NUCLEATED RED CELLS. 155 



the quantity of blood in the body. Thus, a more or less bloodless- 

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

 may notwithstanding give a normal red count. In examining a 

 specimen 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 increases 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. Pathologi- 

 cally, 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 erythrocyte measures about 7.5/4 in diameter. 

 It is nonnucleated 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/j, a microcyte. 



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. 



Poly chromatophilia. This shows itself by red cells taking a 

 brownish 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. 



