Clinical Hematology Second EditionPDF电子书下载

CHAPTER Ⅰ THE ORIGIN AND DEVELOPMENT OF THE CELLS OF THE BLOOD IN THE EMBRYO，INFANT AND ADULT 29

Blood Formation in the Embryo 29

The Blood of the Fetus 30

The Interrelationship of the Blood Cells 33

The Bone Marrow 36

Anatomy 36

Physiology 38

Methods of Examination 40

At Autopsy 40

During Life 41

Teased Preparations 45

Supravital Preparations 45

Dry Imprints 45

Smears 45

Sections of Bone Marrow 45

Dangers and Limitations of Sternal Biopsy 47

The Normal Bone Marrow 47

The Bone Marrow in Disease 48

Extramedullary Hematopoiesis 49

Bibliography 51

CHAPTER Ⅱ THE ERYTHROCYTE Morphology and Normal Values 55

Discovery of the Erythrocyte and Early Studies 55

Normal Development of the Erythrocyte 55

1．Pronormoblast 56

2．Basophilic Normoblast 56

3．Polychromatic Normoblast 56

4．Orthochromatic(Acidophilic)Normoblast 57

5．Diffuse Basophilia 58

6．Granule Red Corpuscle 63

7．Mature Red Corpuscle 63

The Megaloblast Series 63

The Mature Red Corpuscle 65

Structure 65

Function of the Erythrocyte 66

Red Corpuscles of Various Mammals and Lower Vertebrates 66

Elliptical Red Corpuscles 68

Abnormal Forms of the Erythrocyte 70

Normal Values for Number of Erythrocytes，Quantity of Hemoglobin and Volume of Packed Red Cells 72

＂Per cent＂of Hemoglobin 72

Physiological Variations 74

Normal Values for the Size and Hemoglobin Content of the Red Corpuscle 78

Physiological Variations 79

The Response to Increased Demands for Hemoglobin and Red Corpuscles 80

Role of the Spleen 80

Increased Activity of the Hematopoietic System 81

Reticulocytosis 81

Other Morphological Changes in the Red Corpuscles 83

Thrombocytosis and Leukocytosis 83

Bibliography 83

CHAPTER Ⅲ THE ERYTHROCYTE—(Continued)The Production and the Destruction of the Red Corpuscles 88

Chemical Composition of the Red Corpuscle 88

The Requirements for Red Cell Production 90

Amino Acids and Protein 90

Iron 91

Iron Metabolism 91

Copper 94

Cobalt，Nickel，Manganese and Other Minerals 96

The B Vitamins 97

Pyridoxine 97

Riboflavin 98

Nicotinic Acid 99

＂Folic Acid，＂Lactobacillus casei Factor，Vitamin Be，Vitamin M，Xanthopterin，Vitamins B10，B11 99

Extrinsic Factor and Antipernicious Anemia Principle 101

Miscellaneous Substances 102

Pyrrol-containing Pigments 102

＂Secondary Anemia＂Liver Fraction 102

Ascorbic Acid 102

Thyroid Hormone 103

Fate of the Red Corpuscle 104

Life Span of the Red Corpuscles 104

Extent of Normal Blood Destruction 104

Manner of Destruction 105

Hemoglobin Catabolism 106

Verdohemoglobin 107

Mesobilirubinogen 108

Stercobilinogen 108

The Van den Bergh Reaction 109

Coproporphyrins 111

Disturbances in Pigment Metabolism and Abnormal Pigments 111

Carboxyhemoglobin 112

Methemoglobin 112

Idiopathic Methemoglobinemia 112

Sulfhemoglobin 113

Methemalbumin 113

＂Enterogenous Cyanosis＂ 113

＂Inactive＂Hemoglobin 113

Porphyrinuria 114

Porphyria 114

Congenital Porphyria 114

Acute Porphyria 115

Porphobilinogen 116

Evidence of Exaggerated Red Cell Destruction 117

Blood，Urine and Stools 117

Icterus Index(Meulengracht Test) 119

Van den Bergh Test 120

Tests for Urobilinogen and Urobilin 121

Fluorescence in the Presence of Zinc Salts 121

Ehrlich＇s Aldehyde Reaction 121

Agglutination and Hemolysis of Red Corpuscles 123

Pseudoagglutination 123

Isoagglutination 123

Cold Hemagglutination 123

Hemolysis 124

Erythrocyte Fragility Test 125

Bibliography 127

CHAPTER Ⅳ THE LEUKOCYTES 139

Description of the Leukocytes 139

The Myeloid Series 139

The Myeloblast 139

Myelocytes 143

Metamyelocytes or＂Juvenile＂Forms 144

Polymorphonuclear Neutrophils 147

Eosinophils 147

Basophils(＂Mast＂Leukocytes) 147

Macropolycyte 148

Pegler＇s Familial Anomaly of the Granulocytes 148

Lymphocytic Series 148

Lymphoblast 149

Plasma Cells 150

Monocytic Series 150

Monoblast 150

Monocyte 151

Premonocyte 151

Epithelioid Cell 154

Macrophage，Clasmatocyte or Histiocyte 155

Function and Biologic Properties of the Leukocytes 156

Fate of the Leukocytes 158

Normal Values for Leukocytes 159

Physiological Leukocytosis 159

Systems for Differential Counting 161

The Technic of the Differential Count 163

Normal Values for Different Types of Leukocytes 164

Variations of Leukocytes in Disease 165

Leukocytosis．Neutrophilia 165

Causes of Neutrophilia 165

Factors Affecting the Magnitude of Neutrophilia 168

Leukopenia 169

Causes of Leukopenia 170

Leukopenic Index 171

Neutropenia Without Leukopenia 171

Pathogenesis of Leukopenia 171

Eosinophilia 172

Basophilic Leukocytosis 175

Lymphocytosis 175

Plasma Cells 177

Monocytosis 177

Interpretation and Prognostic Value of the Leukocytic Picture 178

Leukemoid Blood Pictures 179

Bibliography 180

CHAPTER V BLOOD PLATELETS AND COAGULATION 187

The Blood Platelet 187

Morphology 187

Physicial and Chemical Properties 188

Origin of Blood Platelets 188

Megakaryocytes 190

Enumeration of Blood Platelets 191

Indirect Methods 192

Direct Methods 193

Volume Occupied by Platelets 194

Normal Values for Platelets 194

Variations in Platelets in Disease 195

Function of Platelets 196

Coagulation 197

Theories of Coagulation 197

Fibrinogen 198

Thrombin 198

Prothrombin 198

Thromboplastin 199

Failure of Circulating Blood to Clot 200

Factors Which Accelerate and Those Which Prevent Coagulation 200

Classification of Causes of Hemorrhage 204

Clinical Methods for the Measurement of Disturbances of Coagulation 204

Coagulation Time 204

Clotting Time of Recalcified Plasma 207

Calcium Time 207

Quantitative Determination of Prothrombin 207

Retraction Time of Blood Clot 209

Estimation of Bleeding Time 210

Capillary Fragility Tests 211

Significance of Coagulation and Capillary Fragility Tests 211

Bibliography 212

CHAPTER VI THE BLOOD AS A WHOLE General Physical and Chemical Considerations 217

The Total Quantity of Blood 217

Methods for Determination 217

Normal Values 219

Physiological Variations 222

Variations in Disease 222

The Specific Gravity of Blood 222

The Blood Viscosity 225

Suspension Stability of the Blood—The Sedimentation Test 226

The Nature of the Sedimentation Phenomenon 227

Methods 229

Normal Values and Physiological Variations 233

Variations in Disease 233

Bibliography 235

CHAPTER Ⅶ THE PRINCIPLES AND TECHNIC OP BLOOD EXAMINATION 239

Obtaining the Specimen 239

Small Samples 239

Collection of Blood From Veins 239

Anticoagulants 241

Macroscopic Examination of the Blood 242

Technic 242

Volume of Packed Red Cells 242

Reddish-gray Layer of Packed Leukocytes and Platelets 244

Color and Opacity of the Blood Plasma 246

Cleaning the Hematocrit 247

Other Methods for Determining Volume of Packed Red Cells 247

Enumeration of Red Corpuscles 248

Critique of Method 253

Enumeration of White Corpuscles 253

Inherent Error in Leukocyte Counting 254

Hemoglobinometry 254

Direct Color Comparison 255

Acid Hematin Methods 256

Alkali-Hematin Method 257

Carbon Monoxide Methods 258

Oxygen Capacity Method 258

Iron Content Method 258

Other Methods 259

Types of Instruments 259

Calibration of Instruments 260

Measurement of Heme Pigments Other Than Hemoglobin 261

The Measurement of the Size and Hemoglobin Content of Red Corpuscles 263

Determination of Size of the Red Corpuscles 263

Measurement of Cell Diameter 263

Measurement of Volume of Red Corpuscle 264

Measurement of Corpuscular Thickness 265

Estimation of Hemoglobin Content of the Red Corpuscles 265

Choice of Methods 268

Care and Preparation of Slides and Cover-glasses 271

Examination of the Wet Film of Blood 271

Darkfield Illumination 272

Supravital Staining 272

Preparation of Blood Smears 273

Cover-glass Technic 273

Slide Technic 274

Fixation of Smears 275

The Staining of Blood Smears 276

Choice of Methods for Microscopic Study of Leukocytes 280

Bibliography 281

CHAPTER Ⅷ ANEMIA：GENERAL CONSIDERATIONS AND TREATMENT 285

Definition of Anemia 285

Concept of the＂Erythron＂ 285

Classification of Anemia 286

Morphological Classification 287

General Symptomatology of Anemia 292

Integumentary System 293

Respiratory and Circulatory Systems 294

Neuromuscular System 295

Gastro-intestinal System 296

Genito-urinary System 296

Metabolism 296

Other Systems 296

Treatment of Anemia 297

General Considerations 297

General Measures 299

Diet in Anemia 300

Transfusion of Blood 302

Method of Blood Typing 302

Errors in Blood Typing and Their Prevention 305

Indications for Transfusion 306

Choice of Methods 308

Effects，Good and Bad 311

Intra-group Hemolytic Reactions 314

Subgroups of A 314

M，N and P 315

Rh Factors 315

＂Universal Donor＂ 318

Prevention of Transfusion Reactions 318

Treatment of Reactions 319

Treatment or Eradication of Cause of Anemia 320

Administration of Substances Specifically Lacking 322

Antipernicious Anemia Principle 322

Methods of Testing Potency of Anti-anemic Substances 324

Oral Therapy 325

Parenteral Therapy 325

Dosage 327

Involvement of the Central Nervous System 328

Effects of Treatment 329

Symptoms 329

Blood 329

Bone Marrow 333

Metabolism 334

Undesirable Effects 335

Maintenance Treatment 336

Failure of Liver Therapy 337

Iron 339

Relative Value of Various Sources of Iron 339

Administration of Iron 340

Effects of Iron Therapy 341

Copper and Other Metals，Various Fractions of Fiver and ？ther＂Accessory＂Substances 343

Bibliography 344

CHAPTER Ⅸ PERNICIOUS ANEMIA AND R？LATED MACROCYTIC ANEMIAS 352

Pernicious Anemia 352

Synonyms and Definition 352

History 352

Etiology 353

Geographical Distribution and Race 353

Age 354

Sex 355

Heredity，Family Predisposition 355

Personal Factors，Individual Susceptibility 355

Association With Other Diseases 356

Symptomatology 357

Mode of Onset and Initial Symptoms 357

Outward Appearance of the Patient 358

Body Temperature 358

Alimentary System 358

Circulatory System 360

Genito-urinary System 360

Nervous System 360

Laboratory Findings 362

The Blood 362

Erythrocytes 362

Leukocytes 365

Platelets 366

Red Cell Resistance 366

Blood Plasma 366

Total Blood Volume 366

The Bone Marrow 366

Gastro-intestinal Secretions 368

Urine 369

Chemical and Other Evidences of Disturbed Metabolism 370

Diagnosis 372

Complications 375

Treatment 375

Prognosis 377

Pathology 378

Sprue，Idiopathic Steatorrhea and Celiac Disease 379

Definition，Synonyms and History 379

Etiology 380

Geographic Distribution and Climate 380

Race 380

Age 380

Sex 380

Heredity．Family Predisposition 380

Personal Factors．Individual Susceptibility 380

Association With Other Diseases 380

Symptomatology 380

Mode of Onset 380

Comparison of Clinical Picture With That of Pernicious Anemia 381

Alimentary System 381

Skeletal System 383

Nervous System 383

Outward Appearance of the Patient 384

Laboratory Findings 385

The Blood and Bone Marrow 385

Gastro-intestinal Secretions and Stool 386

Chemical Evidences of Metabolic Abnormalities．Fat Metabolism 387

Carbohydrate Metabolism 387

Mineral Metabolism 388

Diagnosis 388

Complications 389

Treatment 389

Prognosis 392

Pathology 392

Other Nutritional Macrocytic Anemias 392

＂Tropical＂Macrocytic Anemia 392

Temperate Zones 394

Pellagra 394

Macrocytic Anemia Developing During Pregnancy．Pernicious Anemia of Pregnancy 395

Macrocytic Anemia in Association With Surgical Procedures or Organic Disease in the Gastro-intestinal Tract 397

Carcinoma of the Stomach 397

Gastrectomy and Gastro-enterostomy 397

Intestinal Strictures and Anastomoses 398

Chronic Dysentery．Regional Ileitis．Chronic Pancreatic Disease and Resection of Small Intestine 399

Macrocytic Anemia in Disease of the Liver 399

Infestation With Fish Tapeworm 400

Macrocytic Anemia in Hypothyroidism 402

Achrestic Anemia 404

Pathogenesis of Pernicious Anemia and Related Forms of Macrocytic Anemia 404

Nature of the Liver Factor 405

Role of Achylia Gastrica 406

Intrinsic Factor 407

Extrinsic Factor 407

Mode of Development of the Various Forms of Macrocytic Anemia 408

Criticism of Hypothesis 408

Possible．Role of Toxins 411

Fetal Hematopoiesis in Relation to Pernicious Anemia of Pregnancy 412

Possible Causes of Achylia Gastrica，Glossitis and Faulty Intestinal Function in Pernicious Anemia，Sprue and Related Disorders 414

Etiology of the Neurological Disturbances 415

Bibliography 415

CHAPTER Ⅹ THE NORMOCYTIC ANEMIAS Acute Post-hemorrhagic，Primary Refractory，Myelophthisic and Simple Chronic Anemias 431

General Considerations 431

Acute Posthemorrhagic Anemia 432

Symptomatology 432

Blood Findings 433

Diagnosis 435

Treatment 435

Anemias Characterized Chiefly by Lack of Blood Formation 436

Primary Refractory Anemias 437

Definition and Synonyms 437

Etiology 437

Benzol 438

Organic Arsenicals 439

Gold Compounds and Other Substances 439

Exposure to Radioactive Substances 440

Idiopathic Aplastic Anemia 442

Symptomatology 443

Blood Changes 444

Bone Marrow 444

Diagnosis 445

Treatment 446

Prognosis 446

Pathology 447

Pathogenesis 447

Simple Chronic Anemia 449

Definition 449

Etiology 449

Renal Disease 449

Malignancy 449

Parasite Infestation 450

Endocrine Disorders 450

Vitamin Deficiencies 450

Pregnancy 450

Climate 551

Symptomatology 451

Blood Changes 451

Bone Marrow 452

Diagnosis 452

Treatment 452

Prognosis 452

Pathogenesis 452

Myelophthisic Anemia 455

Definition and Synonyms 455

Etiology 455

Symptomatology 457

Blood Changes 457

Diagnosis 458

Treatment 461

Prognosis．Pathology 461

Pathogenesis 462

Bibliography 462