PATHOLOGICAL RED CELLS 223 



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 2000 feet may increase the red count about 1,000,000, and a height 

 of 6000 feet about 2,000,000. 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 10,000,000. 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 7.5/1 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 20/1, it is called a macrocyte; if smaller, 3 to 6/i, 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. Crena- 

 tion 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. 



Achromia. This is characterized by pallor of the central portion of 

 the stained red cell. It also shows as a central vacuolation in fresh 

 blood and is apt to deceive one in the anaemic blood of malaria. 



Polychromatophilia. 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. Another character- 

 istic is that it frequently appears as does the setting in a ring. Some give the term 

 microblast to smaller nucleated forms. In normoblasts the red cell proper stains 

 normally. The Wgaloblasts not only have a greater diameter than the normoblast, 

 but the nucleuses poor in chromatin, stains less intensely and is less distinctly out- 

 lined. Instead of being round, the nucleus is irregular and may be trefoil in shape. 

 The cytoplasm surrounding the nucleus shows polychromatophilia. This con- 

 trasted with the pure blue of the lymphocytes should differentiate. 



