Now let's look at the neutrophils.
We're going to start with them
because they're the largest percentage
of your white blood cells.
Normal about 55%-75%.
So we're looking at the neutrophils because
they're the largest percentage, right?
Okay, now, these guys are the key players
in the acute phase of inflammation.
Now, acute phase when you look,
you're right in the thick of it.
That's the most intense
part of the infection
because neutrophils respond
to bacterial infection.
In fact, they're the biggest component
of pus, that purulent drainage.
Have you seen some of those crazy videos
on YouTube where they pop things
and giant amounts of pus spurt
out of the patient's body?
Yeah, that's what we're talking about.
That big, drippy, drainage is
So when you're thinking about
these guys, remember,
they're the ones who respond in
the acute phase of inflammation.
They respond to bacterial infection,
and they're the largest component of pus.
Okay, now that we've introduced
ourselves to the neutrophils
and we know that they're key in
the acute bacterial infection,
and the largest component of pus,
let's look at some other things
you're going to want to consider
when you're looking at the results of a CBC,
and you notice the white
cell count is elevated.
Now, usually, the neutrophils
will be elevated
in the midst of an acute
I think we've got that one down pretty solid.
But there are some other things
you may not have considered.
Take acute stress.
Now, we define stress a little
differently than maybe you.
You might be thinking, exams,
grades, all those types of things.
But when we talk about stress here,
we're talking about things your patients
might experience, like after surgery.
So after the body experiences that kind
of trauma, like we've cut on the tissue,
it responds in a major
So after a patient comes back from surgery
when they're post-op or post-operative,
you can expect to see a normal
bump up in their white cells,
specifically, their neutrophils.
Don't get alarmed.
This is a natural part of the
body's healing process.
So we've got acute bacterial
infection or acute stress.
Those are 2 pretty common ones, so make sure
if you're going to memorize anything
on this list that you keep
those top 2 ones in line.
Now, I'm going to look at some special causes.
Neutrophils can also be elevated in burns.
Oh, this causes massive
shifting of fluid and all kinds of
disruption of the body's processes.
But if a patient has gone through
a significant enough burn,
you're going to see a bump up in
their neutrophils or neutrophilia.
Now leukemia, remember,
the cells and counts can be off in lots of
different ways, but a high white cell count
might be a sign of leukemia.
Also see it in corticosteroid use,
or autoimmune things like
or someone who has chronic inflammation.
The last one might really surprise you.
It's intense exercise.
Now this doesn't mean getting up from
the couch and walking to the kitchen.
Someone's doing some really intense
weight lifting or running
or long distances, you may see a
bump up in their white cells, too.
So, see, it's really important when
you're looking at lab values
to talk to your patient or
your patient's family
and get an idea of what
events have happened
right before they came to you
and had this lab work drawn.
So for neutrophilia, that's
a pretty long list.
Remember, if you're going
to remember 2 of them,
I want you to think right off the top;
acute bacterial infection or acute
stress, like after surgery
are 2 of the top things for
you to keep in mind.
The rest are really good to know,
but if you're pressed for time,
focus on those top 2.
Okay, so that was a look
at elevated neutrophils.
Now let's look at the opposite side.
We have decreased neutrophils,
that's neutropenia. Now this can
happen in immunosuppression.
This is an immune system that
isn't working very well, right?
Neutrophilia was when the autoimmune
disease, when it's attacking the body.
Immunosuppression is someone
whose immune system
is not functioning at all. It's not
attacking very much at all.
So that would be a sign of low white
cells that could be immunosuppressed.
Now there's lots of reasons somebody
can be immunosuppressed.
Maybe they're on chemotherapy,
maybe they have some other disease that
has caused them to be immunosuppressed.
But when you see a low white cell count,
that should be a trigger to you to think
how strong is their immune system?
What's going on?
What might have caused them
to be immunosuppressed?
Another reason would be
a bone marrow failure.
They might have an aplastic anemia.
So the bone marrow isn't able
to function and they're not able
to produce the white cells
that their body needs.
They might have some
folate or B12 deficiency,
so there might be a nutritional
problem going on.
So that may be one that you wouldn't
necessarily consider, right?
We don't necessarily always go to nutrition,
but we really should give it a focus,
So we'd have to look at what's going on
with their intake, what they're able to eat,
maybe what their body has
Now chemotherapy shows up.
might be caused by chemotherapy,
but that's why chemotherapy
made this list again.
So we can point out to you --
remember that chemotherapy
goes after high growth fraction
cells in your body.
Cancer is a high growth fraction cell,
but so is your hair, GI, skin, reproductive
system, and bone marrow.
So chemotherapy will suppress
your bone marrow
and that's why you end up with less
white cells than your body needs.
Now, last, there's a couple ideas of
drugs that can also cause neutropenia:
chloramphenicol or sulfonamides are drugs
that can cause a patient's white cell count,
neutrophils specifically, to be lower.
Okay, so that is a lot of list
for you to remember.
Make sure that you take some time
before you go on to the next slides.
Really take a look at these. Maybe group
them in a way that makes more sense to you.
I gave you some ideas on
how you could do it,
but you're the expert in knowing how
your brain remembers things,
how it encodes information,
and how it can recall it.
So pause the video for just a minute
and group these in items and ways
that makes sense to you.