Polymorphonuclear Cells: Neutrophils (Nursing)

00:01 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.

00:07 Normal about 55%-75%.

00:11 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.

00:20 Now, acute phase when you look, you're right in the thick of it.

00:22 That's the most intense part of the infection because neutrophils respond to bacterial infection.

00:29 In fact, they're the biggest component of pus, that purulent drainage.

00:34 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.

00:43 That big, drippy, drainage is predominantly neutrophils.

00:47 So when you're thinking about these guys, remember, they're the ones who respond in the acute phase of inflammation.

00:52 They respond to bacterial infection, and they're the largest component of pus.

00:58 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.

01:14 Now, usually, the neutrophils will be elevated in the midst of an acute bacterial infection.

01:18 I think we've got that one down pretty solid.

01:20 But there are some other things you may not have considered.

01:24 Take acute stress.

01:26 Now, we define stress a little differently than maybe you.

01:29 You might be thinking, exams, grades, all those types of things.

01:33 But when we talk about stress here, we're talking about things your patients might experience, like after surgery.

01:39 So after the body experiences that kind of trauma, like we've cut on the tissue, it responds in a major inflammatory response.

01:47 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.

01:59 This is a natural part of the body's healing process.

02:02 So we've got acute bacterial infection or acute stress.

02:06 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.

02:14 Now, I'm going to look at some special causes.

02:17 Neutrophils can also be elevated in burns.

02:20 Oh, this causes massive shifting of fluid and all kinds of disruption of the body's processes.

02:26 But if a patient has gone through a significant enough burn, you're going to see a bump up in their neutrophils or neutrophilia.

02:33 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.

02:41 Also see it in corticosteroid use, or autoimmune things like rheumatoid arthritis, or someone who has chronic inflammation.

02:49 The last one might really surprise you.

02:52 It's intense exercise.

02:54 Now this doesn't mean getting up from the couch and walking to the kitchen.

02:57 Someone's doing some really intense weight lifting or running or long distances, you may see a bump up in their white cells, too.

03:05 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.

03:16 So for neutrophilia, that's a pretty long list.

03:19 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.

03:30 The rest are really good to know, but if you're pressed for time, focus on those top 2.

03:36 Okay, so that was a look at elevated neutrophils.

03:39 Now let's look at the opposite side. We have decreased neutrophils, that's neutropenia. Now this can happen in immunosuppression.

03:48 This is an immune system that isn't working very well, right? Neutrophilia was when the autoimmune disease, when it's attacking the body.

03:56 Immunosuppression is someone whose immune system is not functioning at all. It's not attacking very much at all.

04:03 So that would be a sign of low white cells that could be immunosuppressed.

04:07 Now there's lots of reasons somebody can be immunosuppressed.

04:11 Maybe they're on chemotherapy, maybe they have some other disease that has caused them to be immunosuppressed.

04:16 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.

04:29 They might have an aplastic anemia.

04:32 So the bone marrow isn't able to function and they're not able to produce the white cells that their body needs.

04:38 They might have some folate or B12 deficiency, so there might be a nutritional problem going on.

04:44 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 problems processing.

04:59 Now chemotherapy shows up. Remember, immunosuppression might be caused by chemotherapy, but that's why chemotherapy made this list again.

05:07 So we can point out to you -- remember that chemotherapy goes after high growth fraction cells in your body.

05:14 Cancer is a high growth fraction cell, but so is your hair, GI, skin, reproductive system, and bone marrow.

05:24 So chemotherapy will suppress your bone marrow and that's why you end up with less white cells than your body needs.

05:31 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.

05:44 Okay, so that is a lot of list for you to remember.

05:47 Make sure that you take some time before you go on to the next slides.

05:51 Really take a look at these. Maybe group them in a way that makes more sense to you.

05:55 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.

06:04 So pause the video for just a minute and group these in items and ways that makes sense to you.