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Nursing2015

June 2011, Volume 41 Number 6 , p 50 - 54

Author

  • Cheryl Kaufman BSN, RN, CLCP, CNLCP

Abstract

MR. L, 69, HAS A HISTORY of dyslipidemia and coronary artery disease. When he visits his primary care provider for an annual physical exam, his only complaints are new-onset fatigue and unexplained weight loss over the last 4 weeks.His vital signs are temperature, 97.5[degrees] F (36.4[degrees] C); pulse, 54, regular; respirations, 16, unlabored; and BP, 144/58 mm Hg. He has no S3, S4, or murmurs; lungs are clear to auscultation, and his abdomen is soft, nontender, and nondistended with normal active bowel sounds and no hepatosplenomegaly. Bilateral axillary lymphadenopathy is present with nodes that measure approximately 1 cm on the left and 1.5 cm on the right.Abnormal lab results include hemoglobin 11 g/dL (normal in men, 14 to 17.4 g/dL), platelets 140,000/uL (normal, 150,000 to 400,000/uL), white blood cell (WBC) count 47,900 cells/mm3 (normal in men, 4500 to 10,500 cells/mm3), lymphocytes 86% (normal, 25% to 40% of the total leukocyte count). These results are consistent with anemia, thrombocytopenia, leukocytosis, and lymphocytosis.This article reviews the function of lymphocytes and discusses what lab results like those for Mr. L tell you about your patient's condition. Let's start with a quick physiology review.The two main groups of WBCs (also called leukocytes) are granulocytes and agranulocytes. (See A closer look at leukocytes.) Lymphocytes, the most common type of agranulocyte, play a major role in the body's immune response, including antibody production and cell-mediated immunity. For a summary of WBC types and functions, see Five infection fighters.The main cells of the immune system, lymphocytes control the intensity and specificity of the immune response. The WBC count and differential (percentages of the different types of leukocytes) provide clues about a patient's immune status.1(See Sorting out the WBC count and differential.)Like all WBCs, lymphocytes originate in the bone marrow. The thymus and the spleen are accessory lymphoid organs that can

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