A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
(3) Variations in Structure.--The most important is the presence of a
nucleus (Plates VI and VIII and Fig. 84). Nucleated red corpuscles, or
_erythroblasts_, are classed according to their size: _microblasts_,
5 µ or less in diameter; _normoblasts_, 5 to 10 µ; and _megaloblasts_,
above 10 µ. Microblasts and normoblasts contain one, rarely two,
small, round, sharply defined, deeply staining nuclei, often located
eccentrically. Occasionally the nucleus is irregular in shape,
"clover-leaf" forms being not infrequent. The megaloblast is probably
a distinct cell, not merely a larger size of the normoblast. Its
nucleus is large, stains rather palely, has a delicate chromatin
network, and often shows evidences of degeneration (karyorrhexis,
etc.). In ordinary work, however, it is safer to base the distinction
upon size than upon structure. Any nucleated red cell, but especially
the megaloblast, may exhibit polychromatophilia.
Normally, erythroblasts are present only in the blood of the fetus and
of very young infants. Pathologically, normoblasts occur in severe
symptomatic anemia, leukemia, and pernicious anemia. They are most
abundant in myelogenous leukemia. While always present in pernicious
anemia, they are often difficult to find. Megaloblasts are found in
pernicious anemia, and with extreme rarity in any other condition.
They almost invariably {178} exceed the normoblasts in number, which
is one of the distinctive features of the disease. Microblasts have
much the same significance as normoblasts, but are less common.
2. The Leukocytes.--An estimation of the number or percentage of each
variety of leukocyte in the blood is called a _differential count_.
The differential count is best made upon a film stained with Wright's,
Jenner's, or Ehrlich's stain. Go carefully over the film with an
oil-immersion lens, using a mechanical stage if available. Classify
each leukocyte seen, and calculate what percentage each variety is of
the whole number classified. For accuracy, 500 to 1000 leukocytes must
be classified; for approximate results, 200 are sufficient. Track of
the count may be kept by placing a mark for each leukocyte in its
appropriate column, ruled upon paper. Some workers divide a slide-box
into compartments with slides, one for each variety of leukocyte, and
drop a coffee-bean into the appropriate compartment when a cell is
classified. When a convenient number of coffee-beans is used (any
multiple of 100), the percentage calculation is extremely easy.
The actual number of each variety in a cubic millimeter of blood is
easily calculated from these percentages and the total leukocyte
count. An increase in actual number is an _absolute increase_; an
increase in percentage only, a _relative increase_. It is evident that
an absolute increase of any variety may be accompanied by a relative
decrease.
A record is generally kept of the number of nucleated red cells seen
during a differential count of leukocytes.
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