Neutrophilia (neutrophilia, neutrophilic leukocytosis) is an increase in the content of neutrophils over 6500 (in a child under 6 years old over 4500) in 1 μl of blood. The cause is bacterial infections, purulent-septic processes, inflammatory, oncological diseases. There are no specific clinical signs in neutrophilia, the symptoms depend on the underlying pathology. The level of neutrophils is determined as part of the calculation of the leukocyte hemogram formula. To correct neutrophilia, the disease against which it developed is treated.
The neutrophilic leukocytes themselves are of two main types: segmented (mature) and stab (young). Stab neutrophils normally make up from 1 to 5% of the total number of leukocytes, segmented - from 35 to 65%. According to the ratio of young and mature cells, neutrophilia are isolated with and without a nuclear shift. The nuclear shift to the left implies an increase in the number of young forms of neutrophils and is divided into the following types:
With neutrophilia, which has a nuclear shift to the right, the hemogram shows the absence of young forms of granulocytes and the appearance of hypersegmented (containing more than 5 segments) neutrophils. Neutrophilia without a nuclear shift is accompanied by an increase in only segmented neutrophils. In relation to other types of leukocytes, there are:
There is a so-called physiological neutrophilia, or pseudoneutrophilia. Its occurrence is not associated with an increase in the production of neutrophils, but with their redistribution, i.e. a change in the ratio of the parietal and circulating pool of neutrophils towards the latter. Pseudoneutrophilia is observed during stress, intense physical activity, exposure to heat or cold, after eating. Also, neutrophils are often increased during pregnancy, in a newborn baby.
In a child of preschool age (up to 5-6 years), due to the physiological decrease in the level of neutrophils due to leukocyte decussation, there is an increased susceptibility to bacterial infections. In children, neutrophils increase mainly with scarlet fever, streptococcal tonsillitis. In the pediatric population, such a dangerous infection as diphtheria is quite common. Parasitic infestations (ascariasis, enterobiasis, toxocariasis) are also common among preschoolers. In these diseases, in addition to neutrophilia, high eosinophilia is observed in the blood.
Most often, neutrophils are increased in bacterial infections. The main function of neutrophils is the anti-infective protection of the macroorganism, namely, the destruction of bacteria. They also take part in the fight against viruses, parasites. Migrating through the vascular wall, neutrophils are sent to the focus of localization of the pathogenic microorganism. By releasing cytokines and inflammatory mediators, neutrophils activate other components of the immune system (complement, T-B lymphocytes).
Neutrophilic leukocytes first phagocytize (absorb) the infectious agent, then secrete degradation enzymes (lysozyme, lactoferrin, phosphatases) and reactive oxygen species (superoxide anion, hydroxyl radical, hydrogen peroxide), which contributes to the death of microorganisms. Neutrophilia increases rapidly, reaches a maximum in parallel with the height of the disease, gradually decreases after antibiotic therapy.
The most common cause of neutrophilia in adults is acute localized bacterial (pneumonia, sinusitis, pyelonephritis) or specific infections (typhoid fever). They are characterized by moderate neutrophilia. Less commonly, severe generalized infections (bacterial endocarditis, sepsis, meningococcal meningitis) are the cause, characterized by high neutrophilia with hyperregenerative or degenerative shift.
Quite often, neutrophils are increased in acute abdominal pathology (cholecystitis, pancreatitis, perforation of a stomach or duodenal ulcer), purulent processes (phlegmon, abscess). Neurophilia in a child is often found with appendicitis. An increase in the number of neutrophilic leukocytes in these diseases acts as a reaction to the inflammatory process. A correlation between the severity of inflammation and the degree of increase in neutrophils has been accurately established. Usually there is a high neutrophilia with a degenerative shift of the leukocyte formula to the left, which quickly regresses after emergency surgery. However, neutrophils can remain within the normal range.
These conditions include heart attacks of various organs (myocardium, lungs, intestines), abdominal operations, gangrene, pancreatic necrosis. The cause of neutrophilia is stimulation of granulocytopoiesis decay products in the bone marrow. An additional role is played by reactive neutrophilia, which occurs due to the release of a large amount of stress hormones (catecholamines, glucocorticosteroids) into the blood.
Also, the occurrence of neutrophilia in these conditions is facilitated by the addition of a secondary infection (for example, pneumonia due to pulmonary infarction). The degree of neutrophilia correlates with the volume of damaged, necrotic tissue, often reaches very high values (especially in a child), can persist for a long time, decreases with recovery.
Neutrophilia can be observed in some chronic inflammatory pathologies of a rheumatic nature. There is an assumption that mediators, cytokines, autoantibodies, which are formed during rheumatic inflammation, stimulate the bone marrow production of neutrophilic granulocytes. Usually, the appearance of neutrophilia along with other laboratory markers, such as an increased erythrocyte sedimentation rate, C-reactive protein, indicates an exacerbation of the disease.
After anti-inflammatory treatment, the concentration of neutrophils gradually returns to normal. In adults, especially high neutrophilia is characteristic of acute gouty attacks, necrotizing vasculitis (polyarteritis nodosa, granulomatosis with polyangiitis). In a child, neutrophils are increased most often with dermatomyositis.
Neutrophilia can sometimes indicate a malignant tumor. Two mechanisms contribute to its occurrence - the disintegration of tumor tissue and the ability of some tumor cells to secrete granulocyte colony-stimulating growth factors (paraneoplastic syndrome). Most often, neutrophilia occurs in patients with cancer of the breast, lung, colon, and ovaries. Neutrophilia increases slowly as the tumor grows, reaches moderate numbers, gradually regresses after chemotherapy, or quickly returns to normal after surgical removal of the neoplasia.
High neutrophilia is observed in oncohematological diseases. It can reach very high numbers (up to 10 thousand) in myeloproliferative diseases (acute, chronic myelogenous leukemia). With lymphoproliferative pathologies (non-Hodgkin's lymphomas, lymphosarcomas), neutrophilia is slightly less pronounced, almost always accompanied by absolute lymphocytosis. In a child, lymphogranulomatosis (Hodgkin's lymphoma) is more often the cause.
In addition to neutrophilia itself, patients with acute leukemia have a basophilic-eosinophilic association in the blood, a large number of blast cells and the absence of intermediate forms (leukemic failure). The mechanism of neutrophilic leukocytosis lies in the malignant transformation of the hematopoietic stem cell. Granulocyte counts return to normal only after several courses of polychemotherapy or bone marrow transplantation.
Detection of neutrophilia requires differential diagnosis. To do this, you need to contact a general practitioner. In order to obtain primary information, an anamnesis is collected - how long ago the symptoms appeared, whether there was recent contact with infectious patients, whether there was an increase in body temperature, pain, skin rashes.
If there is a suspicion of acute surgical abdominal pathology, the abdomen must be palpated for tension in the muscles of the anterior abdominal wall, the presence of a positive Shchetkin-Blumberg symptom. However, it must be borne in mind that in a child under the age of 9 years, these signs are difficult to identify. To confirm the diagnosis, an additional examination is prescribed, including:
There are no direct ways to normalize the number of neutrophilic granulocytes. To combat neutrophilia, it is necessary to treat the underlying disease against which it developed. Short-term neutrophilia after eating, stress or physical work does not require any intervention, as it is not a sign of a disease or pathological condition. Neutrophilia resulting from surgery also does not need to be treated. In the case of persistent neutrophilia, you should consult a doctor to find out the cause and prescribe a differentiated treatment:
Many diseases accompanied by neutrophilia (mainly acute abdominal pathologies) require emergency surgical intervention - laparoscopic appendectomy, laparotomy and suturing of the ulcer, cholecystectomy, opening and drainage of the abscess, etc. cells.
Only one neutrophilia is impossible to predict the prognosis. It all depends on the disease that served as the background for the occurrence of neutrophilia. For example, a transient increase in the number of neutrophils after stress, eating, or in a child on the first day of life is absolutely benign, transient. And vice versa, severe purulent-septic pathologies, oncological diseases have a rather high frequency of deaths. Therefore, any excess of the reference values of neutrophils (especially high and persistent) requires a visit to a doctor.