Red blood cell

“ Fig. 7.—Plasmodium falciparum. (Malignant tertian) Nonsexual cycle in blood and internal organs of man. Note multiple infections of single red cell. (From MacNeal after Doflein.)
In Romanowsky-stained preparations we see, while the fever is sustained, small hair-like rings, with geometrical outline, with frequently two chromatin dots in one end of the ring and a single red cell often showing two or more of these young rings. The rings are often seen as if plastered on the periphery of the red cells or as if having destroyed a rounded section of the rim of the red cell. ”

“ They have a single large nucleus which stains feebly and their bodies may show neutrophile granules. Larger and smaller nucleated red blood cells may be found in spleno-myelogenous leukæmia. The leucocytes are frequently in a condition of fatty degeneration, and there may be a decrease in the number of red blood cells. ”

“ Extensive observations made on wounded soldiers have shown that the number of red blood cells may rise even to 8,000,000 per cmm. in the capillary blood, while the number in the venous blood remains at 5,500,000 or less. This concentration of the red cells is gradual and progressive, and will by itself account for a large part of the loss of volume, since normally the bulk of the blood is made up of corpuscles and plasma in approximately equal parts. ”

“ This they carry back to the lungs to be cast out of the body.
There is one white blood cell to every four hundred red ones. The white cells are the body-guards. They change their shape and are able to crawl through the walls of the capillaries. Wherever the body is hurt, they collect in large numbers and eat the germs which are always trying to get into the body through sores. The white matter called pus in a sore is largely made of white blood cells which came there to fight the germs and were killed in the battle. ”

“ The liquor sanguinis constitutes fully 66 per cent. of the volume of the blood. It is albuminous in nature and contains a small amount of coloring matter of a fatty nature. It holds in solution three proteids—fibrinogen, serum globulin, and serum albumin.
Second, the organized parts, or the cellular structure (Fig. 74, Nos. 1 to 21) . The cells float in the plasma and consist of three groups: the erythrocytes, or red blood cells, the leucocytes, or white blood cells, and the thrombocytes. ”

“ It is a rare condition, and must be distinguished from hematuria, or blood in the urine, which is common. In both conditions chemic tests will show hemoglobin, but in the latter the microscope will reveal the presence of red corpuscles. Urines which contain notable amounts of hemoglobin have a reddish or brown color, and may deposit a sediment of brown, granular pigment.
Hemoglobinuria occurs when there is such extensive destruction of red blood-cells within the body that the liver cannot transform all the hemoglobin set free into bile-pigment. ”

“ Patients have very little energy or initiative and are often considered stupid and lazy. Hypochondriasis is at times noted and some severe cases become melancholic.
The Blood.—The red cell count averages in marked cases 2,500,000 to 3,000,000 red cells per cu. mm. The Hb. percentage is down in such cases to between 30 and 50. The color index is well below 1, except in certain rare cases, when the color index is that of pernicious anaemia, being above 1. These latter cases are very resistant to treatment and often show very few infecting worms notwithstanding the severity of the symptoms. ”

“ The lesson is, that boys who are bleeders may marry, because they will most likely not transmit the disease; but girls who come from a hemophilic family, irrespective of whether they themselves are hemophilics or not, must not marry, because most likely they will transmit the disease.
Anemia
Anemia is a poor condition of the blood. The blood may contain an insufficient number of red blood cells or an insufficient percentage of the coloring matter of the blood, that is, hemoglobin. A special kind of anemia affecting young girls is called chlorosis. ”

“ This phenomenon cannot be demonstrated in areas where a compact mass of red cells obliterates the alveolar space (Fig. XXV) , but in the less firmly consolidated alveoli where red blood cells predominate (Fig. XXVI) the picture of the alveolar wall is very instructive. The capillaries may be prominent and contain red cells almost exclusively. Often the epithelium of the air space is exfoliated so that there is nothing to minimize the prominence of the engorged vessels. ”

“ With regard to the behavior of their serum and red blood-cells, all human beings fall into one of three groups. In the first group, the red cells are not agglutinable by any other human serum, while the serum is found to agglutinate the red cells of all persons not belonging to this first group. In the second group, the red cells are agglutinated by the serums of the first and of the third groups, while the serum agglutinates the cells of the third group only. ”

“ Myelocytes are rare.
The red corpuscles show the changes usual in severe secondary anemia. Erythroblasts are seldom abundant. Blood-plaques are decreased.
3. Pseudoleukemia (Hodgkin's disease) resembles lymphatic leukemia in that there is marked and progressive enlargement of the lymph-nodes. There is, however, no distinctive blood-picture. The changes in hemoglobin and red cells resemble those of a moderate symptomatic anemia, with rather low color-index. The leukocytes are commonly normal in number and relative proportions. ”

“ As the stream diminishes in rapidity, the number of white cells in the clear space increases, the blood plaques appear also, and finally, when the current is reduced to stagnation, the clear space disappears, being filled entirely with cells, chiefly leucocytes, although red cells find their way into it. ”

“ Very constant also is a marked absolute, and often a relative, increase of eosinophiles and basophiles. Polymorphonuclear neutrophiles and lymphocytes are relatively decreased.
[p. 210] The red cells show the changes characteristic of a severe secondary anemia, except that nucleated reds are commonly abundant; in fact, no other disease gives so many. They are chiefly of the normoblastic type. Megaloblasts are uncommon. Blood-plaques are generally increased.
2. Lymphatic Leukemia.—This form may be either acute or chronic. There is marked loss of hemoglobin and red corpuscles. ”

“ There are throughout the red marrow living cells which are constantly dividing and subdividing, forming more and more so-called daughter cells. Within these daughter cells hemoglobin is presently deposited; a little later they lose the nucleus and probably the remainder of the living protoplasm as well, leaving just the framework of nonliving protein with its contained store of hemoglobin. This is the finished red corpuscle, and it breaks loose from the red marrow and floats out into the blood stream. The rate of manufacture of red corpuscles is very rapid ”

“ The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. ”

“ They give the blood its red color. They are cells which have been highly differentiated for the purpose of carrying oxygen from the lungs to the tissues. This is accomplished by means of an iron-bearing proteid, hemoglobin, which they contain. In the lungs hemoglobin forms a loose combination with oxygen, which it readily gives up when it reaches the tissues. Normal erythrocytes do not contain nuclei. They are formed from preëxisting nucleated cells in the bone-marrow.
White corpuscles, or leukocytes, are less highly differentiated cells. ”

“ When freighted with oxygen it becomes oxyhaemoglobin and is red in color; when freed from its oxygen it takes a purple hue; hence the widely different appearance of arterial and venous blood, which so puzzled the early physiologists.
This proof of the vitally important role played by the red-blood corpuscles led, naturally, to renewed studies of these infinitesimal bodies. It was found that they may vary greatly in number at different periods in the life of the same individual, proving that they may be both developed and destroyed in the adult organism. ”

“ Just as under certain conditions fat-cells may completely lose their contents without dying, so the bone-marrow cell, if the blood fails to yield to it the necessary substances, may occasionally be unable to produce more neutrophil granules. ”

“ Oligocythemia occurs in all but the mildest symptomatic anemias. The blood count varies from near the normal in moderate cases down to 1,500,000 in very severe cases. There is always a decrease of red cells in chlorosis, but it is often slight, and is relatively less than the decrease of hemoglobin. Leukemia gives a decided oligocythemia, the average count being about 3,000,000. The greatest loss of red cells occurs in pernicious anemia, where counts below 1,000,000 are not uncommon. ”

“ Nucleated red blood-corpuscles, such as occur in the blood of the foetus and in the red marrow of the adult, have been found in leukæmic blood by Klebs, Mosler, and others. I have observed them in four cases. They are scanty, usually isolated, rarely more than one or two in a field; often, indeed, many fields must be searched before finding one. ”

“ On the contrary, as Laache first observed, in the pernicious anæmias, the hæmoglobin equivalent of the individual discs is raised.
To appreciate correctly pathological conditions, it must always be borne in mind, that in normal blood the individual red blood corpuscles are by no means of the same value. Step by step some of the cells are used up and replaced by new. Every drop of blood contains, side by side, the most various stages of life of fully formed erythrocytes. ”

“ I believe that in time we shall be able to refine this test to tell the exact individual, too.
"What is this principle? It is that the hemoglobin or red colouring-matter of the blood forms crystals. That has long been known, but working on this fact Dr. Reichert and Professor Brown of the University of Pennsylvania have made some wonderful discoveries.
"We could distinguish human from animal blood before, it is true. But the discovery of these two scientists takes us much further. ”

“ These granules are identical with the corresponding granules in the leukocytes just described. The occurrence of two kinds of granules in the same cell is rare.
Myelocytes are the bone-marrow cells from which the corresponding granular leukocytes are developed. Their presence in the blood in considerable numbers is diagnostic of myelogenous leukemia. The neutrophilic form is the less significant. A few of these may be present in very marked leukocytosis or any severe blood condition, as pernicious anemia. ”

“ They [Pg 79] are about as large as the small lymphocytes, possess a rounded deeply stained nucleus, and a small shell of protoplasm studded with a neutrophil granulation. The relatively deep stain of the nucleus and the small share of the protoplasm in the total cell body prevent confusion with the small forms of myelocytes, which never reach such small dimensions. The neutrophil pseudolymphocytes are exceedingly infrequent, and represent products of division of the polynuclear cells; they were first described by Ehrlich in a case of hemorrhagic small-pox. ”

“ 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. ”

“ Leucocytosis is now recognised to be chiefly an increase of the normal polynuclear neutrophil leucocytes; whereas myelogenic leukæmia brings elements into the blood that are abnormal. The cells here introduced are so characteristic as to render the diagnosis of leukæmia possible, even in the very rare cases where the total number of the white blood corpuscles is not to any extent increased. The best example of which we are aware is a case observed by v. Noorden, in which the proportion of white to red was only 1:200. ”

“ The clinical experience, that in acute losses of blood in man, these staining anomalies, can be observed in numerous cells, within so short a time as the first 24 hours. Whilst in our observations, which are very numerous upon this point, embracing several hundred cases, and carried out with particular care, no nucleated red blood corpuscles in this space of time can be found in man [8] .
4. The polychromatophil degeneration can frequently be observed in nucleated red blood corpuscles, particularly in the megaloblasts. ”

“ 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 [p. 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. ”