Causes and symptoms of increased monocytes in adults and children

High-quality medical care in the modern world is impossible without many diagnostic tests that help determine the patient’s condition, give an idea of ​​the functioning of his organs and systems, and also determine the diagnostic search at the stage of diagnosis.

INR (international normalized ratio) is a research method that can tell a lot about the patient’s blood clotting characteristics.

Doctors often use INR analysis both to assess the function of the patient’s blood coagulation system and during therapy with indirect anticoagulants for timely adjustment of the drug dose. Often, the test is used before surgery to assess the patient's risk of bleeding.

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INR - what is it?

Blood INR in combination with a laboratory indicator such as PTT (prothrombin time) gives the doctor complete data on the state of the patient’s blood coagulation system. In fact, the INR is a numerical, artificial value, which is calculated by the laboratory using PTT and other diagnostic criteria. PTT is a value that shows how long it takes for a patient's blood to clot. Then specialists in the laboratory compare the resulting PTT value with the values ​​accepted as the norm and calculate the deviation of the patient’s PTT from the normal value.

The calculation of blood INR occurs as follows: the laboratory determines the ratio of the patient’s PTT to the standard PTT, accepted as the norm. The result is then multiplied by the international sensitivity index, which is a standard indicator and does not vary depending on the laboratory.

There is also such an indicator as PTI (prothrombin index). In medicine, it is the direct ratio of the patient's PTV to the standard PTV.

Thus, the lower the INR, the greater the risk of blood clots in a person. The formation of blood clots threatens serious complications - for example, thrombosis of the veins of the lower extremities can lead to a critical condition - pulmonary embolism.

If the INR is significantly elevated, this means that the risk of bleeding and hemorrhagic complications increases. The patient in this case suffers from sudden heavy bleeding that takes a very long time to stop. In a healthy person, the INR ranges from 0.85 to 1.15 units. In patients taking anticoagulant therapy, the norms vary slightly - 2-3 units are considered the standard indicator.

Thus, the attending physician receives a complete picture of the work and activity of the patient’s blood coagulation system. The doctor has every reason to diagnose pathology and calculate the dosage of therapeutic drugs for diseases of the cardiovascular system.

Causes of monocytosis in children

If, after a thorough blood test, it turns out that the child’s monocytes are higher than normal, you need to sound the alarm. There are many reasons for this disorder.

The most common, as in cases with adults, is the onset of the development of an infectious disease. As a rule, this is not difficult to understand, since the baby begins to have a runny nose, cough, or some other manifestation.

However, cases in which monocytes increase, on the contrary, during the recovery period after suffering a serious illness are not uncommon. In such situations, this phenomenon is considered the norm and only indicates that the body is working.

Monocytes often increase after surgery. If none of the above applies to the baby, then most likely there are blood diseases.

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When is the test ordered?

An INR analysis may be needed by a doctor of any specialty to make a final diagnosis and choose treatment tactics for a patient. Often referrals for diagnostics are given by cardiologists, obstetricians-gynecologists, hepatologists, and general practitioners.

Blood INR must be determined in the following alarming situations:

• heavy, frequent and prolonged nosebleeds in the patient, which can occur suddenly and for no reason;
• the appearance of hematomas of unknown origin in various areas of the human body;
• the patient has thrombosis of large vessels;
• anemic conditions;
• suspicion of the development of disseminated intravascular coagulation syndrome;
• the presence of persistent tachycardia of unknown etiology;
• the presence of confirmed pathology of the cardiovascular system;
• pathology of pregnancy - a woman has a history of several spontaneous abortions or episodes of miscarriage;
• features of the menstrual cycle of the female body - long, heavy menstruation, which brings significant pain;
• availability of data on the pathology of the blood coagulation system in close relatives.

Calculation of the patient's blood INR is also necessary before surgery. If there are pathological changes in the INR analysis, in some cases surgical intervention is prohibited, because the patient may develop intense bleeding on the operating table.

In addition, deciphering the INR is necessary to prescribe anticoagulant therapy to the patient in an individual dosage. When using anticoagulants, INR must be assessed regularly to adjust the treatment regimen if necessary.

What is the research used for?

Blood INR in combination with other parameters of the blood coagulation system makes it possible to analyze the state of various links in the chain of the coagulation system. Often, the main indication for performing an INR analysis is the diagnosis of patient pathologies associated with increased thrombus formation or, conversely, increased bleeding.

In addition, doctors monitor INR quite closely and seriously in patients taking anticoagulants (drugs that prevent excessive blood clotting), which allows timely and regular monitoring of the dosage of the drug. Patients taking indirect anticoagulants (for example, Warfarin) regularly undergo an INR test so that the doctor has a complete understanding of the patient's blood condition. As a rule, when prescribing the dosage of a drug, the doctor uses international recommendations, which include, in particular, the INR , because the prescribed dose of the anticoagulant depends on the INR.

The study is also carried out to assess the degree of liver damage in severe diseases of this organ - for example, during cirrhosis of the liver or due to the development of hepatitis. The fact is that the liver is solely responsible for the production of many factors that ensure the proper functioning of the blood coagulation system.

INR analysis is an accessible and effective test that shows whether a patient has the following diseases:

• liver pathologies;
• disorders of the coagulation system - consumption coagulopathies, which are accompanied by the active formation of blood clots, which disrupts the stability of the patient’s entire blood coagulation system;
• lack of fibrinogen and prothrombin in the patient’s peripheral blood, which trigger successive stages of human blood coagulation;
• deficiency of the most important blood clotting factor - vitamin K;
• taking certain medications that affect components of the coagulation system.

If INR is less than 0.5 units, then the doctor should be wary: there is a high risk of thrombosis in the person. Often, an INR analysis shows a decrease in the indicator in the late stages of a patient’s pregnancy.

When using indirect anticoagulants in human therapy, the analysis is carried out once every 14-21 days. As soon as the doctor selects the required therapeutic dosage of the drug for the patient, the patient is prescribed a study once every 6-8 weeks.

Biological role of monocytes

Monocytes are the largest phagocytes in our body. They perform the following functions in the body:

• Phagocytosis. Monocytes and macrophages have the ability to recognize and capture (absorb, phagocytose) foreign elements, including dangerous proteins, viruses, and bacteria.
• Participation in the formation of specific immunity and protection of the body from dangerous bacteria, viruses, fungi through the production of cytotoxins, interferon and other substances.
• Participation in the development of allergic reactions. Monocytes synthesize some elements of the complement system, due to which antigens (foreign proteins) are recognized.
• Antitumor protection (provided by the synthesis of tumor necrosis factor and other mechanisms).
• Participation in the regulation of hematopoiesis and blood clotting due to the production of certain substances.

Monocytes, along with neutrophils, belong to professional phagocytes, but have distinctive features:

• Only monocytes and their special form (macrophages) do not die immediately after absorbing a foreign agent, but continue to perform their immediate task. Losing a fight against dangerous substances is extremely rare.
• Monocytes live much longer than neutrophils.
• Monocytes are more effective against viruses, while neutrophils deal mainly with bacteria.
• Due to the fact that monocytes are not destroyed after a collision with foreign substances, pus does not form in places where they accumulate.
• Monocytes and macrophages are capable of accumulating in areas of chronic inflammation.

Method of determination

A standardized methodology for assessing the INR norm was adopted by a specialized international organization in 1983.

During the study, blood is taken from the patient from any peripheral vein, as with other diagnostic methods - a general blood test, biochemical blood test and other studies. In a test tube, blood is mixed with a special reagent that acts as a preservative (citrate). Citrate in a test tube is necessary to bind calcium ions and prevent the blood from quickly clotting. Then the plasma is separated from the cells in it. At the next stage, exclusively pure serum is examined.

In laboratory conditions, calcium is added to the test plasma in order to neutralize the preservative. The specialist then estimates the time it took for the clotting reaction to occur. Thus, the time obtained is an indicator of prothrombin time. Then, based on the PTT, the specialist calculates the INR.

INR = (patient PT/control plasma PT)*MICH, where:

* The PTT of control plasma is a standard measure of the PTT of capillary blood from a person who has normal amounts of coagulation factors.

Exclusively thanks to the analysis of INR, it is possible to compare without error data on the functioning of the human blood coagulation system obtained in different laboratories and at different periods of time. The INR norm is a classic standard that is used in laboratories all over the world and is assessed equally by all doctors.

Monocytes and macrophages: what is the difference?

In the 70s of the last century, it was believed that all monocytes sooner or later turn into macrophages, and there are no other sources of “professional janitors” in the tissues of the human body. In 2008 and later, new studies were conducted that showed that macrophages are heterogeneous. Some of them actually originate from monocytes, while others arise from other progenitor cells even at the stage of intrauterine development.

The transformation of some cells into others follows a programmed pattern. Coming out of the bloodstream into the tissue, monocytes begin to grow, and the content of internal structures - mitochondria and lysosomes - increases. Such rearrangements allow monocyte macrophages to perform their functions as efficiently as possible.

INR norm

The standardized INR norm is 0.85-1.15 units. If a person takes anticoagulants, then his INR is increased , which is natural: the patient’s blood contains fewer coagulation factors. In this case, the INR norm for the patient is 2-3 units.

The blood INR indicator is influenced by many factors, ranging from the patient’s gender and age to the characteristics of his medical history. Depending on the age of the patients, the following limits of normal blood INR are distinguished:

Table 1. INR indicator depending on the patient’s age

As you can see, blood INR by age is an indicator that varies significantly depending on the category in which the patient belongs.

Interpretation of the INR analysis

The interpretation of the INR analysis is carried out exclusively by the patient’s attending physician, because he knows the characteristics of his body, medical history and medications that the person takes, which can affect the INR value.

Table 2. INR values ​​and their possible interpretation

It is recommended to draw conclusions about the state of the blood coagulation system based on INR analysis over time, after a series of studies. It is in this way that the doctor obtains the most complete picture of the patient’s health.

Determination of the level of monocytes in the blood

The total number of monocytes is displayed as part of the leukocyte formula and is included in the complete blood count (CBC). The material for research is taken from a finger or from a vein. Blood cell counting is carried out manually by a laboratory assistant or using special devices. The results are issued on a form, which must indicate the standards adopted for a particular laboratory. Different approaches to determining the number of monocytes can lead to discrepancies, so it is imperative to take into account where and how the analysis was taken, as well as how the blood cells were counted.

INR during pregnancy

The INR norm in women changes slightly during pregnancy. The changes are due to the fact that during pregnancy a new element appears in a woman’s body - the placental circulation. In addition, during pregnancy there are significant hormonal changes and changes in circulating blood volume, which affects changes in INR. Because of this, the INR is increased in a pregnant woman, but the increase does not reach critical values: as a rule, the indicator does not go beyond the normal limit. The PTT in pregnant women is 17-20 seconds, while in a normal healthy adult the PTT ranges from 24-25 seconds.

In pregnant women, INR diagnosis is carried out 3 times on an empty stomach in different trimesters of pregnancy. If the doctor has noticed changes in the INR, then when prescribing therapy, the analysis must be performed more often.

Determining the INR rate in women during pregnancy is extremely important: the value of the indicator affects a woman’s ability to bear a child and go through the stage of natural childbirth. It is especially necessary to check the INR before childbirth in order to assess a woman’s ability to give birth to a child on her own. If bleeding occurs, a situation may arise when a woman needs to be given additional medications or drugs to stop the bleeding if there is severe blood loss during childbirth.

INR decreased

If the INR analysis shows reduced values, then the patient is at high risk of developing blood clots in the peripheral vessels. The reasons for a decrease in INR may be the following:

1. long-term storage of the test material at temperatures up to 4 degrees Celsius;
2. drawing blood from a catheter located in the patient’s central vein;
3. change in hematocrit (the ratio of the cellular fraction of blood to its liquid part);
4. an increase in the level of antithrombin III or aPTT in the test blood sample;
5. taking certain medications - diuretics, anticonvulsants, glucocorticoids, and oral contraceptives (for women).

If the INR is low , then it is necessary to conduct a diagnostic search to detect the causes of this phenomenon. In addition, it would not be superfluous to carry out repeated diagnostics to exclude the possibility of an error occurring when performing the study.

INR increased

An INR analysis may show elevated values ​​if the patient is taking certain medications, for example, non-steroidal anti-inflammatory drugs - Diclofenac.

Blood INR may increase in the following pathological conditions:

1. diseases of one or more parts of the blood coagulation system;
2. pathology of the hepatobiliary system;
3. disturbances in the gastrointestinal tract, poor absorption of fats;
4. ulcerative damage to the digestive system, the presence of inflammatory changes in the wall of the stomach or intestines;
5. pathology of the cardiovascular system - hypertension, pre-infarction state, development of myocardial infarction;
6. pathology of cerebral vessels, cerebral disorders;
7. kidney diseases;
8. the presence of malignant neoplasms;
9. polycythemia;
10. disruption of vitamin K synthesis.

We offer you an INR analysis as quickly and efficiently as possible at the medical office! Our experienced specialists will perform blood sampling and complete diagnostics using modern equipment, and promptly provide you with the results of the study. We conduct blood INR tests in our medical center at an attractive price!