neutrophils Archives - Student Nurse Life

Blood Components and Functions

The internal environment of the human organism is made up of blood within the blood vessels, interstitial fluid surrounding the body cells, and lymph inside the lymph vessels.

The blood is able to pick up:

nutrients (from the digestive tract)
oxygen (from the lungs)
hormones (from the endocrine glands)
enzymes (from multiple body sites)

The blood can also act as a transportation means for disease-causing organisms. For this reason, the lymphatic system helps in picking up wastes from the interstitial fluid, cleansing them of bacteria, and returning them bacteria-free into the blood.

Physical Characteristics of the Blood

blood components — Retrieved from https://quizlet.com/96941163/56-what-is-the-normal-ph-of-blood-181b-physical-characteristics-of-blood-flash-cards/ on 12th May 2022

Blood Functions

1. Transportation

Blood helps in the transportation of:

Oxygen (from the lungs to the body’s cells)
Carbon Dioxide (from the cells to the lungs)
Nutrients (from the digestive organs to the cells)
Waste Products (from the cells to the kidneys, lungs, and sweat glands)
Hormones (from the endocrine glands to the cells)
Enzymes (to various cells)

2. Regulation

Blood helps in the regulation of:

pH (through buffers)
Body Temperature (through heat-absorbing and coolant properties of its water content)
Water within the Cells (mainly through dissolved sodium ions)

3. Protection

Blood helps in protecting the body against:

Blood Loss (through the blood clotting mechanism)
Toxins and Foreign Microbes (through special combat-unit cells such as white blood cells)

Blood Composition

Blood is made up of 2 portions:

1. Formed Elements

make up 45% of the total blood volume
include Red Blood Cells, White Blood Cells (Granular – neutrophils, eosinophils & basinophils; and Agranular – lymphocytes & monocytes), and Platelets.

2. Plasma

makes up 55% of the total blood volume
water (91.5% of total plasma)
proteins (7% of total plasma)
other solutes (1.5% of total plasma)

Haematopoiesis – Blood Cell Formation

Haematopoiesis a.k.a. blood cell formation takes place within the Red Bone Marrow (myeloid tissue in the humerus, femur, sternum, ribs, vertebrae & pelvis) and Lymphoid Tissue (in the spleen, tonsils & lymph nodes).

Red Blood Cells, Leucocytes & Platelets are produced within the Bone Marrow.
Agranular Leucocytes (lymphocytes & monocytes) are produced by the Bone Marrow and the Lymphoid Tissue.

Red Blood Cells a.k.a. Erythrocytes

do not contain a nucleus
cannot reproduce
cannot carry on extensive metabolic activities
plasma membrane is selectively permeable
plasma membrane encloses cytoplasm and haemoglobin
have a biconcave shape which promotes increased surface area for diffusion purposes
contain a lot of haemoglobin molecules which increase their capacity for oxygen transportation
allow transportation of a small amount of carbon dioxide along with haemoglobin

Normal Haemoglobin Values

Infants	14-20gm/dl
Adult Females	12-15gm/dl
Adult Males	14-16.5gm/dl

Erythropoiesis – Erythrocyte Production

erythropoiesis and erythrocyte destruction usually proceed at the same pace
if the balance between erythropoiesis and erythrocyte destruction is disrupted, a homeostatic mechanism is initiated to promote erythrocyte production
in oxygen deficiency, particular kidney cells release the enzyme Renal Erythropoietic Factor which converts plasma protein into the hormone erythropoietin, which, when reaching the red bone marrow, stimulates haemocytoblasts to develop into red cells

NOTE: Blast is a short name for an immature WBC, such as a lymphoblast or myeloblast. In normal circumstances, less than 5% of the cells in healthy bone marrow at any one time are blasts. Within the bone marrow, normal blasts develop into mature, functioning blood cells and are then released into the bloodstream.

Retrieved from https://labpedia.net/erythropoiesis-rbc-maturation-rbc-counting-procedure/ on 12th May 2022

Haemoglobin in Erythrocytes

erythrocyte life span is around 120 days long
the plasma membrane of depleted cells are removed from the circulation by macrophages in the spleen, liver, and bone marrow
haemoglobin is broken down into Haemosiderin (iron-containing pigment which is stored or used in the bone marrow for the production of new haemoglobin for new RBCs), Bilirubin (pigment secreted by the liver into bile) and Globin (protein metabolised in the liver).

White Blood Cells a.k.a. Leucocytes

there is a much lesser amount of WBCs than RBCs in the human body: 700 RBCs per 1 WBC
leucocytes contain nuclei
leucocytes do NOT contain haemoglobin
leucocytes have surface proteins called Human Leucocyte Associated Antigens (HLA) which are unique to each and every person

There are 2 types of WBCs:

GRANULAR LEUCOCYTES:

NEUTROPHILS (POLYMORPHS) – make up the biggest amount of total leucocytes; involved in phagocytosis of bacterial pathogens and the release of antimicrobial chemicals
EOSINOPHILS – involved in phagocytosis of antigen-antibody complexes, allergens and inflammatory chemicals, and the release of enzymes which help weaken or destroy parasites
BASOPHILS – involved in the secretion of histamine which promotes blood flow to a particular tissue, and the secretion of heparin which promotes mobility of other WBCs by clotting prevention
develop from red bone marrow
have granules in the cytoplasm
have a lobed nuclei

AGRANULAR LEUCOCYTES:

MONOCYTES – turn into macrophages; phagocytise pathogens, dead neutrophils, and dead cells debris; and present antigens that activate other cells within the immune system
LYMPHOCYTES – assist with immune memory, secrete antibodies, present antigens for the activation of other cells within the immune system, and help in destroying cancer cells, virus-infected cells, and foreign cells
develop from lymphoid and myeloid tissue
do not have granules in the cytoplasm

Retrieved from https://www.pinterest.com/pin/452752568781425426/ on 13th May 2022

Differential Blood Count

*Type of White Blood Cell*	*Normal Differential Count*	*High WBC Count Implication*
Neutrophils	60% – 70%	damage caused by invading bacteria
Eosinophils	2% – 4%	allergic reaction
Basophils	0.5% – 1%	allergic reaction
Lymphocytes	20% – 25%	antigen-antibody reaction
Monocytes	3% – 8%	chronic infection

Life Span of Leucocytes

leucocytes can live from just a few days to a few months, depending on what type of leucocytes they are
during infection, white blood cells become very active, usually living for only a few hours

Platelets

platelets contain no nucleus
platelets have a life span of between 5 to 9 days
platelets help prevent fluid loss through a chain of reaction leading in blood clotting
stem cell development from haemocytoblast to platelets takes place in the red bone marrow

Stem cell developmental pathway. Retrieved from https://slideplayer.com/slide/12774626/ on 14th May 2022

Plasma

Plasma is made up of:

WATER – 90% of total amount of water in plasma is derived from the GI tract; 10% is derived from cellular respiration; water absorbs heat and acts as a solvent and suspending medium for the blood’s solid components
SOLUTES – makes up 8.5% of the total plasma volume
PROTEINS – ALBUMINS (55% of plasma proteins) are produced by the liver; provide viscosity in the blood which helps maintain blood pressure; exert osmotic pressure to help in maintaining water balance between the blood and the tissues; help regulate blood volume; GLOBULINS (38% of plasma proteins) a.k.a. antibodies; FIBRINOGEN (7% of plasma proteins) is produced by the liver; it helps in the blood clotting process

blood plasma components — Retrieved from https://www.austincc.edu/apreview/PhysText/Blood.htm on 14th May 2022

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Infection Control Measures in Immunosuppressed Patients

Infection complications are most often predictable and possibly preventable through adequate infection control measures. In immunosuppressed patients this is of high importance, especially since the greater the impairment, the higher the risk of infection. Recognising patients with increased risk, identifying and correcting risk factors in advance, and reducing sources of infection are important aspects related to prevention of infection.

Immunosuppressed Patients

Immunosuppressed patients typically are those patients who have:

extensive burns
organ transplants
particular genetic disorders eg. immunoglobulin A deficiency
HIV infections
leukaemias (cancer of white blood cells)
lymphomas (cancer of the lymphatic system)
high-dose chemotherapy
haematological malignancies (cancers originating in blood-forming tissue eg. bone marrow, or in immune system cells)
neutropenia (lack of neutrophils)

Neutropenia

Neutropenia is characterised by lack of neutrophils – white blood cells that help fight infections, especially those caused by bacteria. Normal range for neutrophils is 2.5-7.5 x 10⁹/L. The lower the neutrophil count, the steeper the fall or the longer the duration of neutropenia, the higher the risk of infection.

immunosuppressed patients — Retrieved from https://www.haematologica.org/article/view/7075 on 2nd April 2022

Protective Precautions vs Protective Isolation

COMMENSAL MICRO-ORGANISMS – can be found on body surfaces which are covered by epithelial cells and exposed to the external environment (GI tract, respiration tract, vagina, skin, etc).

COMMENSAL BACTERIA – although co-evolved with their hosts, in specific circumstances can overcome protective responses in the host, causing pathologic effects.

NOSOCOMIAL INFECTIONS – eg. healthcare associated infections & MRSA.

OPPORTUNISTIC INFECTIONS – infections affecting solely the immunosuppressed patient eg. Kaposi’s sarcoma.

Infection-causing micro-organisms in immunosuppressed patients may be acquired through:

the presence of the individual’s normal flora
hospital staff hands
hospital equipment
food

Protective isolation components include:

physical separation from the main population through the use of a single room
restriction on movement, visitors and diet
antimicrobial prophylaxis and selective decontamination of the digestive system
care for the maintenance of skin and mucous membrane integrity
application of hand hygiene to prevent exogenous acquisition of micro-organisms

NOTE: Signs & symptoms of infection are most commonly absent in immunosuppressed patients.

Transferring an immunosuppressed patient in Protective Isolation may not be enough to prevent subsequent development of infection.

Infection Control Measures

Infection control measures help prevent infection in immunosuppressed patients. Standard precautions should be applied when caring for neutropenic patients as well as severely immunosuppressed patients.

Component	Recommendations
Hand hygiene	after contact with body fluids (including contaminated items), after glove removal, and between one patient and another
Gloves	use when touching body fluids (including contaminated items), when touching mucous membranes, and non-intact skin
Gown	use during procedures and patient care which require contact with clothing and exposed skin with anticipated exposure to body fluid
Face protection (eg. masks, goggles, visors)	use during procedures and patient care which are likely to generate splashes of body fluids, including aerosol-generating procedures with suspected or proven infections that transmit by respiratory aerosols (in which case wear an N95 or higher respirator along with gloves, gown, face and eye protection)
Soiled equipment	handle using preventative measures to avoid transferring micro-organisms to other individuals and to the environment; perform hand hygiene and wear gloves when handling visibly contaminated items
Environmental control	support/advocate for routine care, cleaning and disinfection of surroundings, especially surroundings close to patient-care areas

Standard Precautions

Textiles and laundry	handle using preventative measures to avoid transferring micro-organisms to other individuals and to the environment
Sharps	avoid recapping, bending, breaking or manipulating used needles; if recapping is needed, use one-hand scoop technique; use safety features if available; use appropriate sharps disposal containers
Patient resuscitation	use mouthpiece, resuscitation bag, or other ventilation devices to prevent oral contact and contact with oral secretions
Patient placement	use single-patient room if patient is at increased risk of transmission, contamination, lacking hygiene maintenance, or if patient is at increased risk of becoming infected or developing adverse outcomes following infection
Hygiene etiquiette	teach symptomatic patients to cover mouth and nose when sneezing and coughing, correct use and disposal of tissues, wearing of surgical mask if tolerated, or maintaining spatial separation (if possible more than 3 feet)

Patient Placement

SINGLE ROOM – promotes reinforcement of infection control measures; should be prioritised for isolating individuals with communicable diseases or epidemiologically important organisms, to avoid exposing immunosuppressed patients to such organisms. A patient placed in a single room should:

have an isolation notice displayed on the door
have an ensuite bathroom
have its door closed at all times
have limited staff entering the room
be provided with psychological support and reassurance whilst in isolation
not have staff with infections to provide patient care
not have staff to provide patient care whilst providing care to infectious patients in the same duty shift

SINGLE ROOM + HIGH EFFICIENCY PARTICULATE AIR (HEPA) FILTERS – promote reduction of risk to healthcare associated infections due to airborne fungi such as Aspergillus Genus (especially where construction-related work is in progress).

Patient Hygiene

FATIGUE – Immunosuppressed patients are often fatigued. Thus, patient hygiene must be assessed on a daily basis, and assistance must be provided where necessary.

PERINEAL CARE – Immunosuppressed patients frequently suffer from irritation or infection in the perineal area – an area which would be heavily colonised with bacteria. Thus, particular attention to this area is a must to maintain patient hygiene. Note that the use of soap may irritate the mucous membranes, leading to irritation exacerbation.

STAFF ILLNESS – immunosuppressed patients should not be nursed by staff with known or suspected infections or communicable diseases eg. oral-facial herpes simplex and upper respiratory tract infections; contact between such individuals should be reported to the infection control team and to the patient’s medical consultant.

Hand Hygiene

Environment and Equipment

Removal of dust from surfaces may help prevent infection (routine use of chemical disinfectant has not yet been proven to reduce infection) – surfaces need to be damp-dusted daily with single use cleaning cloths and neutral detergent; mop head needs to be laundered daily
Isolation rooms require cleaning with the use of gloves and aprons, followed by hand hygiene prior to leaving the room
Vacated rooms must be cleaned thoroughly before they are reoccupied
Medical equipment should be decontaminated after each use
Single-use items must be discarded and not re-used
Toys of immunosuppressed children should be decontaminated
Flowers and plants have not been directly linked to infection in immunosuppressed patients, however, are usually not permitted since they may act as a reservoir for Gram Negative bacteria or fungal spores like Aspergillus

Personal protective equipment

Use of face masks is not known to prevent infection in immunosuppressed patients, but can help protect healthcare staff from body fluid splashing
Routine use of non-sterile gloves and aprons/gowns may help in preventing acquisition of micro-organisms
PPEs must be minimally used to prevent contact with body fluids or contaminated items, and when in contact with non-intact skin and mucous membranes
Must be removed and discarded of as clinical waste after use, followed by application of hand hygiene
Sterile gloves are only required in certain aseptic or invasive procedures, or when in contact with sterile sites

Nutrition

Immunosuppressed patients have an increased risk of acquiring food-borne illnesses and harmful micro-organisms, and so, should be advised to avoid high-risk foods such as shellfish, pate’, soft cheeses and foods that are made with raw eggs
Neutropenic individuals have an increased risk of acquiring infection from Gram-Negative bacteria which is commonly found in sink plugholes and overflow outlets

Immunosuppressed Patient Visitors

Visitors should:

report to a staff member prior to entering the patient’s room so precautions can be explained, and infections that may pose danger for the patient may be identified
not visit if they have any transmissible infection
not bring any pets, and plants or flowers (fresh or dried)

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