3.7 The analysis of the blood and urine


Red blood, as a rule, changes a little in tuberculosis. Only after the blood acute loss — from lung or intestines — can cause anemia. The small downturn of hemoglobin is marked at chronically developed forms of fibrotic-cavernous tuberculosis. One of parameters of activity of tubercular process is the ESR (erythrocyte sedimentation rate) reaction. Accelerated ESR testifies not only activity and volume of fresh process current but also about volume of chronic, especially at fibrotic-cavernous processes. White blood cells react to tubercular process more sensitively.

Three various phases of white blood cells changes are described, which connect to character of tubercular defeat of lungs:

  1. Neutrophilic – a phase of struggle. In blood the number neutrophiles is increased and the shift of the formula to the left is expressed. Eosinophiles are absent, the quantity lymphocytes and monocytes is reduced. Lymphopenia is often met at progressing forms of tuberculosis.
  2. Monocytic – a phase of overcoming of an infection. In blood the quantity of lymphocytes is increased, the shift to the left, number neutrophiles a little bit less is expressed, eosinophyles occur.
  3. Phase of recovery. The number of lymphocytes and eosinophyles is increased. Blood is gradually normalized.

Such division of phases represents only general reactions, which are not reflecting to all complexity changes in blood on a chronic tuberculosis infection.

Nuclear shift of neutrophiles in tuberculosis.
Besides quantitative, the group of neutrophiles has the qualitative characteristic, which is much more precisely and earlier testifies to various pathological processes. The adult tuberculosis, is usual post primary, causes in blood only increase stub neutrophiles more often. At expressed infiltrative-pneumonic forms and in the process of lung tissue destruction the shift of neutrophiles to the left comes to light rather clearly and can reach up to 20 – 30 % stub neutrophiles.

Less prominent deviations from norm revealed at infiltration in lungs without disintegration and focus form of tuberculosis during their first revealing or the aggravations at subfebrile temperature and without prominent functional frustration. At the same time other hemogram elements do not show changes from the norm. Therefore careful definition of nuclear shift receives tuberculosis the diagnostic meaning. The doctrine about nuclear shift neutrophiles was put forward (Arneth) on the basis of study at various infections and, specially, at tuberculosis. Making complex calculations with numerous sketches, (Arneth) has noticed some law in a configuration of neutrophiles nucleuses. In blood of the healthy person neutrophiles with, not segmented nucleus (I class) make 5 %; neutrophiles with two segments thread connection (II class), — 35 %, III of a class — 41 %, IV of a class — 17 % and V of a class — 2 %.

At infections the number of the multisegmented forms of neutrophiles proportionally decreases, the proportion of 2-3 segments and not segmented nucleuses grows. In the Arneth’s scheme the number of not segmented neutrophiles is located at the left; number of II class neutrophiles, then III of a class and so on to the right settles down. Hence, at increase of not segmented and 2-3 segments forms the number of cells of the left party of the circuit is increased and there is «a shift at the left».

Evidence of tubercular process, besides changes of the hemogram, is hyponatremia. It is most typical metabolic change. The reason of hyponatremia consists in development of antidiuretic hormonal substance by lung tissue damaged with tuberculosis. Especially intensively this substance is developed during widespread caseous destructive forms of lung tuberculosis.

The analysis of urine.
Urinary excretion among tuberculosis patients is usually completely normal. Pathological changes could be revealed at tubercular damage of kidneys or of urinary excretion paths. In such situations, proteins, leucocytes, MBT could be determined in urine. In patients with chronic forms of lung or bones tuberculosis with big amount of purulent masses, the signs of amyloidosis could be revealed (stable proteinuria, macrohematuria).

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