky test and the Reberg-Ta-reev test.
The Zimnitsky test allows you to evaluate the ability of the kidneys to concentrate urine by measuring the density of urine collected during the day every 3 hours, i.e., a total of 8 urine samples are examined.
This test should be carried out with normal drinking regimen; it is not advisable for the patient to take diuretics. It is also necessary to take into account the volume of fluid taken by a person in the form of water, drinks and the liquid portion of food.
The daily urine volume is obtained by adding the volumes of the first 4 portions of urine collected from 09.00 to 21.00, and nighttime diuresis is obtained by summing the 5th to 8th portions of urine (from 21.00 to 09.00).
In healthy people, 2/3 - 4/5 (65-80%) of the liquid drunk per day is excreted during the day. In addition, daytime diuresis should be approximately 2 times higher than nighttime, and the relative density of individual portions of urine should fluctuate within fairly large limits - at least 0.012-0.016 and reach an indicator of 1.017 in at least one of the portions.
An increase in the daily amount of urine excreted compared to the liquid drunk can be observed as edema subsides, and a decrease, on the contrary, as edema (renal or cardiac) increases.
An increase in the ratio between nighttime and daytime urine output is typical for patients with heart failure.
Low relative density of urine in various portions collected per day, as well as a decrease in daily fluctuations of this indicator is called isohyposthenuria and is observed in patients with chronic diseases kidneys (chronic glomerulonephritis, pyelonephritis, hydronephrosis, polycystic disease). The concentration function of the kidneys is disrupted before other functions, so the Zimnitsky test makes it possible to detect pathological changes in the kidneys in the early stages, before signs of severe renal failure appear, which, as a rule, is irreversible.
It should be added that low relative density of urine with small fluctuations during the day (no more than 1.003-1.004) is characteristic of a disease such as diabetes insipidus, in which the production of the hormone vasopressin (antidiuretic hormone) in the human body decreases. This disease is characterized by thirst, weight loss, increased urination and an increase in the volume of urine excreted several times, sometimes up to 12-16 liters per day.
The Rehberg test helps the doctor determine the excretory function of the kidneys and the ability of the renal tubules to secrete or absorb back (reabsorb) certain substances.
The test method consists of collecting urine from a patient in the morning on an empty stomach in a supine position for 1 hour and in the middle of this period of time taking blood from a vein to determine the level of creatinine.
Using a simple formula, the value of glomerular filtration (characterizes the excretory function of the kidneys) and tubular reabsorption is calculated.
In healthy young and middle-aged men and women, the glomerular filtration rate (GFR), calculated in this way, is 130-140 ml/min.
A decrease in CF is observed in acute and chronic nephritis, kidney damage due to hypertension and diabetes mellitus - glomerulosclerosis. The development of renal failure and an increase in nitrogenous waste in the blood occurs when the EF decreases to approximately 10% of normal. In chronic pyelonephritis, the decrease in CP occurs later, and in glomerulonephritis, on the contrary, earlier than the impairment of the concentrating ability of the kidneys.
A persistent drop in EF to 40 ml/min in chronic kidney disease indicates severe renal failure, and a decrease in this indicator to 15-10-5 ml/min indicates the development of the final (terminal) stage of renal failure, which usually requires connecting the patient to a machine “ artificial kidney" or kidney transplant.
Tubular reabsorption normally ranges from 95 to 99% and may decrease to 90% or lower in people without kidney disease when drinking large amounts of fluid or taking diuretics. The most pronounced decrease in this indicator is observed in diabetes insipidus. A persistent decrease in water reabsorption below 95%, for example, is observed with a primary wrinkled kidney (against the background of chronic glomerulonephritis, pyelonephritis) or a secondary wrinkled kidney (for example, observed with hypertension or diabetic nephropathy).
It should be noted that usually, along with a decrease in reabsorption in the kidneys, there is a violation of the concentration function of the kidneys, since both functions depend on disturbances in the collecting ducts.
General analysis indicators:
1. HEMOGLOBIN (Hb) is a blood pigment found in erythrocytes (red blood cells), its main function is the transfer of oxygen from the lungs to the tissues and the removal of carbon dioxide from the body.
Normal values for men are 130-160 g/l, women - 120-140 g/l.
Reduced hemoglobin occurs with anemia, blood loss, hidden internal bleeding, damage to internal organs, for example, kidneys, etc.
It can increase with dehydration, blood diseases and some types of heart failure.
2. ERYTHROCYTES - blood cells that contain hemoglobin.
Normal values are (4.0-5.1) * 10 to the 12th power/l and (3.7-4.7) * 10 to the 12th power/l, for men and women, respectively.
An increase in red blood cells occurs, for example, in healthy people at high altitudes in the mountains, as well as in congenital or acquired heart defects, diseases of the bronchi, lungs, kidneys and liver. The increase may be due to an excess of steroid hormones in the body. For example, with Cushing's disease and syndrome, or during treatment with hormonal drugs.
Decreased - with anemia, acute blood loss, with chronic inflammatory processes in the body, as well as later pregnancy.
3. LEUCOCYTES - white blood cells, they are formed in the bone marrow and lymph nodes. Their main function is to protect the body from adverse effects. The norm is (4.0-9.0) x 10 to the 9th power /l. Excess indicates the presence of infection and inflammation.
There are five types of leukocytes (lymphocytes, neutrophils, monocytes, eosinophils, basophils), each of them performs a specific function. If necessary, a detailed blood test is done, which shows the ratio of all five types of leukocytes. For example, if the level of leukocytes in the blood is increased, a detailed analysis will show what type of leukocytes increased due to total number. If due to lymphocytes, then there is an inflammatory process in the body; if there are more eosinophils than normal, then an allergic reaction can be suspected.
WHY ARE THERE MUCH LEUKOCYTES?
There are many conditions in which changes in white blood cell levels are observed. This does not necessarily indicate illness. Leukocytes, as well as all indicators of general analysis, react to various changes in the body. For example, during stress, pregnancy, or after physical exertion, their number increases.
An increased number of leukocytes in the blood (also known as leukocytosis) also occurs with:
+ infections (bacterial),
Inflammatory processes
Allergic reactions,
Malignant neoplasms and leukemia,
Taking hormonal medications, some heart medications (for example, digoxin).
But a reduced number of leukocytes in the blood (or leukopenia): this condition often occurs with viral infection(for example, with the flu) or taking certain medications, for example, analgesics, anticonvulsants.
4. PLATELETS - blood cells, an indicator of normal blood clotting, are involved in the formation of blood clots.
Normal amount - (180-320) * 10 to the 9th power / l
An increased amount occurs when:
chronic inflammatory diseases (tuberculosis, ulcerative colitis, cirrhosis of the liver), after operations, treatment with hormonal drugs.
Reduced when:
the effects of alcohol, heavy metal poisoning, blood diseases, kidney failure, liver diseases, spleen diseases, hormonal disorders. And also under the influence of certain medications: antibiotics, diuretics, digoxin, nitroglycerin, hormones.
5. ESR or ROE - erythrocyte sedimentation rate (erythrocyte sedimentation reaction) - this is the same thing, an indicator of the course of the disease. Typically, ESR increases on days 2-4 of the disease, sometimes reaching a maximum during the recovery period. The norm for men is 2-10 mm/h, for women - 2-15 mm/h.
Increased with:
infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation.
Downgraded:
with circulatory failure, anaphylactic shock.
Diagnosis of cancer tumors is a comprehensive examination using specific instrumental and laboratory methods. It is carried out according to indications, including disorders identified by a standard clinical blood test.
Malignant neoplasms grow very intensively, consuming vitamins and microelements, as well as releasing waste products into the blood, leading to significant intoxication of the body. Nutrients They are taken from the blood, and the products of their processing also end up there, which affects its composition. Therefore, it is often during routine examinations and laboratory tests that signs of a dangerous disease are discovered.
Cancer can be suspected based on the results of standard and special studies. During pathological processes in the body, changes in the composition and properties of blood are reflected in:
- general blood test;
- biochemical research;
- analysis for tumor markers.
However, cancer cannot be reliably determined by a blood test. Deviations in any indicators can be caused by diseases that are in no way related to oncology. Even the specific and most informative analysis for tumor markers does not provide a 100% guarantee of the presence or absence of the disease and needs to be confirmed.
Is it possible to determine oncology (cancer) using a general blood test?
This type of laboratory test gives an idea of the number of basic formed elements that are responsible for blood functions. A decrease or increase in any indicators is a signal of trouble, including the presence of neoplasms. A sample is taken from a finger (sometimes from a vein) in the first half of the day, on an empty stomach. The table below shows the main categories of general or clinical blood tests and their normal values.
When interpreting analyses, it is necessary to take into account that depending on gender and age, indicators may vary, and there are also physiological reasons for increasing or decreasing values.
| Name, unit of measurement | Description | Quantity |
| Hemoglobin (HGB), g/l | Component of red blood cells that transports oxygen | 120-140 |
| Red blood cells (RBC), cells/l | Red cell count indicator | 4-5x10 12 |
| Color index | Has diagnostic value for anemia | 0,85-1,05 |
| Reticulocytes (RTC). % | Young red blood cells | 0,2-1,2% |
| Platelets (PLT), cells/l | Provide hemostasis | 180-320x10 9 |
| ESR (ESR), mm/h | Plasma sedimentation rate of erythrocytes | 2-15 |
| Leukocytes (WBC), cells/l | Perform protective functions: maintaining immunity, fighting foreign agents and removing dead cells | 4-9x10 9 |
| Lymphocytes (LYM), % | These elements are components of the concept of “leukocytes”. Their number and ratio is called the leukocyte formula, which has important diagnostic value for many diseases | 25-40 |
| Eosinophils, % | 0,5-5 | |
| Basophils, % | 0-1 | |
| Monocytes, % | 3-9 | |
| Neutrophils: band | 1-6 | |
| segmented | 47-72 | |
| myelocytes | 0 | |
| metamyelocytes | 0 |
Almost all of these blood parameters change in the direction of decrease or increase in oncology. What exactly does the doctor pay attention to when studying the test results:
- ESR. The erythrocyte sedimentation rate in plasma is higher than normal. Physiologically, this can be explained by menstruation in women, increased physical activity, stress, etc. However, if the excess is significant and is accompanied by symptoms of general weakness and low-grade fever, cancer can be suspected.
- Neutrophils. Their number has been increased. The appearance of new, immature cells (myelocytes and metamyelocytes) in the peripheral blood, characteristic of neuroblastomas and other oncological diseases, is especially dangerous.
- Lymphocytes. These CBC indicators in oncology are higher than normal, since it is this element of the blood that is responsible for immunity and fights cancer cells.
- Hemoglobin. Decreases if there are tumor processes in internal organs. This is explained by the fact that waste products of tumor cells damage red blood cells, reducing their number.
- Leukocytes. The number of white blood cells, as shown by oncology tests, always decreases if the bone marrow is affected by metastases. The leukocyte formula shifts to the left. Neoplasms of other localization lead to an increase.
It should be borne in mind that a decrease in hemoglobin and the number of red blood cells is characteristic of ordinary anemia caused by iron deficiency. An increase in ESR is observed during inflammatory processes. Therefore, such signs of oncology from a blood test are considered indirect and need confirmation.
Biochemical research
The purpose of this analysis, carried out annually, is to obtain information about metabolism, the functioning of various internal organs, the balance of vitamins and microelements. A biochemical blood test for oncology is also informative, since changes in certain values allow one to draw conclusions about the presence of cancerous tumors. From the table you can find out what indicators should be normal.
Suspect cancer biochemical analysis blood is possible when the following values do not correspond to the norm:
- Albumin and total protein. They characterize the total amount of proteins in the blood serum and the content of the main one. The developing tumor actively consumes protein, so this indicator is significantly reduced. If the liver is affected, then even with adequate nutrition there is a deficiency.
- Glucose. Cancer of the reproductive (especially female) system, liver, and lungs affects insulin synthesis, inhibiting it. As a result, symptoms of diabetes mellitus appear, which is reflected in a biochemical blood test for cancer (sugar levels increase).
- Alkaline phosphatase. It increases primarily with bone tumors or metastases to them. It may also indicate oncology of the gallbladder or liver.
- Urea. This criterion allows you to evaluate the functioning of the kidneys, and if it is elevated, there is a pathology of the organ or there is an intensive breakdown of protein in the body. The latter phenomenon is characteristic of tumor intoxication.
- Bilirubin and alanine aminotransferase (ALT). An increase in the amount of these compounds informs about liver damage, including cancer.
If cancer is suspected, a biochemical blood test cannot be used to confirm the diagnosis. Even if there are coincidences on all points, additional laboratory tests will be required. As for donating blood directly, it is taken from a vein in the morning, and eating and drinking (it is allowed to consume boiled water) is not possible since the previous evening.
Basic Analysis
If a biochemical and general blood test for oncology only gives a general idea of the presence of a pathological process, then a study of tumor markers can even determine the location of a malignant neoplasm. This is the name of a blood test for cancer, which detects specific compounds produced by the tumor itself or the body in response to its presence.
In total, about 200 tumor markers are known, but a little more than twenty are used for diagnosis. Some of them are specific, that is, they indicate damage to a specific organ, while others can be detected when different types cancer. For example, alpha-fetoprotein is a common tumor marker for cancer; it is found in almost 70% of patients. The same applies to CEA (carcinoembryonic antigen). Therefore, to determine the type of tumor, the blood is tested for a combination of general and specific tumor markers:
- Protein S-100, NSE - brain;
- , SA-72-4, – the mammary gland is affected;
- , alpha-fetoprotein – cervix;
- , hCG – ovaries;
- , REA, NSE, SCC – lungs;
- AFP, CA-125 – liver;
- CA 19-9, CEA, – stomach and pancreas;
- SA-72-4, REA – intestines;
- – prostate;
- , AFP – testicles;
- Protein S-100 – skin.
But despite all the accuracy and information content, the diagnosis of oncology using a blood test for tumor markers is preliminary. The presence of antigens can be a sign of inflammatory processes and other diseases, and CEA is always elevated in smokers. Therefore, without confirmation by instrumental studies, the diagnosis is not made.
Can there be a good blood test for cancer?
This question is natural. If poor results are not confirmation of oncology, then could it be the other way around? Yes it is possible. The test result may be affected by the small size of the tumor or the use of medications (given that for each tumor marker there is a specific list of drugs, the use of which can lead to false-positive or false-negative results, the attending physician and laboratory staff should be notified about the drugs taken by the patient).
Even if the blood tests are good and instrumental diagnostics have not given any results, but there are subjective complaints of pain, we can talk about an extra-organ tumor. For example, its retroperitoneal variety is detected already at stage 4, before which it practically does not make itself felt. The age factor also matters, since metabolism slows down over the years, and antigens also enter the blood slowly.
What blood indicators indicate cancer in women?
The risk of getting cancer is approximately the same in both sexes, but the fair half of humanity has an additional vulnerability. The female reproductive system is at high risk of cancer, especially the mammary glands, which makes breast cancer the 2nd most common among all malignant neoplasms. The epithelium of the cervix is also prone to malignant degeneration, so women should take examinations responsibly and pay attention to following results tests:
- CBC in oncology shows a decrease in the level of red blood cells and hemoglobin, as well as an increase in ESR.
- Biochemical analysis - here the cause for concern is an increase in the amount of glucose. Such symptoms of diabetes are especially dangerous for women, as they often become precursors to breast and uterine cancer.
- When examining tumor markers, the simultaneous presence of SCC antigens and alpha-fetoprotein indicates a risk of cervical lesions. Glycoprotein CA 125 is a threat to endometrial cancer, AFP, CA-125, hCG - ovarian cancer, and the combination of CA-15-3, CA-72-4, CEA indicates that the tumor can be localized in the mammary glands.
If there is something alarming in the tests and there are characteristic signs of oncology in the initial stage, a visit to the doctor cannot be postponed. In addition, you should visit a gynecologist at least once a year, and regularly examine your breasts yourself. These simple preventive measures often help detect cancer in its early stages.
When is tumor marker analysis necessary?
You should undergo an examination if there is a prolonged deterioration in your health in the form of weakness, constant low temperature, fatigue, weight loss, anemia of unknown origin, enlarged lymph nodes, the appearance of lumps in the mammary glands, changes in the color and size of moles, disturbances in the gastrointestinal tract, accompanied by the discharge of blood after defecation, obsessive cough without signs of infection, etc.
Additional reasons are:
- age over 40;
- family history of cancer;
- exceeding the normal range of biochemical analysis and blood test results;
- pain or prolonged dysfunction of any organs or systems, even to a minor extent.
The analysis does not take much time, while helping to identify in time life-threatening disease and cure it in the least traumatic way. In addition, such examinations should become regular (at least once a year) for those who have relatives with cancer or have crossed the age of forty.
How to prepare for a tumor marker test
Blood for antigen tests is donated from a vein in the morning. Results are issued within 1-3 days, and in order for them to be reliable, you must follow certain recommendations:
- don't have breakfast;
- do not take any medications or vitamins the day before;
- three days before diagnosing cancer using a blood test, avoid alcohol;
- do not eat fatty or fried foods the day before;
- the day before the study, avoid heavy physical activity;
- on the day of delivery, do not smoke in the morning (smoking increases CEA);
- To prevent third-party factors from distorting the indicators, first cure all infections.
After receiving the results in hand, you should not draw any independent conclusions or make diagnoses. This blood test for cancer is not 100% reliable and requires instrumental confirmation.
So what does our blood tell us? We take a blood test for almost any disease. And a competent doctor will certainly send you first for blood tests. For a general analysis, blood is taken either from a vein or from a finger. And the primary analysis can be taken without an empty stomach. But under no circumstances should you eat it for the unfolded one! Remember this!
The reason for this requirement is simple: any food will change your blood sugar, and the analysis will not be objective. It is best to donate blood after a short rest (this is why we most often go for testing in the morning). Again, for the purity of the study.
A competent doctor will definitely take into account your gender and physiological condition. Because, say, in women during PMS, ESR increases and the number of platelets decreases.
General analysis indicators:
1. Hemoglobin (Hb)
This is a blood pigment contained in red blood cells, the main function of which is to transport oxygen from the lungs to the tissues and remove CO2 from the body. Normal indicators for men they are 130–160 g/l, for women - 120–140 g/l. If hemoglobin is low, this indicates possible anemia, blood loss or hidden internal bleeding due to damage to internal organs. An increase in hemoglobin is usually observed in blood diseases and some types of heart failure.
2. Red blood cells
These are the red blood cells themselves, containing hemoglobin. Normal values for men are (4.0–5.1) * 10 to the 12th power/l and for women - (3.7–4.7) * 10 to the 12th power/l. An excess of red blood cells occurs in healthy people at high altitudes in the mountains, as well as with heart defects, diseases of the bronchi, lungs, kidneys and liver. Sometimes this indicates an excess of steroid hormones in the body. A lack of red blood cells indicates anemia, acute blood loss, and chronic inflammatory processes. And sometimes it happens in late pregnancy.
3. Leucrocytes
White blood cells. Produced in the bone marrow and lymph nodes and protect the body from external influences. The norm for everyone is (4.0–9.0) x 10 to the 9th power /l. Excess indicates the presence of infection and inflammation. A large number of them occur when different situations, sometimes not related to diseases. They can jump from physical exertion, stress or pregnancy. But it happens that leukocytosis is associated with diseases, namely:
bacterial infections;
inflammatory processes;
allergic reactions;
leukemia;
taking hormonal medications, some heart medications (such as digoxin).
But leukopenia (lack of white blood cells) may indicate a viral infection (for example, influenza) or taking certain medications, for example, analgesics, anticonvulsants.
4. Platelets
Cells that provide blood clotting are involved in the formation of blood clots. The normal amount is (180–320) * 10 to the 9th power/l. If they are more than normal, then you may have tuberculosis, ulcerative colitis, or cirrhosis of the liver. This also happens after operations or when using hormonal drugs. Their reduced content occurs under the influence of alcohol, heavy metal poisoning, blood diseases, kidney failure, liver diseases, spleen diseases, and hormonal disorders. And also under the influence of certain medications: antibiotics, diuretics, digoxin, nitroglycerin, hormones.
5. ESR or ROE
Erythrocyte sedimentation rate. This is an indicator of the course of the disease. Typically, ESR increases on days 2–4 of the disease, and reaches a peak during the recovery period. The norm for men is 2–10 mm/h, for women – 2–15 mm/h. Increased performance occur with infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation, and a decrease is observed with circulatory failure, anaphylactic shock.
6. Glucose
The glucose concentration in a healthy body should be 3.5–6.5 mmol/liter. A lack of glucose indicates insufficient and irregular nutrition, hormonal diseases, an excess indicates diabetes mellitus.
7. Total protein
Its norm is 60–80 grams/liter. With deterioration of the liver, kidneys, or malnutrition, it decreases. This often happens after strict diets.
8. Total bilirubin
Bilirubin should show no higher than 20.5 mmol/liter. It is an indicator of liver function. With hepatitis, cholelithiasis or destruction of red blood cells, bilirubin increases.
9. Creatinine
Creatinine is responsible for your kidneys. Its normal concentration: 0.18 mmol/liter. Exceeding the norm is a sign of kidney failure; if it falls short of the norm, it means you need to increase your immunity.
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What you can read about your health from the most informative analysis
Whatever your illness, the first test that a competent doctor will send you for will be a general (general clinical) blood test, says our expert - cardiologist, doctor highest category Tamara Ogieva.
Blood for general analysis is taken venous or capillary, that is, from a vein or from a finger. The primary general analysis can be taken without an empty stomach. A detailed blood test is given only on an empty stomach.
For biochemical analysis, blood will have to be donated only from a vein and always on an empty stomach. After all, if you drink, say, coffee with sugar in the morning, the glucose level in your blood will certainly change and the analysis will be incorrect.
A competent doctor will definitely take into account your gender and physiological condition. For example, in women during “ critical days” ESR increases and platelet count decreases.
A general analysis provides more information about inflammation and the state of the blood (propensity for blood clots, the presence of infections), and biochemical analysis is responsible for the functional and organic state of internal organs - liver, kidneys, pancreas.
General analysis indicators:
1. HEMOGLOBIN (Hb) is a blood pigment found in erythrocytes (red blood cells), its main function is the transfer of oxygen from the lungs to the tissues and the removal of carbon dioxide from the body.
Normal values for men are 130-160 g/l, women - 120-140 g/l.
Reduced hemoglobin occurs with anemia, blood loss, hidden internal bleeding, damage to internal organs, for example, kidneys, etc.
It can increase with dehydration, blood diseases and some types of heart failure.
2. ERYTHROCYTES - blood cells that contain hemoglobin.
Normal values are (4.0-5.1) * 10 to the 12th power/l and (3.7-4.7) * 10 to the 12th power/l, for men and women, respectively.
An increase in red blood cells occurs, for example, in healthy people at high altitudes in the mountains, as well as in congenital or acquired heart defects, diseases of the bronchi, lungs, kidneys and liver. The increase may be due to an excess of steroid hormones in the body. For example, with Cushing's disease and syndrome, or during treatment with hormonal drugs.
Decrease - with anemia, acute blood loss, with chronic inflammatory processes in the body, as well as in late pregnancy.
3. LEUCOCYTES - white blood cells, they are formed in the bone marrow and lymph nodes. Their main function is to protect the body from adverse effects. Norm - (4.0-9.0) x 10 to the 9th degree / l. Excess indicates the presence of infection and inflammation.
There are five types of leukocytes (lymphocytes, neutrophils, monocytes, eosinophils, basophils), each of them performs a specific function. If necessary, a detailed blood test is done, which shows the ratio of all five types of leukocytes. For example, if the level of leukocytes in the blood is increased, a detailed analysis will show which type has increased their total number. If due to lymphocytes, then there is an inflammatory process in the body; if there are more eosinophils than normal, then an allergic reaction can be suspected.
WHY ARE THERE MUCH LEUKOCYTES?
There are many conditions in which changes in white blood cell levels are observed. This does not necessarily indicate illness. Leukocytes, as well as all indicators of general analysis, react to various changes in the body. For example, during stress, pregnancy, or after physical exertion, their number increases.
An increased number of leukocytes in the blood (also known as leukocytosis) also occurs with:
Infections (bacterial),
Inflammatory processes
Allergic reactions,
Malignant neoplasms and leukemia,
Taking hormonal medications, some heart medications (for example, digoxin).
But a low number of white blood cells in the blood (or leukopenia): this condition often occurs with a viral infection (for example, the flu) or taking certain medications, for example, analgesics, anticonvulsants.
4. PLATELETS - blood cells, an indicator of normal blood clotting, are involved in the formation of blood clots.
Normal amount - (180-320) * 10 to the 9th power/l
An increased amount occurs when:
Chronic inflammatory diseases (tuberculosis, ulcerative colitis, cirrhosis of the liver), after operations, treatment with hormonal drugs.
Reduced when:
The effects of alcohol, heavy metal poisoning, blood diseases, kidney failure, liver diseases, spleen diseases, hormonal disorders. And also under the influence of certain medications: antibiotics, diuretics, digoxin, nitroglycerin, hormones.
5. ESR or ROE - erythrocyte sedimentation rate (erythrocyte sedimentation reaction) - this is the same thing, an indicator of the course of the disease. Typically, ESR increases on days 2-4 of the disease, sometimes reaching a maximum during the recovery period. The norm for men is 2-10 mm/h, for women - 2-15 mm/h.
Increased with:
Infections, inflammation, anemia, kidney disease, hormonal disorders, shock after injuries and operations, during pregnancy, after childbirth, during menstruation.
Downgraded:
In case of circulatory failure, anaphylactic shock.
Biochemical analysis indicators:
6. GLUCOSE - it should be 3.5-6.5 mmol/liter. Decreased - with insufficient and irregular nutrition, hormonal diseases. Increased in diabetes mellitus.
7. TOTAL PROTEIN - norm - 60-80 grams / liter. Decreases with deterioration of the liver, kidneys, malnutrition (a sharp decrease in total protein is a frequent symptom that a strict restrictive diet clearly did not benefit you).
8. TOTAL BILIRUBIN - normal - no higher than 20.5 mmol/liter shows how the liver is working. Increase - with hepatitis, cholelithiasis, destruction of red blood cells.
9. CREATININE - should not be more than 0.18 mmol/liter. The substance is responsible for the functioning of the kidneys. Exceeding the norm is a sign of kidney failure; if it falls short of the norm, it means you need to increase your immunity.
