White blood cell

“ Uskoff has in particular published experimental work in this province of hæmatology. This has led him to see in the white blood corpuscles the developmental series of one kind of cell, and to distinguish in it, three stages: (1) "young cells," which correspond to our lymphocytes; (2) "ripe cells" (globules mûrs) , large cells with fairly large and irregularly shaped nucleus, which are therefore our large mononuclear and transitional forms; (3) "old cells" (globules vieux) , which represent our polynuclear cells. The eosinophil cells are completely excluded from this classification. ”

“ 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. ”

“ Their voracity is useful for the preservation of the social organism. By eliminating old, exhausted, diseased cells they rejuvenate the structure and prepare the way for new generations. And when the fecundity of these is exhausted the leucocytes come in to occupy the vacated situations, and conduct the organism thus patched up through a senile degeneracy to natural death.
The leucocytes, white globules, or phagocytes, by virtue of their mobility, are found everywhere—in the blood, in all the organs, and in all parts of the body—but are perhaps most abundant in the blood. ”

“ 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. ”

“ 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. ”

“ The white blood corpuscles are larger in size; they possess the power of changing form and creeping. They gather particles of foreign substance, and creep with them out of the blood vessels, and even to the surface of the body. They also feed upon bacteria, and help to rid the body of harmful kinds. The white blood corpuscles are, in a sense, eating cells. They are renewed from the spleen and the lymphatic glands. Physiologists now recognize several kinds of white blood corpuscles. ”

“ 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. ”

“ 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. ”

“ 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. ”

“ The cytoplasm is relatively abundant, and contains great numbers of very fine neutrophilic granules. With Wright's stain the nucleus is bluish-purple, and the granules, reddish-lilac.
Polymorphonuclear leukocytes are formed in the bone-marrow from neutrophilic myelocytes. They constitute 60 to 75 per cent. of all the leukocytes: 3000 to 7500 per c.mm. of blood. Increase in their number practically always produces an increase in the total leukocyte count, and has already been discussed under "phagocytic leukocytosis." The leukocytes of pus, pus-corpuscles, belong almost wholly to this variety. ”

“ In a case of carcinoma of the bone-marrow, described by Epstein, with an anæmic constitution of the blood (nearly always present it may be mentioned in leukæmia) , there was found a marked increase of the white blood corpuscles, numerous neutrophil myelocytes and nucleated red corpuscles. Anyone holding, as Müller and Rieder do, that the number of eosinophil cells need not be considered in the diagnosis, must in this case have diagnosed myelogenic leukæmia. ”

“ The blood shows a great increase in the white cells. Sometimes they are more numerous than the red blood cells. (b) Lymphatic type is rare, various groups of the lymph glands are enlarged, usually separate, but sometimes matted together; others, such as the tonsils may become large. The blood shows an increase of the white cells, but less than in the other form. ”

“ Since this time the phenomenon has been observed with a great variety of cells other than red blood corpuscles and bacteria—leukocytes, spermatozoa, cells from liver, kidney, brain, epithelia, etc., protozoa, and many vegetable cells.
It is therefore a well-established fact that the proper injection of an animal with almost any cell foreign to it will lead to the blood of the animal injected acquiring the power to injure or destroy cells of the same kind as those introduced. ”

“ Yet Baur says that in anæmia there is a greater metabolism of proteids and more excretion of urea. How easy it is to blunder in looking from one single point of view. Again after bleeding there is a great relative increase of the various forms of white blood globules, most of them young and therefore with somewhat altered functions. The paucity of red globules and excess of white are brought about by the pneumonia and independently of bleeding, so that it is difficult to say whether the phlebotomist is enhancing an evil, or helping a natural therapeusis. ”

“ It is chiefly by means of their activity that other sorts of substances are removed. They often contain dead cells or cell fragments, and when hæmorrhage takes place in a tissue they enclose and remove the granules of blood pigment which result. They often join together, forming connected masses, and surround such a foreign body as a hair, or a thread which the surgeon places in a wound to close it. They may destroy living cells, and do this seemingly when certain cells are in too great numbers and superfluous in a part, their action tending to restore the cell equilibrium. ”

“ Such damaged cells are selectively removed by the spleen. A is a normal spleen. B shows an abscess in the spleen. Note dark ring of radioactivity surrounding the lighter area of decreased activity at the central portion of spleen.
In certain types of anemia the patient’s red blood cells die before completing the usual red-cell lifetime of about 120 days. To diagnose this, red cells are tagged with chromium-51 (51Cr) in the manner just described. Then 16 some of them are injected back into the patient and an identical sample is injected into a compatible normal individual. ”

“ 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. ”

“ 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 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. ”

“ 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 ”

“ Their eminent importance for the diagnosis of myelogenic leukæmia, where they have been regularly found by the best observers, is in no way diminished by their transitory appearance in a few other conditions (see pages 77, 78) . Though they have been occasionally found, according to Türk's investigations, in the critical period of pneumonia as parts of a general leucocytosis, the danger of confusion with leukæmic blood changes is non-existent. This is guarded against by (1) the much smaller increase of the white cells; (2) the diminution of the eosinophil and mast cells ”

“ So too in leukemia, the symptom of excessive abundance of white cells in the circulating blood can be surprisingly altered for the better by X rays, but generally without real cure of the underlying condition. ”

“ The mononuclear cells of man however are finally transformed into the neutrophil granulated cells, whilst the cells of Kurloff remain free from granules in the course of their metamorphosis. In acute leucocytosis in the guinea-pig only the pseudo-eosinophil polynuclear cells are increased, which wander as such out of the bone-marrow, but not the polynucleated non-granulated forms, which but slowly grow to maturity in the blood. Thus the peculiarities of guinea-pig's blood, in which two kinds of polynuclear cells are recognisable, throw light upon the corresponding conditions in human blood. ”

“ The clearest proof that the neutrophil, eosinophil, and mast cells are entirely separated from one another by the fundamental diversity of their protoplasm, of which the granulation is but a specially striking expression, is afforded by the study of the various forms of leucocytosis. As will be shewn in detail in the following chapter, neutrophil and eosinophil leucocytes behave quite differently in their susceptibility to chemiotactic stimulation. Substances strongly positively or negatively chemiotactic for one cell group are as a rule indifferent for the other ”

“ The pseudo-eosinophil granules of the mononuclear cells, of the guinea-pig for example, stain bluish-red in eosine-methylene blue after long fixing in superheated steam: in the transitional stages this admixture is gradually lost, and finally completely vanishes in the granules of the polynuclear leucocytes which stain pure red. Analogous observations may be made in the eosinophil cells of man and animals, and in the neutrophils of man. Hence it is even possible to decide whether an isolated granule belonged to an old or to a young cell. ”

“ As the blood-tubes are not only supply-pipes but sewers and drainage canals as well, it is a good thing to have some kind of tiny animals living and moving about in them, which can act as scavengers and eat up some of the waste and scraps; and hence your microscope will show you another kind of little blood corpuscle, known, from the fact that it is not colored, as the white corpuscle. These corpuscles are little cells of the body, which in shape and behavior are almost exactly like an ameba—a tiny "bug," seen only under the microscope, that lives in ditch-water. ”