Leukocytes in a smear in women - the norm in the table and the reasons for increased values

Smears Genitourinary system

02/02/201801/24/2019 Yulia Martynovich (Peshkova) 2959 Views gynecology, leukocytes

Within the framework of the article, we consider leukocytes in a smear, their norm in women and a table are presented. Leukocytes (white blood cells) are a heterogeneous group of cells, united by the presence of a nucleus and the absence of color. They react to the penetration of infectious agents, helping the human body destroy them. Taking a smear for examination is a standard procedure for every patient when visiting a gynecologist.

An increased number of leukocytes in a smear is a sign of an inflammatory process, which requires establishing the cause and selecting adequate treatment methods. Timely detection of the disease greatly facilitates therapy and improves the prognosis.

• 1 What are leukocytes in a smear in women?
• 2 About the diagnostic method 2.1 How to prepare?

What are leukocytes in a smear in women?

The heterogeneous population of white blood cells consists of 5 cell types that differ in morphology and functionality: neutrophils, basophils, monocytes, eosinophils and basophils. It should be noted that during the study of biomaterial from the vagina, cervix and urethra, the total number of white cells is determined, and not each type separately. Their main functionality comes down to protection from infectious agents and is implemented in 2 ways:

• phagocytosis – direct interaction and destruction of foreign microorganisms. At the first stage, neutrophils migrate, and then other types of cells migrate to the site of inflammation. After which they attack foreign bodies by absorbing and digesting them, followed by the release of degradation products into the environment. After the process of phagocytosis, the white cells die off, and the accumulation of dead cells forms purulent discharge. The size of objects available for phagocytosis varies from insignificantly small to large accumulations of cells;
• stimulation of the human immune system involves activating the production of antibodies that stop the proliferation of pathogenic microorganisms and also neutralize their toxins.

A lot of leukocytes in a woman’s smear are recorded when the body is infected. The disadvantage of the method is the impossibility of accurately determining which type of leukocytes is elevated. For this purpose, a general blood test is performed with a decoding of the leukocyte formula.

Receiving material

Cervical cancer most often develops in the transformation zone, it is preceded by background processes and intraepithelial lesions (epithelial dysplasia), which can be located in small areas, so it is important that material is obtained from the entire surface of the cervix, especially from the junction of squamous and columnar epithelium . The number of altered cells in a smear varies, and if there are few of them, then the likelihood increases that pathological changes may be missed when viewing the specimen. For effective cytological examination it is necessary to consider:

• During preventive examinations, cytological smears should be taken from women, regardless of complaints, the presence or absence of changes in the mucous membrane. Cytological examination should be repeated at least once every three years;
• it is advisable to obtain smears no earlier than on the 5th day of the menstrual cycle and no later than 5 days before the expected start of menstruation;
• you cannot take material within 48 hours after sexual intercourse, use of lubricants, vinegar or Lugol’s solution, tampons or spermicides, douching, insertion of medications, suppositories, creams into the vagina, including creams for performing ultrasound examinations;
• pregnancy is not the best time for screening, as incorrect results are possible, but if you are not sure that the woman will come for examination after childbirth, it is better to take smears;
• for symptoms of acute infection, it is advisable to obtain smears for the purpose of examining and identifying pathological changes in the epithelium, the etiological agent; Cytological control is also necessary after treatment, but not earlier than 2 months. after completing the course.

Material from the cervix should be taken by a gynecologist or (during screening, preventive examination) by a well-trained nurse (midwife).

It is important that the smear contains material from the transformation zone, since about 90% of tumors come from the junction of the squamous and columnar epithelium and the transformation zone, and only 10% from the columnar epithelium of the cervical canal.

For diagnostic purposes, material is obtained separately from the ectocervix (vaginal portion of the cervix) and endocervix (cervical canal) using a spatula and a special brush (such as Cytobrush). When conducting a preventive examination, Cervex-Brush, various modifications of the Eyre spatula and other devices are used to obtain material simultaneously from the vaginal part of the cervix, the junction (transformation) zone and the cervical canal.

Before obtaining the material, the cervix is ​​exposed in “mirrors”; no additional manipulations are performed (the cervix is ​​not lubricated, mucus is not removed; if there is a lot of mucus, it is carefully removed with a cotton swab without pressing on the cervix). A brush (Eyre spatula) is inserted into the external os of the cervix, carefully guiding the central part of the device along the axis of the cervical canal. Next, its tip is rotated 360° (clockwise), thereby obtaining a sufficient number of cells from the ectocervix and from the transformation zone. The instrument is inserted very carefully, trying not to damage the cervix. Then the brush (spatula) is removed from the canal.

About the diagnostic method

The collection of biomaterial for research is carried out by a doctor in a special gynecological chair using sterile instruments. After inserting the gynecological speculum, biomaterial is taken from the posterior wall of the vagina (V) for examination using a cytobrush, from the surface of the cervix (C) with an Eyre spatula, and from the urethra (U) with a Volkmann spoon.

The level of leukocytes is determined by microscopy. In the laboratory, a Gram-stained and fixed (killed cells) smear is examined under a microscope to count the number of opportunistic bacteria and white blood cells. In addition, the presence of atypical cells characteristic of cancer pathology is visually determined.

The turnaround time for the analysis depends on the workload of the laboratory, but on average does not exceed 1 day, excluding the day of collection of the biomaterial.

How to prepare?

Preparation for taking biomaterial for research includes the following rules:

• restriction of sexual life for 2-3 days;
• for 2 days, the use of vaginal medications, as well as douching, is excluded;
• 2-3 hours of abstaining from urination;
• At least 2 days must pass from the end of menstruation. The preferred time for research is before the start of menstruation;
• Hygiene procedures are carried out in the evening and exclude the use of soap and gel.

Important: the accuracy and reliability of the results obtained depends on the correct preparation of the patient.

Analysis methodology

In non-pregnant women, a smear test is recommended in the first days after the cessation of menstruation or shortly before its onset.

Violation of the technique of taking a smear can lead to the so-called. false positive results – increased leukocytes in the smear in the absence of objective pathology. To avoid this, a woman must follow the rules of preparation for taking a smear.

These rules provide:

• stopping taking medications – both general and local – a week before taking a smear;
• exclusion of intimate contacts 2-3 days before the analysis;
• 2-3 hours before collecting material, do not urinate.

Intimate toileting is carried out the night before only with warm water, without douching and any hygiene products, which are also excluded 2-3 days before taking a smear.

Leukocytes in a smear - the norm in women in the table

The decoding of the received data should be carried out exclusively by a doctor. Self-diagnosis leads to a delay in adequate treatment, which can significantly worsen the patient’s condition and the severity of the disease, including death.

Normal (reference) values ​​of leukocytes in the vagina and cervical canal are presented in the table.

Read further: Leukocytes and their normal levels in the blood of women by age in the table, as well as all the data on increased and decreased values

Smear purity level

For a healthy patient, a slight deviation from the reference values ​​​​presented for the vagina is allowed. In this case, the urethra and cervix, in the absence of pathologies, must be completely sterile. Currently, it is customary to distinguish between 4 degrees of purity of the test smear, which are shown in the table.

The standard designation for grade 4 purity of a gynecological smear for leukocytes is the term “completely”, the causes of which may be an infectious infection or an acute stage of an infectious disease. In this case, an additional large-scale examination of the patient is necessary, which includes laboratory and instrumental research methods.

Degrees of vaginal smear purity

Taking a smear is not only to identify microorganisms, but also to determine the degree of cleanliness of the vagina. This is a separate collection of material, which is carried out by taking material from the walls of the vagina. Then, the material is dried on individual glass.

For indications of purity, 4 degrees were determined. Of these, the first two are accepted as the norm, degrees 3 and 4 determine the presence of pathology.

The number of white blood cells/leukocytes is approximately 0 - 5, a small number of bacteria are observed in the microflora, and the maximum number of Doderlein rods is recorded. The indicators are considered ideally pure and are given the first degree.

The amount is from 5 to 10, in a smear, microorganisms such as yeast fungi or cocci are present to a minimum. The number of rods is considered sufficient, mucus and the presence of white bodies are found in a moderate order. The second degree is diagnosed.

An increase in the number of corpuscles to 50 also reveals an increase in mucus, the level of Doderlein rods decreases significantly. The third degree is diagnosed.

If the quantity is no longer countable, then you can see such a term when describing the analysis as “completely”. Various venereal microorganisms are also found. There are no rods that can protect the body, the level of mucus and epithelial cells increases (a kind of buildup). The last degree is diagnosed.

Attention! The fourth/last degree is a clear sign of a serious inflammatory process. If you already have the third, and even more so the fourth degree, you should first of all go to a medical institution, retake tests, establish the cause, and then receive treatment.

Causes of elevated leukocytes in a smear in women

Elevated leukocytes in a smear in women are recorded during inflammation. A direct relationship has been established between the level of white cells in human biomaterial and the severity of the inflammatory process. In other words, the higher their content, the more severe the stage of the disease, for example, an increase in leukocytes in a smear above 100 indicates extensive infectious infection. In this case, it is impossible to determine the exact location of the inflammation.

It should be noted that it is unacceptable to use smear analysis data in isolation to make a final diagnosis.

In addition, leukocytosis (increased level of white cells) in a smear in women is also observed in the following pathological conditions:

• malignant neoplasms of the internal genital organs, which is accompanied by an abnormal proliferation of mutant cells with damage to normal tissues. In this case, the body begins to develop defense mechanisms directed against its own cells. If a tumor is visually detected during an ultrasound, a woman should consult an oncologist as soon as possible and select therapy;
• disruption of the normal composition of the microflora of the vagina or intestines, as a result of the development of pathogenic species or a long course of antibiotic therapy;
• sexually transmitted infectious diseases (STDs).

White blood cells in the cervical canal indicate an ascending infection. In this case, the pathogen penetrates from the vagina into the uterus and appendages.

Read further: How to quickly reduce and how to increase white blood cells in the blood at home

Reasons for deviation of smear readings

During an acute inflammatory process, the secretion of mucus increases, which is necessary for more effective removal of pathogenic microorganisms. It should be noted that the presence of yeast cells (Candida) in the smear indicates thrush, and the presence of representatives of pathogenic species of bacteria and protozoa indicates sexually transmitted infections. In this case, the patient is indicated for additional examination to identify the pathogen.

An increased content of mucosal epithelial cells is also the result of the development of an inflammatory process, and a decrease in the number of lactobacilli is a result of bacterial vaginosis. The number of lactobacilli decreases when taking antibiotics, which inhibit the growth and development of not only pathogenic strains, but also representatives of normal microflora.

Preparing for the test

The microflora of the genital organs consists of various microorganisms. To a greater extent it is represented by beneficial bacteria, to a lesser extent by opportunistic microbes and in small quantities by pathogenic bacteria.

A flora test is taken from all women who come to see a gynecologist. It allows timely detection of female diseases (for example, cervical erosion), various infectious and inflammatory processes, and sexually transmitted diseases.

The study is carried out in three cases - a preventive analysis, during a woman’s pregnancy, and also if the patient complains of unpleasant symptoms (vaginal discharge, itching, burning, hyperemia, pain, etc.).

Important: two days before the smear, you should refrain from using vaginal medications - suppositories, tablets, creams, etc. Their use can distort the reliability of the information received.

Features of preparation for a smear:

• Two weeks before the examination, you need to stop taking antibiotics and other synthetic drugs. Against the background of their use, inform the doctor so that when deciphering he takes into account their probable influence;
• Three days before the delivery of biological material, you cannot have sex;
• The night before, hygiene measures are carried out using soap or intimate gel. In the morning you can only wash yourself with warm running water, do not use soap;
• Immediately before visiting the doctor, you should not go to the toilet.

A few days before a gynecological smear, you should abandon the douching procedure, as the laboratory results obtained will be distorted.

During a gynecological examination, the doctor takes scrapings from three points. The medical procedure is painless, the woman feels slight discomfort. The biological material is applied to a glass slide and distributed evenly. Then it is sent to the laboratory.

For microscopic examination, it is stained with a Gram stain, as a result, different cells become different colors, which helps to differentiate them.

After washing off the paint, gram-positive microbes still remain colored because they have a thick membrane.

Gram-negative are characterized by a thin membrane, so after washing off the paint changes its color. Based on this, the laboratory assistant fills out a medical form.

Diagnosis of leukocyturia problems in women

If elevated white blood cells are found in women, and scrapings were carried out from different points, then first of all a medical specialist must determine the cause of the pathological increase. Afterwards a certain treatment is prescribed.

In some pictures, elevated leukocytes are detected in a woman’s body, but there are no clinical manifestations or growth of opportunistic microflora. In addition, all laboratory tests show the absence of pathogens. This situation requires re-examination.

When there is an increase in white blood cells in the cervix, urethra and on the walls of the vagina, then expanded diagnostics are required. It includes additional tests:

1. Examination of scrapings by bacterial culture;
2. PCR is a method that helps diagnose sexually transmitted diseases;
3. Ultrasound of the internal organs of the pelvis;
4. Colposcopy – examination of the cervix;
5. Visiting additional specialized specialists.

Bacterial culture involves isolating colonies of bacteria of a conditionally dangerous and dangerous type from scrapings. The specific type of microbe and its susceptibility to groups of antibacterial agents must be determined. The last study is necessary to prescribe the optimal antibiotic option.

PCR is a highly accurate method that can detect latent infections that do not give external symptoms. If they are not detected in time and therefore not treated, this can lead to infertility.

Ultrasound using a transvaginal sensor allows you to assess the condition of the walls of the uterus and its appendages. You can detect a focus of inflammation, a tumor neoplasm, compactions of various etiologies.

Worth knowing: colposcopy is the most informative method that allows you to examine the cervix through multiple magnification. At an early stage, it detects cancer, leukoplakia, dysplasia and other diseases that increase the number of leukocytes in the cervical canal.

Deciphering a smear from the cervical canal

So, what should be the norm of leukocytes in a smear from the cervical canal? The doctor is deciphering the research. The norm of leukocytes in the cervix is ​​no more than 30 per field of view.

Epithelial tissue covers the inner mucosa of the vagina and cervical canal. The canal must contain columnar epithelium, the norm of which is up to 15 in the field of view. An increase indicates the presence of an anomalous process.

The results of a cervical smear contain the following information:

• Key cells are normally absent;
• Gonococci, trichomonas, yeasts are not normally detected;
• Gram-positive lactobacilli are absent in the normal state (specifically in the cervical canal);
• Mucus – the amount should be moderate.

Ideally, a smear should be taken from 10 to 20 days of the menstrual cycle. The concentration of mucus during this period is normally moderate. Depending on the menstrual cycle, mucus can vary from scanty to abundant.

Why are leukocytes in the smear elevated?

The reasons for the increase in the content of leukocytes in a smear are due to disruptions in the reproductive system and failures in the functioning of other internal organs and systems. In the cervical canal, the norm of leukocytes is up to 30. If there is an increase, the following pathological conditions are suspected:

1. Inflammatory processes in the cervix;
2. A source of inflammation in the tubes or ovaries;
3. Inflammation of the uterus (endometritis disease);
4. Colpitis or vaginitis (vaginal damage);
5. Urethritis (damage to the urethra);
6. Tumors of a malignant nature (destruction of healthy tissue is always characterized by inflammation);
7. Dysbacteriosis of both intestines and vagina;
8. Venereal diseases.

Leukocytes, as gynecological practice shows, are concentrated in the focus of the inflammatory process. In turn, pathogenic and opportunistic microorganisms lead to inflammation. A smear on the flora rarely reveals them, so it is necessary to undergo extensive diagnostics. A polymerase chain reaction is used to examine the blood, urine, and secretions from the woman’s genitals.

Note: PCR can detect pathogens of tuberculosis, granuloma inguinale, syphilis, HPV, gonorrhea, ureaplasma, mycoplasma, immunodeficiency, Candida fungi, etc.

In the presence of one or more provoking factors, growth and reproduction of opportunistic microflora is observed, which is accompanied by an increase in the content of leukocytes. The most common reasons include:

• Vaginal microtrauma due to intense sex;
• Decreased local or general immune status;
• Hormonal imbalance;
• Surgical interventions in the genital area;
• Allergic reactions to medications, etc.

A high concentration of leukocytes can be observed if the woman had sex before taking the test or had an intrauterine device installed.

Norm of leukocytes in a smear

The white blood cell count is based on the point where the smear was taken. Normally, their number should not be large. In the urethra their content varies from zero to ten, in the vagina no more than 15, and in the cervical canal up to 30. If there are more of them, other diagnostic methods are needed to determine the cause of the pathological deviation.

Other indicators of flora analysis:

1. Leptothrix is ​​a bacteria that should not be detected. If they are present, this indicates urogenital candidiasis, bacterial vaginosis, chlamydia or trichomoniasis.
2. Key cells are missing in a healthy woman. Their detection indicates gardnerellosis and some other infections.
3. A single presence of yeast-like fungi is allowed at any point in the scraping for a smear. Increased concentration – thrush.
4. Lactobacilli should be contained in large quantities, but are absent in the cervical canal and urethra - this is the norm. At low levels, activity of opportunistic microflora is observed.
5. The presence of mucus in moderate quantities at three points, and the absence in the urethra is the norm.
6. In a normal smear, squamous epithelium is found 5-10. If there is 0 in the field of view, this is tissue atrophy; when there is a lot of it, this is an inflammatory process.

If leukocytes are elevated in a smear during pregnancy

Slight leukocytosis in a smear in a pregnant woman is considered normal. The indicator values ​​should not exceed more than 20-25 white blood cells in the field of view of the microscope. This condition is explained by the fact that after conception, a woman’s hormonal levels are significantly rearranged, and there is an active production of female sex hormones. They contribute to a shift in pH to the acidic side in the vagina, which creates favorable conditions for increased growth of lactobacilli. It is known that they are able to effectively suppress the activity of pathogenic strains of bacteria, and also help to increase the level of leukocytes.

However, women are often interested in why leukocytes in a gynecological smear in a pregnant woman can be greatly increased? The reasons are similar to non-pregnant patients and may be the result of an inflammatory process, thrush or oncological pathology.

Important: leukocytes in a smear during pregnancy above the reference values ​​require close attention from doctors.

Why is an increase in leukocytes dangerous for a pregnant patient? It is possible that the pathogen may quickly spread from the vagina to the cervix, and then into its cavity. As a result, the amniotic fluid and the baby become infected, which can lead to spontaneous abortion.

Read further: Elevated leukocytes in urine during pregnancy - normal, causes of leukocyturia

Leukocytes in the blood

One of the main tests of modern medicine has been and remains a general blood test. It gives the doctor the first idea about the presence of a disease in a person and tells the specialist the main directions of diagnostic actions. But how to recognize pathology?

Normal values ​​in healthy women

To identify the disease using a general blood test, you should have an idea of ​​the normal levels of leukocytes. Throughout a person’s life, their number changes:

• From birth until the child reaches one year of age, the blood contains 7 - 13 per 109 white blood cells.
• By the age of 12, the number of leukocytes in a child decreases and is 5 - 9 per 109.
• As the body grows and hormonal changes begin, the number of white blood cells in the blood continues to decrease and by the age of 16 it can reach 4.5 - 9 per 109.
• Adult sexually mature men and women have 4–9 leukocytes per 109 leukocytes in their blood, and their number in men is slightly reduced, which is explained by the large volume of circulating blood.

The correctness of blood sampling for general analysis is of great importance. The level of the number of white cells can be affected by various thermal procedures, physical activity, or even regular food immediately before the test.

All these external influences lead to a decrease in the liquid fraction of the blood and, accordingly, cause the growth of leukocytes.

Leukocytes in the blood of women: features

White blood levels in women are affected by various specific conditions of the female body. There is an increase in the number of leukocytes during pregnancy, childbirth and lactation. Doctors usually explain this uniqueness of the female body for two reasons:

• The main role in the growth process is played by a decrease in the volume of circulating blood and its associated thickening. There is an increase in the percentage of all blood cells, including leukocytes.
• A surge in white blood cells is also a consequence of hormonal changes in the female body during such conditions.

In the fair sex, leukocytes in the blood also increase before menstruation. Experts attribute this to the preparation of the woman’s compensatory forces for the upcoming blood loss. A hormonal factor in this process also cannot be ruled out.

The norm of leukocytes before menstruation in a healthy woman is usually 6-8 per 109. However, these indicators can fluctuate greatly if the patient has concomitant diseases.

When do white blood cells signal illness?

Experts consider the growth of white blood cells in a woman’s blood as a sign of the presence of a serious pathology in her body. The main reasons for such a change in blood test are usually:

• Various diseases of the upper respiratory tract. Chronic bronchitis, tonsillitis and even a common ARVI can lead to the presence of leukocytosis in a blood test.
• Any intoxication will certainly cause a surge in the number of leukocytes, and the nature of the toxic substance is not important. In severe poisoning, the number of leukocytes can reach 40 - 60 per 109.
• Oncological diseases and other processes that reduce the immune strength of the female body can also cause the growth of white blood cells in the analysis. Leukocytes in the blood before menstruation, in the presence of such concomitant pathology, will be even more elevated.
• Surgery, trauma, especially burns and bleeding will certainly lead to a sharp increase in white blood cells. In addition to blood thickening, which provokes changes in indicators, in such cases the natural function of white blood cells to fight infection in the body is important.

It should be taken into account that in the blood formula there are five main types of leukocytes. They perform different tasks, and the growth of one species may well be offset by a decrease in the number of another. Doctors call this condition a leukocyte formula.

Changing the percentage of different white cells in the blood allows for timely and accurate diagnosis of various diseases of the female body.

Watch the video about leukocytes:

Leukocytes in a smear in men

Taking a smear for women is a standard procedure, however, for men it is also carried out if indicated:

• discharge on the head of the penis;
• pain and stinging during urination;
• redness and itching;
• infertility of unknown etiology.

Biomaterial in men is taken from the urethra using a disposable sterile probe. Normally, the smear of men is completely absent of white cells or contains them in small quantities (no more than 5 white cells in the field of view). An increase in the level of leukocytes in men is recorded in the following pathologies:

• inflammation of the internal genital organs;
• prostatitis;
• cystitis;
• urethritis;
• oncological pathology;
• venereal infections.

To make a final diagnosis, a man must donate blood for STDs, as well as undergo a complete examination of the prostate gland.

Read further: About the norms and deviations of leukocyte values ​​​​in the blood of men

Reasons for the growth of leukocytes in a gynecological smear

A slight increase in the number of leukocytes may indicate an inflammatory type pathology, but is not yet a negative result. First, laboratory technicians look at the presence of these cells, and then at their condition. If the cells are destroyed, pathology is confirmed. Calm, undestroyed bodies, even slightly exceeding the above amount, are not a sign of any acute diseases.

A smear with a thick consistency is often misleading. It is difficult to see, since the cells seem to be superimposed on one another, mixed with leukocytes. In this case, it is recommended to take tests twice.

Attention! Repeating tests is, in principle, useful, because laboratory errors are not uncommon even in the modern world. Incorrect preparation for the test can also be a bad result.

How to lower leukocytes in a smear - treatment methods

In order to bring the values ​​of white blood cells to normal levels, it is necessary to first establish the cause of their increase. After which the doctor prescribes treatment, which usually consists of a course of antibiotic therapy. It is strictly forbidden to choose antibacterial drugs for treatment on your own. The danger of this is due to 2 reasons:

• ineffectiveness, which will lead to the spread of the pathogen throughout the patient’s body and significantly complicate further treatment;
• large-scale spread of bacterial strains resistant to antibacterial drugs. As a result, they may be immune to any of the known groups of antibiotics.

On the advice of a doctor, it is permissible to use douching with a solution of chamomile, aloe or St. John's wort. However, this method is not independent and should be used in combination with drug therapy.

The lack of positive dynamics in the reduction of white cells in the analysis indicates the need to correct the course of treatment.

After a course of antibiotic therapy, it is necessary to use probiotic drugs that restore the normal symbiotic microflora of the vagina.

Reasons for the decrease in the number of leukocytes

Everything in the body is interconnected. A decrease in white cells is not always an indication of health. In such cases, it is recommended to take another blood test. If leukocytes have decreased there too, this may also indicate a process of serious inflammation. Most often, low numbers indicate problems in the endocrine system, gastrointestinal disorders, and various viruses.

Monitoring the level of leukocytes is important at any age, since for young women this is fraught with infertility, and for mature women with serious illnesses. Also, a low level will be an indicator of decreased immunity.