A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
1, Normal red corpuscle for comparison; 2, normoblasts, one with
lobulated nucleus; 3, megaloblast and microblast. The megaloblast
shows a considerable degree of polychromatophilia; 4, blood-plaques,
one lying upon a red corpuscle; 5, lymphocytes, large and small; 6,
large mononuclear leukocyte; 7, transitional leukocyte; 8,
polymorphonuclear neutrophilic leukocytes; 9, eosinophilic leukocytes,
one ruptured; 10, basophilic leukocyte; 11, neutrophilic myelocyte.
The granules are sometimes less numerous and less distinct than here
shown; 12, eosinophilic myelocytes; 13, basophilic myelocyte; 14,
"irritation" or "stimulation" form, with small vacuoles; 15,
degenerated leukocytes: two polymorphonuclear neutrophiles, one
ruptured, one swollen and vacuolated; and a "basket cell" composed of
an irregular meshwork of nuclear material; 16, large mononuclear
leukocyte containing pigment-granules: from a case tertian malaria;
17, four stages in the asexual cycle of the tertian malarial parasite:
the second and fourth were drawn from the same slide taken from a case
of double tertian; 18, red corpuscle containing tertian parasite and
showing malarial stippling; 19, estivo-autumnal malarial parasites:
two small ring forms within the same red cell, and a crescent with
remains of the red corpuscle in its concavity.]
{175} B. STUDY OF STAINED FILMS
Much can be learned from stained blood-films. They furnish the best
means of studying the morphology of the blood and blood parasites,
and, to the experienced, they give a fair idea of the amount of
hemoglobin and the number of red and white corpuscles. A
one-twelfth-inch objective is required.
1. Erythrocytes.--Normally, the red corpuscles are acidophilic. The
colors which they take with different stains have been described. When
not crowded together, they appear as circular, homogeneous discs, of
nearly uniform size, averaging 7.5 µ in diameter (Fig. 84). The center
of each is somewhat paler than the periphery. The degree of pallor
furnishes a rough index to the amount of hemoglobin in the corpuscle.
They are apt to be crenated when the film has dried too slowly.
Pathologically, red corpuscles vary in size and shape, staining
properties, and structure.
(1) Variations in Size and Shape (See Plate VIII and Fig. 84).--The
cells may be abnormally small (called _microcytes_, 5 µ or less in
diameter); abnormally large (_macrocytes_, 10 to 12 µ); or extremely
large (_megalocytes_, 12 to 20 µ).
Variation in shape is often very marked. Oval, pyriform, caudate,
saddle-shaped, and club-shaped corpuscles are common. They are called
_poikilocytes_, and their presence is spoken of as poikilocytosis.
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