Bruce K. Wiseman

IDIOPATHIC AND SECONDARY THROMBOCYTOPENIC PURPURA: CLINICAL STUDY AND EVALUATION OF 381 CASES OVER A PERIOD OF 28 YEARS

Excerpt For the last 28 years we have been concerned with the study of thrombocytopenic purpura. Our spiraling interest has paralleled the progressive increase in the total number of patients with ...

PRIMARY SPLENIC NEUTROPENIA; A NEWLY RECOGNIZED SYNDROME, CLOSELY RELATED TO CONGENITAL HEMOLYTIC ICTERUS AND ESSENTIAL THROMBOCYTOPENIC PURPURA

Excerpt The spleen may no longer be regarded as an organ of complete mystery. Out of ancient and modern superstitious musings and the obscurity of an incomplete, controversial and largely hypotheti...

THE MONOCYTE, MONOCYTOSIS, AND MONOCYTIC LEUKOSIS: A CLINICAL AND PATHOLOGICALSTUDY

Excerpt THE MONOCYTE AND THE CELLS OF THE BLOOD THE MONOCYTE AND THE CELLS OF THE CONNECTIVE TISSUES THE MONOCYTE IN PATHOLOGIC STATES THE MONOCYTE IN LEUKEMIA CHRONIC MONOCYTIC LEUKEMIA MONOCYTIC ...

THE TREATMENT OF POLYCYTHEMIA VERA WITH RADIOACTIVE PHOSPHORUS

Excerpt Prior to 1941, polycythemia vera was treated in the hematology clinic at The Ohio State University, College of Medicine, by the conventional methods of venesection, x-radiation and induced ...

An Improved Direct Method for Obtaining the Total White Cell Count in Avian Blood.

Because of the normal presence of nucleated erythrocytes and thrombocytes in avian blood, it has always been difficult to count accurately all of the white blood cells. For this reason, most direct methods have been based upon some technique providing for the recognition of specific types of cells in the counting chamber and then, from the percentage of these types found in the differential count made upon the stained smear, the total number of white cells per cu. mm. of blood have been calculated. To distinguish between the various types of white blood-cells, previous investigators have used a solution of vital neutral red alone, 1 vital neutral red with formalin in a separate solution, 2 or neutral red with a separate solution containing formalin plus crystal violet. 3 Neutral red, however, stains both granulocytes and monocytes, and it is often difficult to distinguish the one from the other under the powers of magnification that can be used in conjunction with the counting chamber. On the other hand, if one attempts to include both of these cell types in the count, the wide variation in staining intensity of the monocytes frequently occasions inaccuracies through the missing of individual cells. This is especially a source of error when the counting of blood cells is assigned to technicians. Moreover, it was found that the diluting fluids which do not contain a fixative frequently fail to preserve the red blood cells intact, the resulting hemolysis making a further complication in arriving at accurate counts of both the red and white blood cells. The fact that the predominating granulocyte in avian blood contains eosin-staining granules suggested the use of the dye given below, which, when combined with a fixative to preserve the erythrocytes, stains these granular cells so as to make them stand out sharply and distinctly in the counting chamber.

The treatment of infectious mononucleosis

A LTHOUGH infectious mononucleosis has been recognized as a clinical entity for at least 67 years, following the clinical description by Pfeiffer in 1889,’ and even though the hematologic picture was accurately characterized 23 years ago by Downey and McKinley2 and Tidy and Daniel3 simultaneously, identifying the lymphocyte as the cell form involved, the causative agent of this disease has not yet been identified. It is axiomatic that specific treatment of a disease is rarely possible without first identifying the causative agent. It is therefore likely that treatment of infectious mononucleosis will remain on a symptomatic basis until the etiologic factor is identified. Although there is rather uniform agreement among workers in this field that the causative agent is a lymphotropic virus, this has by no means been proved. Under the limitations of these circumstances, therefore, the important advances in treatment have been confined to management of the complications and a consideration of this topic necessarily occupies the main portion of this discussion.

A New Method for Determining the Fragility of Red Blood Cells

Prevailing methods for the determination of the fragility of erythrocytes are based upon the theory of their hemolytic stability when brought into contact with chemicals such as saponin and bile salts, with specific sera, or with hypotonic salt solutions. Theoretical as well as practical considerations have directed the development of these studies toward improving the technique for determining the resistance of the red blood cells to solutions containing different concentrations of various salts. Of the many variations in the original method of Ribierre, 1 that of Simmel, 2 or one of its modifications, 3 appears to be the best. However, the necessity of freshly prepared hypotonic salt solution of very exact concentrations, together with the labor in using the counting chamber and the necessity for setting up a control test with a known normal blood at each observation, are definite disadvantages. We have devised a fragility test in which the difficulties mentioned are largely eliminated. The testing of the relative fragility of the patients cells in varying dilutions of his own plasma is the essential principle introduced in this new method. Technique. Test tubes of 20-30 cc. capacity and capable of withstanding the high speed of the centrifuge are fitted with rubber stoppers. To each is added 2 mg. of powdered heparin, an amount sufficient to prevent the clotting of 10 cc. of blood for approximately 24 hours. After weighing out this quantity a few times to visualize the approximate volume involved, the quantity of heparin added to each test tube may be estimated without disturbing the accuracy of the test. Ten cc. of blood are drawn from one of the arm veins, using a dry (not rinsed in salt solution) 10 cc. syringe and needle.