A Manual of Clinical DiagnosisTodd, James Campbell
Science
A Manual of Clinical Diagnosis
Todd, James Campbell
Diagnosis, Laboratory
The usual classification of leukocytes is based upon their size, their
nuclei, and the staining properties of the granules {179} which many
of them contain. It is not altogether satisfactory, but is probably
the best which our present knowledge permits.
(1) Normal Varieties.--(_a_) Lymphocytes.--These are small mononuclear
cells without granules (Plate VI and Fig. 86). They are about the size
of a red corpuscle or slightly larger, and consist of a single,
sharply defined, deeply staining nucleus, surrounded by a narrow rim
of protoplasm. The nucleus is generally round, but is sometimes
indented at one side. Wright's stain gives the nucleus a deep purple
color and the cytoplasm a pale robin's-egg blue in typical cells.
Larger forms of lymphocytes are frequently found, especially in the
blood of children, and are difficult to distinguish from the large
mononuclear leukocytes.
Lymphocytes are formed in the lymphoid tissues, including that of the
bone-marrow. They constitute, normally, 20 to 30 per cent. of all
leukocytes, or about 1000 to 3000 per c.mm. of blood. They are more
abundant in the blood of children.
The percentage of lymphocytes is usually moderately increased in those
conditions which give leukopenia, especially typhoid fever, chlorosis,
pernicious anemia, and many debilitated conditions. A marked increase,
accompanied by an increase in the total leukocyte count, is seen in
pertussis and lymphatic leukemia. In the latter, the lymphocytes
sometimes exceed 98 per cent.
(_b_) Large Mononuclear Leukocytes (Plate VI).--These cells are two or
three times the diameter of the normal red corpuscle. Each contains a
single round or oval nucleus, often located eccentrically. The zone of
protoplasm surrounding the nucleus is relatively wide. With {180}
Wright's stain the nucleus is less deeply colored than that of the
lymphocyte, while the cytoplasm is very pale blue or colorless, and
sometimes contains a few reddish granules. The size of the cell, the
width of the zone of cytoplasm, and the depth of color of the nucleus
are the points to be considered in distinguishing between large
mononuclears and lymphocytes. When large forms of the lymphocyte are
present, the distinction is often difficult or impossible. It is then
advisable to count the two cells together as lymphocytes. Indeed, they
are regarded by some hematologists as identical.
Large mononuclear leukocytes probably originate in the bone-marrow or
spleen. They constitute 2 to 4 per cent. of the total number of
leukocytes: 100 to 400 per c.mm. of blood. An increase is unusual
except in malaria, where it is quite constantly observed, and where
many of the cells contain ingulfed pigment.
(_c_) Transitional Leukocytes (Plate VI).--These are essentially large
mononuclears with deeply indented or horseshoe-shaped nuclei. A few
fine neutrophilic granules are sometimes present in their cytoplasm.
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