PATH2100 Fall 2023 Blood Lab NOTE: This is a two-week long lab. During Week 1, you will learn how to conduct and interpret Complete Blood Counts, and learn how to create a blood smear with blood samples we will provide to you. During Week 2, you will learn about White Blood Cell morphologies, and use the blood smears you created during Week 1 to do a Differential White Blood Cell count. Be sure to bring this lab to BOTH Week 1 and Week 2. Objectives: • • • • • To understand what a complete blood count (CBC) is. To be able to perform numerous parts of the CBC, including analysis of hematocrit, total protein, and differential White Blood Cell (WBC) counts. To learn how to recognize various types of cells seen on a routine blood smear. To create (and eventually analyze) blood smears made from provided blood samples. To understand basis of blood typing and perform a simple blood typing test. Introduction to Blood Cells and Blood Proteins The purpose of this lab is to familiarize you with the many types of cells and proteins that are found within blood. Your blood is a major connective tissue of the body, and is responsible for supplying tissues with oxygen, transporting white blood cells around as they scout out and fight off infections, and for delivery of numerous important proteins sites around the body. Blood is made up of two major parts: the cellular component, which includes red and white blood cells, and the liquid component, known as plasma, which contains a large number of proteins. Your blood is mostly comprised of Red Blood Cells, or Erythrocytes (H), which possess a characteristic biconcave “donut-like” shape. In some species, these cells are “crenated,” and possess small spike-like projections from their surface (as you’ll see later in this lab). Erythrocytes contain the protein hemoglobin, which binds oxygen in the lungs for transport to tissues and binds CO2 in tissues for transport back to the lungs. Hemoglobin, Oxygen, and Dissociation Curves One of the most important functions of blood is the delivery of oxygen to the various tissues of the body. Hemoglobin, a major protein found in Erythrocytes (red blood cells, RBCs), plays an enormously important roles in this process. Hemoglobin is a protein with a very high affinity for oxygen and, to a lesser extent, carbon dioxide. As RBCs circulate through the blood vessels of the lungs, oxygen diffuses into the blood stream, into the RBCs, and binds to hemoglobin. It is then carried via the blood to the various tissues of the body, where certain kinds of signals (namely the relative acidity of the blood) trigger for hemoglobin to release the oxygen. Once this happens, the hemoglobin will be free to pick up CO2, a major byproduct of cellular metabolism, from that tissue and transport it back to the lungs for release and removal from the body. An Oxygen-Hemoglobin Dissociation Curve is a type of graph used to plot the proportion of hemoglobin in the blood that would be in its saturated oxygen-carrying state based on the partial pressure of oxygen at a given time. It gives an approximation of the oxygen carrying capacity of the blood in a given tissue at any point in time. As the curve is heavily influenced by the availability of oxygen (the partial pressure of O2), the amount of hemoglobin we might expect to be saturated with O2 will change greatly depending on the tissue in question. Certain environmental conditions can change the affinity of hemoglobin for oxygen. For example, decreased temperature, decreased partial pressure of CO2, and more basic blood pH levels increase the affinity of the hemoglobin for oxygen, and cause a so-called Left Shift. Increased partial pressure of CO2, increased temperature, and more acidic blood pH favor a decrease in the oxygen affinity, and cause a so-called Right Shift. These conditions vary from tissue to tissue, and help to control hemoglobin’s ability to transport oxygen and CO2 around the body. Blood Proteins Blood contains a number of different kinds of proteins, or plasma proteins, which are soluble in the liquid fraction and provide a range of different functions. We will discuss a few of these in lecture and lab. These include the Complement proteins, Immunoglobulins, proteins involved in maintaining oncotic pressure, and proteins involved in clotting blood. Broadly speaking, these proteins will fall into two categories: those that are involved in immunity, and those that are not. Non-immune-related Proteins Albumin (also often called Serum Albumin) is the most common protein found in blood. Its job is to help maintain oncotic pressure (a special type of osmotic pressure regulated by proteins in the blood) by binding various proteins and ions found in the plasma. Low Serum Albumin (also called hypoalbuminemia) can be an indicative of liver disease, malnutrition, and kidney disease. High serum albumin (also called hyperalbuminemia) is usually a sign of dehydration. Damage to blood vessels must be repaired if an injured individual is going to heal (or survive, for that matter). The process of blood clotting, which is responsible for the closure of such wounds, is incredibly complicated and beyond the scope of this lab activity. Briefly, wound closure involves a number of key actors: Platelets (G), Clotting Factors, and a number of accessory proteins. Platelets are small nonnucleated cells produced from multinucleated giant cells. They contain a number of proteins that allow them to stick to one another and to proteins exposed on damaged tissues, which helps them to close openings in damaged vessels. A number of proteins will associate with platelets during this process, including fibrin, thrombin, and numerous others, most of which are products of the activities of enzymes known as Clotting Factors. These pathways can differ based one whether you’re looking at clotting in a test tube or in a living animal. Most of these factors are present in the blood at all times, and are activated by certain wound-specific signals and proteins. Notably, these proteins also define the difference between two major blood liquids that you will need to know: Plasma and Serum. Plasma is the liquid portion of blood which contains all proteins, including those related to clotting activities. Blood collected in a regular test tube will clot on its own at room temperature, so collection of plasma requires the use of chemicals known as anticoagulants, which prevent the clotting of blood by interfering with the activity of the clotting proteins. Many of these anticoagulants function by inhibiting or binding calcium ions, which are required for many steps of the clotting pathway. Examples of some common anticoagulants include EDTA, heparin, and sodium citrate. On the other hand, Serum is the liquid portion of the blood minus the proteins required for clotting. Serum is often obtained by collecting blood without an anticoagulant, allowing the blood to clot, and then spinning down the sample to deposit the clot at the bottom. The liquid portion that is left in the tube still contains many other types of proteins, but will not contain those responsible for clotting, as they were “used up” in the clotting process. Immune Cells In addition to your red blood cells, your blood also contains many white blood cells, which are responsible for defending you from microbial infections. White blood cells are referred to as leukocytes, which fall into 2 major categories: granulocytes and agranulocytes. Granulocytes are a class of cells which contain protein-rich granules within their cytoplasm, and include neutrophils, eosinophils, and basophils. Agranulocytes do not contain these protein-rich granules, and include cells like monocytes and lymphocytes. Granulocytes Neutrophils (C) possess irregularly shaped nuclei which typically comprise 2-5 lobes, and utilize their intracellular protein-granules to help them kill bacteria. These cells are named for the fact that they stain a “neutral” pinkish color under H&E stain. They are cells of the innate immune system, and make up the majority of leukocytes found in the blood of most mammals. Abnormally elevated levels of neutrophils are typically an indicator of a bacterial infection. Eosinophils (E) also possess irregular shaped nuclei, which typically have 2 to 3 lobes. The granules of eosinophils are highly acidophilic, and therefore pick up the stain “Eosin” very well, causing them to take on a darker pink color under H&E stain. Eosinophils are cells of the innate immune system, and are involved in immune responses to parasitic infections, but are also major components of allergic responses in mice and humans. They represent a very small fraction (1-3%) of leukocytes in healthy mammals, and elevated levels are typically indicative of a parasitic infection or allergic reaction. Basophils (B) are the least common type of leukocyte found in the blood of healthy mammals, representing less than 1% of circulating cells, and are part of the innate immune system. They are large cells containing many protein-rich granules which stain dark blue (“basophilic”) under H&E stain. These granules are so large and stain so dark that they often block view of the nucleus of the cell. Their granules contain many inflammatory proteins, including histamine, that are released during infections or allergic reactions and contribute to the inflammation of tissues. Agranulocytes Monocytes (F) are the largest of all white blood cells that possess a very large nucleus, often pushed off to one side of the cell. These cells are immature precursors of macrophages, a type of phagocytic cell of the innate immune system. Monocytes can also be precursors to some types of dendritic cells, which are specialized phagocytes and antigen presenting cells which act as sentinels in tissues, keeping an eye out for foreign microbes throughout the body. Lymphocytes (D) include cells of the adaptive immune system, your B and T cells, and are round in shape with a single large, circular nucleus within the cell. These cells tend to be smaller than many of the cells we’ve discussed, and stain a very dark blue due to the nucleus taking up most of the intracellular space. This prominent nucleus often results in students mistaking lymphocytes for a basophils, but lymphocytes make up a much larger proportion of leukocytes in the blood than do basophils. Immune-related Proteins Immunoglobulins, more commonly referred to as Antibodies, are possibly the most important proteins of adaptive immunity. Antibodies are proteins produced by B cells and which very specifically bind to structures on foreign molecules, or antigens, which induce an antibody-based immune response. Antibodies can bind antigens on microbes, allowing for neutralization, or “blocking,” of important microbial proteins which may inhibit infection. Antibodies also enable opsonization, which is the process of “decorating” microbes with antibodies, complement proteins, or both, ultimately making it easier for phagocytic cells to grab onto and destroy the microbes. Immunoglobulins come in 5 different forms: IgM, IgD, IgG, IgA, and IgE. Each of these different forms have different roles in immune responses, and have slightly different structures. Three forms are ‘monomeric’ (IgG, IgD, and IgE), and have two antigen binding sites each (can bind two separate antigen molecules at once). One form is dimeric (IgA) and one is pentameric (IgM), and thus have 4 and ten binding sites each (see figure below). Pentameric IgM is often the first type of antibody produced during an infection, while IgG, IgE, and IgA are more “mature” antibody types and arise from specialized activities of B cells. Complement proteins are a family of proteins involved in innate immune responses, but can assist with adaptive immune responses through their interactions with antibodies. Through a number of different mechanisms, these proteins can stick to the surface of bacteria, where they attract immunoglobulin proteins (a process called “complement fixation,” and a crucial part of opsonization), induce inflammation, and form Membrane Attack Complexes (MACs). All three of these processes can help the immune system kill bacteria. The Structure of Different Antibody Subclasses A Brief Introduction to Allergy Interestingly, IgE appears to play a very important role in allergic responses, and this is due to an interaction between IgE and certain types of immune cells. Many immune cells have receptors on their surface that can grab onto antibodies and attach them to the cell. Some immune cells, including eosinophils, basophils, and another type of cell called a mast cell (which we haven’t discussed), have receptors for IgE that are incredibly effective at grabbing IgE out of the blood and sticking it to the cell. These receptors are so good that IgE makes up a miniscule fraction of all antibodies found in the blood, because most that is produced ends up stuck to immune cells. Certain types of molecules, including pollen, pet dander, bee venom, and certain foods, can be misinterpreted as dangerous foreign compounds by the immune systems of certain individuals. When this happens, IgE antibodies specific to that substance can be produced by B cells to help fight the nonexistent foreign invader. IgE produced by these B cells will get rapidly picked up by eosinophils, basophils, and mast cells. The first time your body encounters this substance, when the B cells produce that IgE, is called sensitization. If you encounter that substance again, and the IgE stuck to the surface of those cells recognizes the substance, it triggers those cells to immediately release inflammatory chemicals, including histamine, bradykinin, and leukotriene, into their surroundings, causing a very intense inflammatory response. In some individuals, this inflammation can be so severe that it causes constriction of the trachea, swelling of blood vessels, and a rapid drop in blood pressure, known as anaphylactic shock, which can be fatal if not treated quickly. All of these factors combined help to explain why some individuals are incredibly allergic to things like bee venom or peanuts. Blood Typing and the Importance of Donor-Matching Self/Non-self recognition underscores all immune responses, and operates on a system not dissimilar to name tags. All cells in a given organism’s body display that organism’s “name tag” in the form of certain surface proteins, called self-antigens. During development of the animal, immune cells that inappropriately respond to self-antigens are eliminated before they become dangerous to the host – the immune system of an individual does not try to attack cells bearing its own name tags. Interestingly, the self-antigens present on blood cells can differ between individuals of a given species. This is important, because blood from one individual (X) may lack self-antigens that are present on blood cells of a second individual (Y). Thus, X retains the immune cells that dangerously respond to self-antigens on Y, because the name tags are slightly different. Defining the set of self-antigens on an individual’s blood, and thus compatibility of blood between individuals, is the basis of blood typing. The blood type of an individual is based on the self-antigens displayed on RBCs. In some species, there are few blood types (cats have 2 types; A and B) and in some there are many (dogs have over 15 types). This lab will use synthetic human blood to demonstrate the concepts of blood typing. Humans have 4 major blood types, with an additional sub-type for each of the major types. The major human blood types are A, B, AB, and O, and refer to the presence of A antigen, B antigen, or both on the RBC surface (for A, B, and AB types) or the absence of A and B antigens (for the O type). Additionally, the presence of “Rhesus Antigen” (Rh) is indicated with a plus (+), and absence of Rh is noted with a minus (-). The physical tests used for blood typing are actually rather simple, and use reagents already discussed in this unit and lab. At their most simple, blood typing kits include antibodies known to react with the surface antigens of a specific blood type. When blood from your individual of interest is mixed with a specific antibody (one which binds A antigens, for example), one of two things will happen. 1) The RBCs lack the specific self-antigens (here, A antigen) and are not bound by the test antibody, or 2) RBCs express the specific self-antigen (again, A antigen) and are bound by the test antibody. In the absence of binding in 1), the test blood continues to look like blood. When specific binding occurs in 2), the two antigen binding sites on each antibody will bind on one or two RBC, causing a crosslinking and clumping of RBC in the test. Thus, a positive test result (i.e. RBC contains the specific self-antigen) will be clumped (i.e. ‘agglutinated’) and a negative result (i.e. RBC lacks the specific self-antigen) will continue to look like regular blood. If the immune system of an individual is to be exposed to blood from another individual, say in the case of a blood transfusion during surgery, it is incredibly important that the antigens displayed by the donor’s RBCs match the antigens of the recipient’s RBCs. Non-type-matched blood, displaying foreign surface antigens, will stimulate an immune response in the recipient against the blood of the donor, leading to immune killing of the transfused RBCs, which can be deadly for the recipient. Complete Blood Counts and some Important Diagnostic Terms A Complete Blood Count (also called a CBC) is one of the most commonly performed basic hematology techniques. It consists of: • Hematocrit (also known as a Packed Cell Volume, or PCV) which measures the percentage of Erythrocytes (Red Blood Cells, or RBCs) in a volume of blood. PCV can be used to analyze many things. For example, a very low PCV might indicate that a patient has anemia. • A determination of Total Protein (usually given in units of mg/dL), which measures the protein levels of the plasma portion of the blood. Blood plasma typically contains many proteins, including: serum albumin, immunoglobulins, clotting factors, protein-based hormones, complement proteins, and more. A low total protein level may indicate blood protein loss from any one of a number of sources, including gastrointestinal parasitism or renal disease. Elevated total protein can be associated with dehydration, excessive immunoglobulin in the blood, or other disorders. • Total White Blood Cell Count (usually given in units of #WBCs per mL of blood), which measures the number of white blood cells per unit volume of blood. An elevated WBC count may indicate an infection. • A Differential White Blood Cell Count, which counts the number of the specific types of WBCs present in a blood smear. Differential White Blood Cell Counts are done on blood smears, where RBCs and Platelets can also be analyzed to identify possible abnormalities. Usually, these counts are done by counting 100 WBCs and then converting the number of each type of cell into a percentage. The proportion of each type of WBC present can change dramatically during bacterial, viral, or parasitic infections. Lab Goal: Students will be assigned Blood Sample A, B, or C, each of which comes from a different animal. Using baseline data provided by TAs, as well as their Complete Blood Counts, students will attempt to determine which animal their sample came from. Week 1 • TA demonstration of creating a blood smear and creation of hematocrit tubes. • Prepare and read Hematocrit (PCV) using hematocrit tubes and centrifuge. • Utilize a refractometer to measure total protein concentrations in blood plasma • Prepare, fix, and stain blood smears for use next week. • Fill out relevant information in results sheet. Week 2 • TA demonstration of total WBC count using a hemacytometer. Note: Students will not use hemacytometers, but will be expected to know what a hemacytometer is, what its function is, and how to get a total WBC count per mL using a hemacytometer. • TA introduction to WBC morphology • Conduct a Differential White Blood Cell Count on stained blood smears from Week 1. • Familiarize students with various tube types for blood collection, including information on various anticoagulants used in various types of tubes. • Hands on Blood-typing practice • Hand in results sheet. Procedure Week 1 1. Watch TA demonstration of creating a blood smear and use of hematocrit tubes. TAs will also demonstrate how to read PCV using the charts provided. 2. Obtain your blood sample from a TA. Using this blood sample and the techniques you saw in the TA demonstration, prepare 2 hematocrit tubes. a. Briefly, orient your hematocrit tube with the red line closer to your hand. Hold the tube parallel to the ground and dip the opposing end into your blood sample (carefully, so as to avoid spilling the blood out of the tube.) b. Allow capillary action to fill the tube up towards to red line. Do not let the blood pass the red line. Once your tube is appropriately filled, remove it from the blood, but keep it parallel to the ground, so that the blood will not leak out of the tube. c. In a quick and controlled motion, seal the end of the tube with clay by tilting the tube perpendicular to the ground (upright) and pushing the end of the tube that does not have the red line into the clay block. Clay blocks will be provided on the bench at your station. 3. Place your hematocrit tubes in the centrifuge with assistance from a TA. Write down the number of the slots you placed your tubes in. a. Ensure that the clay-sealed end of the tube faces the outside of the centrifuge. 4. While your hematocrit tubes are spinning, prepare a thin blood smear using the techniques demonstrated to you at the beginning of lab and outlined below. This may take several tries, and that’s alright! Preparing blood smears takes practice! Label your best 2 slides using your last name and section number, as well as your sample letter. Allow your smears to dry for 10 minutes. a. Briefly, using a hematocrit tube filled with blood, dab a small drop of blood onto a slide just past the frosted end, in the center (see diagram below). Slide 1 b. Using another slide oriented at a 45-degree angle to the first (see diagram below), touch the edge of the blood with the end of slide 2, and “wiggle” it slightly to draw the blood under the slide (See next page for diagram). Slide 2 Slide 1 c. In one continuous, controlled movement, push slide 2 across the surface of slide 1 to spread the blood across the slide. Doing this well will take multiple attempts for most people but the end result should look like the diagram below. Slide 1 d. Once you’ve obtained a successful blood smear, allow the slide to dry on the bench for at least 10 minutes. 5. Retrieve your hematocrit tubes from the centrifuge. Read your sample’s Packed Cell Volume using the charts provided. Record this data in your results. a. Within your spun-down hematocrit tube, there will be an area of packed red cells pelleted towards the bottom, and an area of faint yellow liquid (and in some cases a small white area) above those packed red cells. This area of packed red cells is the packed cell volume. To measure it, slide the tube across the chart (keeping the base lined up with the x-axis) and identify the value at which the top of your packed cell volume aligns with the curve of the graph. 6. Using your second tube and a tool called a refractometer, you will now measure total protein in the clear plasma fraction. a. Identify where on your second tube the packed cell volume ends and the plasma portion of the blood (the yellow-ish liquid) begins. b. Carefully break your tube somewhere within this yellow plasma region. Your goal is to collect this plasma, so be sure to break the tube in a spot that will leave some yellow on either side of the break point. If you’re unsure about this step, ask a TA for assistance. c. Invert the tube over the sample surface of the refractometer. Allow the liquid to drip onto the surface. Do not tap the hematocrit tube on the surface of the refractometer, as the broken glass will scratch and damage the refractometer. d. Gently close the door over the sample surface. Slamming the door down will splatter the sample off of the refractometer, limiting your ability to measure your sample’s total protein. e. Aim the refractometer at a light source. The lights in the ceiling of the classroom will do just fine. Look through the viewfinder of the refractometer and identify the point where the blue and white boxes meet one another. The values on the scale to the right side of the image represent total protein. The values on the scale towards the left and middle measure specific gravity, which we will not use in this lab. Record your total protein value on the lab activity sheet. Use the diagram on the next page. A Refractometer Field The grey area at the top will appear blue in the refractometer. Along the right side of the field, we see a measure of total protein level. We obtain this value by reading the point at which the white area and the blue area intersect. In this example image, the specific gravity is about 9grams/100mL. 7. Fix and stain your blood smears using the stain sets provided. After allowing your stained slides to dry, place them in one of the slide folders for your section. a. You will stain your slides with the Kwik-Diff stain kit provided to you. This kit has 3 different parts. Part 1 is a fixative, which will adhere your cells to the surface of the slide. Part 2 contains Eosin, which will stain protein within the cell pink. Part 3 contains Hematoxylin, which stains nuclear material a dark blue. This type of staining procedure is one of the most common stains used in histology, and is known as an H&E stain. b. To stain your cells, begin by holding your slide by the frosted end and dip it into part 1 five times, for about 1 second each time. Remove your slide from the stain and tap the end of the slide on a paper towel. Do not rub the slide or tap the side with the blood smear on the paper. c. Next, dip your slide into part 2 five times, once again about 1 second each time. Tap the slide on paper to remove any excess stain, as done in step b. d. Proceed to part 3, again dipping the slide five times, for about 1 second each time. Tap the slide on paper to remove any excess stain, as done in step b. e. Finally, invert your slide, so that the frosted side faces down, and very gently run a small amount of water from the sink over the back of your slide. This will wash off excess stain to allow easier viewing of the slide on the microscope. It is important that you use a very small amount of water that is running very slowly. If you turn the sink up too high and run the water too quickly, you risk washing away the smear you’ve worked so diligently on all lab. Week 2 Procedure 2) Watch TA introduction to WBC morphology. This information will be critical to your understanding of Differential WBC counting, which will be the main focus of this week’s exercise. 3) Retrieve your stained blood smear slides from a TA. a. Using the image in the introductory section, identify 100 white blood cells based on their morphology. Convert the absolute number of cells you count into a percentage, and record it in your results section. 4) Look around at the various types of tubes used to collect blood samples. Understand the difference between a tube with an anticoagulant and one without, and think about situations where one might be a better fit than the other. a. Fill out the questions on the last page related to anticoagulants. 5) Using the data you collected this lab and the reference data sets provided by the TAs, try to identify which species your blood sample likely came from. Record this information on your lab sheet. 6) Complete the Blood Typing Exercise by using the following procedure a. Using the dropper vial, place one drop of one sample of your choosing (A thru D) in each well of the blood typing slide (ensuring that you use the same sample for each well). Be sure to close the cap on the vial after use. b. Add one drop of anti-A serum (blue liquid) to the well labeled A. Close the cap on the vial after use. c. Add one drop of anti-B serum (yellow liquid) to the well labeled B. Close the cap on the vial after use. d. Add one drop of anti-Rh serum (clear liquid) to the well labeled Rh. Close the cap on the vial after use. e. Using the appropriately colored mixing sticks (blue stick for A, yellow for B, white for Rh) mix the serum and blood present in each well. Each stick should only be used for one well, and not reused. f. Examine the resulting mixture. If the mixture is uniform in appearance, there is not agglutination, and therefore the blood type does not match the type of serum present in that well. If the mixture has a granular appearance, agglutination has occurred and the blood type matches that type of serum. Agglutination in the Rh well is considered positive for Rh, and no agglutination is considered negative. Record the blood type of your sample as well as the sample letter in your answer sheet. Name: ___________________________________________________ NetID (ABC12345): _________________________________________ Date:_______________________ Section Number: ______________ This sheet is to be handed in at the end of Week 2. Be sure to enter all data you collect in this sheet! Blood Smear Sample ID Letter: _________ PCV (Packed Cell Volume): ____________ Total Protein: __________ Differential White Blood Cell Count: Neutrophils: ______________ Basophils: ______________ Eosinophils: ______________ Lymphocytes: ___________ Monocytes: ______________ Was your RBC morphology normal? Y/N: ____________ Did you see Platelets? Y/N: _______________ Based on the Data provided and your investigations the past 2 weeks, your sample (Letter ______) is most like sample ___________ (See list provided). Blood Typing Blood Sample: __________ Well A Agglutination Y/N? _________ Well B Agglutination Y/N? _________ Well Rh Agglutination Y/N? _________ Based on the above, the patient’s blood type is most likely __________ What happens in agglutinating wells that gives the well its distinctive appearance? What is the difference between Serum and Plasma? What does an Anticoagulant do, and when might it be useful to use a tube with an Anticoagulant? What is an example of a commonly used anticoagulant in a blood collection tube? What does hematocrit measure? Briefly explain how we measure hematocrit. A patient has blood work done, and it is found that they have an abnormally low Packed Cell Volume (PCV). What common blood condition is this often associated with? What are antibodies? What cells produce antibodies? Matt is using his hemacytometer in lab, loads 10uL of his sample, and counts 150 cells in his 25 boxes. How many cells does he have in each milliliter of his sample? (Show your math). Draw each of the 5 classes of antibodies (aim for accuracy, not artistry). List at least 1 defining characteristic of each antibody (size, shape, role, etc.). NOTE: you do not need to include IgD. A patient arrives at the clinic with an unknown medical condition. A blood test is done, including a differential WBC count, and it is found that the patient has elevated levels of neutrophils, as well as higher than average levels of IgM and IgG. What might be the cause of the patient’s condition? Draw a sketch of each type of White Blood Cell that was discussed in this lab. List a few defining characteristics of each cell type (what is its role, what might help you identify it in a differential WBC count, etc.)