PATHOLOGICAL RED CELLS 189 



looking individual, the total quantity of whose blood is greatly reduced, 

 may, notwithstanding, give a normal red count. In examining a speci- 

 men of peripheral blood we get a qualitative, not a quantitative result. 



Normally, we have an increase in red cells in those living at high altitudes. 

 An altitude of two thousand feet may increase the red count about one million, and 

 a height of six thousand feet about two million. Profuse sweats and diarrhoeas also 

 increase the red count. Pathologically, in chronic polycythemia with cyanosis 

 and splenic enlargement, we have a red count of about ten million. In cyanosis 

 from heart disease, etc., and in Addison's disease there is also an increase in red 

 cells. 



The normal red cell or ery throcyte measures about 7.5^ in diameter. It is non- 

 nucleated and normally stains with acid dyes, taking the pink of eosin or the orange 

 of orange G. If larger, 10 to 20;*, it is called a macrocyte; if smaller, 3 to 6/*, a 

 microcyte. 



Anisocytosis is a term applied to a condition where marked varia- 

 tion in size of the red cells occurs. 



Macrocytes are rather indicative of severe forms of anaemia, the 

 microcytes, of less grave types. When the red cell is distorted in shape, 

 it is called a poikilocyte. Care must be exercised that distorted shapes 

 are not due to faulty technic. Crenation and vacuolation of red cells 

 are marked in poorly prepared specimens. 



In addition to variation in size and shape, we also have pathological 

 variation in staining affinities. 



Polychromatophilia. This shows itself by red cells taking a brown- 

 ish to a dirty blue tint, as is frequently seen in immature red cells, 

 especially nucleated ones. 



Granular basophilic degeneration (also termed punctate baso- 

 philia and stippling) refers to the presence of blue dots in the pink back- 

 ground of stained red cells. It is found in many severe anaemias, as 

 pernicious anaemia, the leukaemias, malarial cachexia, etc. It is very 

 characteristic of lead poisoning. 



The nucleated red cell, while normal for the marrow, is always 

 pathological for the blood of the peripheral circulation. Normoblasts 

 have the diameter of a normal red cell. The nucleus is round and stains 

 intensely with basic dyes, often appearing almost black. Another 

 characteristic is that it frequently appears as does the setting in a ring. 

 Some give the term microblast to smaller nucleated forms. In normo- 

 blasts the red cell proper stains normally. The megaloblasts not only 

 have a greater diameter than the normoblast, but the nucleus is poor 

 in chromatin, stains less intensely and is less distinctly outlined. In- 



