50 ABNORMAL CHANGES IN RED AND WHITE BLOOD-CORPUSCLES. 



ABNORMAL CHANGES IN THE RED AND WHITE BLOOD- 

 CORPUSCLES. 



Loss of blood is always followed by diminution in the number of erythrocytes 

 in proportion to the extent of the hemorrhage, and the number may fall to even 

 less than 400,000 in the cu. mm. The loss is soon made good by the absorp- 

 tion of lymph from the tissues. Menstruation furnishes an indication that 

 moderate loss of red blood-corpuscles may be replaced in twenty-eight days. 

 In case of considerable loss of blood, causing a reduction in all of the formative 

 processes, this period may be prolonged to five weeks. In cases of acute febrile 

 disease the elevation of temperature is generally attended with a reduction in the 

 number of red blood-corpuscles, though with an increase in the number of white 

 corpuscles. Chronic diseases diminish the number and often the hemoglobin-con- 

 tent of the erythrocytes in still greater degree. In some individuals, in whom 

 the red blood-corpuscles are deficient in resistance, these undergo dissolution 

 in consequence of the action of profound cold upon peripheral portions of the 

 body, as, for instance, from the application of ice-water, while the blood-plasma 

 becomes reddened and hemoglobinuria may even develop. 



Diminished regenerative activity on the part of new erythrocytes will also 

 cause reduction in their number, as blood-corpuscles are constantly undergoing 

 destruction. If with this there be associated direct loss of blood, as, for instance, 

 menstruation, the reduction may become considerable. In the case of chlorosis 

 a congenital deficiency in the development of the blood-forming and blood-pro- 

 pelling apparatus, that is the vascular system, appears to constitute the cause. 

 The heart and the vessels are small, and the absolute number of blood-corpuscles 

 may be reduced even one-half. In the blood-corpuscles themselves, whose relative 

 number may be either maintained or even reduced as much as one-third, the hemo- 

 globin is reduced about one-third. The total volume of erythrocytes has been 

 found diminished. The iron-content of the blood has been reduced, even to one- 

 half. Courses of treatment with iron again increase the amount of hemoglobin 

 and iron in the blood. So-called progressive pernicious anemia, which is char- 

 acterized by the fact that the progressive impoverishment of the blood may even 

 finally terminate fatally, is probably dependent upon some profound derange- 

 ment of the blood-forming organs. In the presence of this disease the erythro- 

 cytes are reduced in number, while their hemoglobin-content is increased. Invo- 

 lution-forms, disintegrat ing-products (microcytes and poikilocytes) and earlier 

 developmental stages of erythrocytes (nucleated erythrocytes of normal and of 

 excessive size : normoblasts and megaloblasts) are also present . Numerous chronic 

 intoxications, as with lead, swamp -miasm or syphilis, are likewise attended 

 with reduction in the number of blood-corpuscles. 



The size of the corpuscles varies in disease between 2.9 and 12.9 //, with an 

 average size of from 6 to 8 //. Dwarf blood-corpuscles (6 i* and below, microcytes) 

 have been considered as juvenile forms and are found in abundance in almost 

 all forms of anemia (Fig. 8, 6). Giant corpuscles (megalocytes, 10 n and above) 

 are found constantly in cases of pernicious anemia, occasionally in cases of leuke- 

 mia, chlorosis, and cirrhosis of the liver (Fig. 8, 4, 5, represents a nucleated 

 megalocyte as the forerunner of a non-nucleated megalocy te) . If the erythrocytes 

 exhibit marked variation in form and size, they are designated poikilocytes (Fig. 

 8, 6). 



Abnormalities in the form of the red blood-corpuscles have been observed after 

 severe burns. The corpuscles appear much reduced in size and the thought sug- 

 gests itself that under the influence of the heat accompanying the burn droplets 

 of the corpuscles have become detached, in the same way as this can be ob- 

 served in microscopic preparations on application of heat. Disintegration 

 of blood-corpuscles in many such droplets (erythrocytotrypsy) has been 

 observed in connection with various disorders, as, for instance, severe 

 malarial fevers. These particles represent fragments of blood-corpuscles and 

 not independent, intact, small, individual corpuscles. From these fragments 

 there result dark pigment-particles closely related to hematin and which at first 

 float about in the blood (melanemia) . This condition can be developed artificially 

 in rabbits by introducing carbon disulphid (7 parts to 90 parts of oil) subcutane- 

 ously. The leukocytes take up a number of these particles, which later on are 

 found deposited in various tissues, particularly the spleen, the liver, the brain, 

 and the bone-marrow. 



In some cases the red blood-corpuscles exhibit abnormal softness, so that they 



