Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic. An elastic band is placed around the upper arm to apply pressure and cause the vein to swell with blood. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. In the laboratory, NBT is added to a sample of white blood cells. The neutrophils (white blood cell in your immune system that ingest and kill bacteria) normally make a chemical that kills the bacteria. In chronic granulomatous disease (CGD), this chemical is absent. As a result, neutrophils are able to ingest bacteria, but not kill them. The chemical that kills the bacteria is the same that turns NBT from clear to deep blue. If the chemical is absent when NBT is added to the sample, it will not change color. This can be seen by looking at the white blood cells under an ordinary microscope.
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