PERNICIOUS ANAEMIA. 165 



fluid, but normally-colored drop of blood upon puncture. The yellow 

 marrow of the long bones is transformed into a soft, bright red lymphoid 

 tissue, smears from which show great numbers of megaloblasts. 

 Areas of fatty degeneration are characteristic, especially the tiger-lily 

 spots in the heart muscle. Iron-containing pigment (hemosiderin) is 

 found in the liver, spleen and kidneys. Areas of degeneration in the 

 spinal cord may account for nervous symptoms. The red cells fre- 

 quently fall below 2,000,000 with patients going about. Cases have 

 been reported with counts under 200,000. The color-index is high. 

 Megaloblasts are the most characteristic qualitative change in the red 



FIG. 53. Pernicious anaemia. M.m, Megaloblasts; n, normoblast; 

 s, stippling (punctate basophilia). (Cabot.) 



cells. Megaloblastic crises may at certain times show enormous 

 numbers of 'megaloblasts. Cases often present remissions in which no 

 megaloblasts can be found. In such cases the presence of many 

 macrocytes should prevent an examiner reporting against a pernicious 

 anaemia previously diagnosed. 



Poikilocytosis, polychromatophilia and stippling are also features of 

 the disease. Normoblasts are far less frequent than megaloblasts and 

 there is usually a moderate lymphocytosis. Myelocytes may be 

 present. Cases of pernicious anaemia show remissions during which 

 the patient is apparently on the road to recovery. Such improvements 

 are only temporary. The remissions may last from two months to 



