Atlas of Clinical Hematology

318 Pages·1989·34.882 MB·English

by  Herbert Begemann, Johann Rastetter (auth.)

H. Begemann J. Rastetter
Atlas of
Clinical Hematology
Initiated by L. Heilmeyer and H. Begemann
With Contributions by
D. Huhn, B.R. Kranz, and W. Mohr
Translated by T. C. Telger
Fourth, Completely Revised Edition
With 205 Figures in Color
and 35 in Black and White
Springer-Verlag Berlin Heidelberg NewY ork
London Paris Tokyo HongKong
English editions Editions published under license
© Springer-Verlag Berlin Heidelberg Spanish edition
1st ed.1955 published by
2nd ed. 1972 Editorial Cientifico-Medica
3rd ed. 1979 Barcelona, 1973
4th ed.1989
Italian edition
published by
German editions
PICCIN Editore S.A.S.
Atlas der klinischen Hamatologie
Padova, 1973, 1980
© Springer-Verlag Berlin Heidelberg
Japanese edition
1st ed.1955
published by
2nd ed. 1972
Igaku Shoin Ltd.
3rd ed. 1978
Tokyo, 1975
4th ed. 1987
Japanese edition
Rinsho Ketsuekigaku Atlas
© Springer-Verlag Tokyo
1989
ISBN-13: 978-3-642-97157-0 e-ISBN-13: 978-3-642-97155-6
DOl: 10.1007/978-3-642-97155-6
Library of Congress Cataloging-in-Publication Data. Begemann, Herbert. [Atlas der klinischen Hiimatologie.
English] Atlas of clinical hematology 1 H. Begemann, J. Rastetter; initiated by L. Heilmeyer and H.
Begemann ; with contributions by D. Huhn, B.R. Kranz, and W. Mohr; translated by T.C. Telger. -
4th completely rev. ed. p. em. Translation of: Atlas der klinischen Hiimatologie. Includes index.
ISBN-13: 978-3-642-97157-0 1. B1ood-Examination-Atlases. 2. Blood-Diseases-Diagnosis-Atla-
ses. 3. Hematology-Atlases. I. Rastetter, Johann. II. Heilmeyer, Ludwig. III. Title. [DNLM: 1. Hematology
atlases. WH 17 H466a] RB145.B41313 1989. 616.1'5075'022--{fc20. DNLM/DCL for Library of Congress.
89-19659 CIP
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© Springer-Verlag Berlin Heidelberg 1955,1972,1979,1989
Softcover reprint of the hardcover 4th edition 1989
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6
Addresses
HERBERT BEGEMANN, Prof. Dr. med.
emerit. Chefarzt der I. Medizinischen Abteilung des SUidtischen Krankenhauses
Munchen-Schwabing, Munchen, Federal Republic of Germany
JOHANN RASTETTER, Prof. Dr. med.
Leiter der Abteilung fUr Hiimatologie und Onkologie, I. Medizinische Klinik
und Poliklinik, Klinikum rechts der Isar der Technischen Universitiit Munchen,
Federal Republic of Germany
DIETER HUHN, Prof. Dr. med.
Leiter der Abteilung Hiimatologie und Onkologie, Freie Universitiit Berlin, Uni
versitiitsklinikum Charlottenburg, Medizinische Klinik und Poliklinik, Berlin,
Federal Republic of Germany
BERND R. KRANZ, Dr. med.
Institut fUr Immunologie, Hiimatologikum, Gesellschaft fur Strahlen- und
Umweltforschung mbH, Munchen, Federal Republic of Germany
WERNER MOHR, Prof. Dr. med.
emerit. Chefarzt der klinischen Abteilung des Bernhard-Nocht-Instituts fUr
Schiffs- und Tropenkrankheiten, Hamburg, Federal Republic of Germany
Translator:
TERRY C. TELGER
Fort Worth, Texas, USA
v
Preface to the Fourth Edition
Hematology, the study of the blood and its disorders, has existed as a science
for about one hundred years. During that period it has remained true to its
goals. Despite many advances in the submicroscopic and biochemical realm,
hematology has clung to its basic postulate that the majority of blood disorders
are expressed in morphologically distinct cell changes. Even modern hematology
relies largely on the morphologic examination of cells, and the microscope con
tinues to be its main diagnostic tool. Today we may describe hematology as
the only morphologically oriented clinical science. It owes its existence chiefly
to the development of staining methods which make it possible to assign mor
phologic structures to specific cellular functions and thus to specific pathologic
states. The first step in this direction was the brilliant discovery of panoptic
stains in the early part of this century by Pappenheim, Wright, and others.
This was followed in the 1950s and 1960s by the development of numerous
cytochemical procedures for the differentiation of diverse biochemical reactions
and cell types. In the last decade, immunologic methods have been employed
to identify cell type-specific antigens as a means of classifying lymphoid and
other cells more precisely and more objectively. This has aided in the differentia
tion of many important hematologic diseases.
In this fourth edition of the Atlas of Clinical Hematology, we have attempted
to update the text and bring it in line with recent developments. As before,
the book is subdivided into a theoretical part and a pictorial part which illus
trates the morphologic features of specific disorders using a combination of
photomicrographs and watercolor paintings created by Hans and Thea Dettel
bacher. The paintings convey a sense of depth to the microscopic image that
will aid the student in the differentiation of morphologic details. We have
retained the chapter on electron microscopy, which we regard as a kind of
connecting link between cell structures that are visible with the light microscope
and the functional significance of those structures. Tropical medicine has become
a subject of growing interest to hematologists and internists in our increasingly
mobile population, so the section on tropical medicine has been revised and
expanded. Also, we have added new photomicrographs and have replaced a
number of old ones with photos of greater clarity.
The present edition features a new, comprehensive chapter on the light-micro
scopic demonstration of immunologic cell markers. It is divided into a methodo
logic and a cytologic section and deals extensively with the sub typing of normal
and malignant lymphoid cells. This new and difficult chapter was authored
by Bernd R. Kranz, who proved to be not only an expert in his field but
also a cooperative, constructive coworker who offered many helpful suggestions
VII
going beyond his area of specialization. We express our sincere thanks for his
contributions. We are also deeply indebted to our coauthors Dieter Huhn and
Werner Mohr, who worked with us on earlier editions and extensively revised
and updated their chapters.
We thank our colleagues Heimpel of Ulm, Kaiserling of Tiibingen, Lopes-Cardo
zo of Leiden, Miiller-Hermelink ofWiirzburg, and Sepp of Munich for supplying
specimens and photomicrographs of rare disorders or special cell forms. We
are grateful to Mr. Jorg Kiihn, who mastered the difficult task of supplementing
the watercolor illustrations done for the first edition by Hans and Thea Dettel
bacher. Mr. Kiihn proved to be a talented and sensitive artist, and his contribu
tion is gratefully acknowledged.
Despite her other professional obligations, Dr. Gudula Wernekke-Rastetter has
again provided an outstanding subject index. We thank her for turning our
atlas into a useful reference work.
If this book recaptures the visual impact of the earlier editions, the credit belongs
to Springer-Verlag and its staff as well as to the Dreher Reproduction Service
in Stuttgart and Stiirtz Printers in Wiirzburg. All contributed to the success
of our book, and all demonstrated great technical expertise and understanding.
Everyone with whom we worked took pains to implement our wishes as regards
the finished appearance of the volume. Working with them was always a pleasant
and satisfying experience. We express our sincere thanks to Dr. H. Gotze, Mrs.
T. Deigmoller, Mrs. U. Pfaff, Dr. J. Wieczorek, and Mr. K. SolI, to name
but a few of the many persons who contributed to the success of this book.
Finally we would like to express our deep gratitude to our translator, T.C.
Telger.
It is the hope of the editors and authors that this fourth edition of our atlas
will enjoy the same enthusiastic critical and consumer response which greeted
the first three editions.
Munich, Summer 1989 HERBERT BEGEMANN' JOHANN RASTETTER
VIII
Preface to the First Edition
So far the diagnostic advances of smear cytology have found only limited appli
cations in medical practice. This is due largely to the fact that available illustra
tive materials have been too stylized to give the novice a realistic introduction
to the field. In the present atlas we attempt to correct this situation by portraying
the great morphologic variety that can exist in individual cells and in pathologic
conditions. In so doing, we rely mainly on artist's depictions rather than photo
graphs. On the one hand the "objectivity" of color photos, though much
praised, is inherently questionable and is further degraded by the process of
chemographic reproduction. An even greater drawback of photomicrographs
is their inability to depict more than one plane of section in sharp detail. By
contrast, a person looking through a microscope will tend to make continual
fine adjustments to focus through multiple planes and thus gain an impression
of depth. A drawing can recreate this impression much better than a photograph
and so more closely approximates the subjective observation. We have avoided
depicting cells in black and white; while there is merit in the recommendation
of histologists that students' attention be directed toward structure rather than
color, this is rarely practicable in the cytologic examination of smears. The
staining methods adopted from hematology still form the basis for staining
in smear cytology. For this reason most of the preparations shown in this
atlas were stained with Pappenheim's panoptic stain. Where necessary, various
special stains were additionally used. For clarity we have placed positional draw
ings alongside plates that illustrate many different cell types, and we have used
arrows to point out particular cells in films that are more cytologically uni
form.
We were most fortunate to have our color plates drawn by an artist, Hans
Dettelbacher, in whom the faculties of scientific observation, technical precision,
and artistic grasp are combined in brilliant fashion. We express our thanks
to him and to his equally talented daughter Thea, who assisted her father in
his work. Without their contribution it is doubtful that the atlas could have
been created.
We are also grateful to a number of researchers for providing scientific help
and specimens, especially Prof. Dr. Henning and Dr. Witte of Erlangen, Dr.
Langreder of Mainz, Prof. Dr. Mohr of the Tropical Institute of Hamburg,
Dr. Moeschlin of Zurich, Dr. Undritz of Basel, and Dr. Kuhn of our Freiburg
Clinic. We also thank our translators, specifically Dr. Henry Wilde of our Frei
burg Clinic for the English text, Dr. Rene Prevot of Mulhouse for the French
text, and Dr. Eva FeIner-Kraus of Santiago de Chile for the Spanish text. We
must not fail to acknowledge the help provided by the scientific and technical
IX
colleagues at our hematology laboratory, especially Mrs. Hildegard Trappe and
Mrs. Waltraud Wolf-Lamer. Finally, we express our appreciation to Springer
Verlag, who first proposed that this atlas be created and took the steps necessary
to ensure its technical excellence.
Freiburg, Spring 1955 LUDWIG HEILMEYER· HERBERT BEGEMANN
x
Contents
Methodology
A. Techniques of Specimen Collection and Preparation. . .... 3
Blood Smear. . . . . . . . . . . . 3
Bone Marrow . . . . . . . . . . . 3
Puncture of Lymph Nodes and Tumors 5
Splenic Puncture . . . . . . . . . . 6
Concentration of Leukocytes from Peripheral Blood in Leukocytopenia 7
Isolation of Mononuclear Cells by Density Gradient Centrifugation 8
Lupus Erythematosus (LE) Cell Test 8
Detection of Sickle Cells. . . . . . . . . . . . . . . . . . . 9
B. Light Microscopic Procedures. . . . . . . . . . . . . . . . . . . . 11
1. Staining Methods for the Morphologic and Cytochemical Differentiation
of Cells. . . . . . . . . . . . 11
Pappenheim's Stain (Panoptic Stain) 11
Wright Stain. . . . . 11
Hemacolor Fast Stain. . . . . . . 11
Sangodiff G Stain . . . . . . . . 11
Undritz Toluidine Blue Stain for Basophils . 12
Mayer's Acid Hemalum Nuclear Stain . 12
Reticulocyte Stain . . 12
Heinz Body Test . . . . . . . . . . 12
Nile Blue Sulfate Stain . . . . . . . 13
Stain for Demonstrating Hemoglobin F in Red Blood Cells. 13
Stain for Demonstrating Methemoglobin-Containing Cells in Blood Smears. 14
Iron Stain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Cytochemical Detection of Glycogen in Blood Cells Using the Periodic Acid
Schiff Reaction and Diastase Test (PAS Reaction) . . . . . . . . . . 15
Cytochemical Detection of Peroxidase. . . . . . . . . . . . . . . . . 17
Cytochemical Detection and Semiquantitative Assay of Leukocyte Alkaline
Phosphatase (LAP) in the Blood Smear . . 17
Cytochemical Detection of Acid Phosphatase. . . . . . . . . . . . . . 18
XI
Cytochemical Detection of Nonspecific Esterases . . . . . . . 19
a-Naphthyl Acetate Esterase. . . . . . . . . . . . . . . 19
Inhibition of a-Naphthyl Acetate Esterase by Sodium Fluoride 20
Naphthol-AS-Acetate Esterase. . . . 20
Naphthol-AS-D-Chloracetate Esterase . . . . . . . . . . 22
2. Immunocytochemical Detection of Cell-Surface and Intracellular Antigens .... 23
3. Staining Methods for the Demonstration of Blood Parasites 28
Thick Smear Method . . . . . . . . . . . . . . . . 28
Examination of Blood for Bartonella . . . . . . . . . 28
Examination of Bone Marrow Smears for Blood Parasites 28
Examination for Toxoplasma. . . . . 28
Examination of the Blood for Filariae . 28
Examination for Mycobacterium leprae 29
C. Electron Microscopy 31
Introduction. 31
Methodology 31
lliustrations Fig. Page
A. Overview of Cells in the Blood, Bone Marrow, and Lymph Nodes 34
Illustrative Overview . . . . . . . . . . . . . . . . . . 1 36,37
B. Blood and Bone Marrow . 38
1. Individual Cells . . . . 38
a) Light Microscopic Morphology and Cytochemistry 38
Cells of Erythropoiesis. . . . . . . . 2 38
Erythrocytes . . . . . . . . . . . . 3,4 40,42
Erythropoiesis in Megaloblastic Anemias 5 44
Myeloblasts and Promyelocytes . . . . 6 46
The Neutrophils: Myelocytes, Metamyelocytes, Band
and Segmented Forms . . . . . . . . 7 48
Degenerate Forms and Toxic Granulation. . 8 50
Eosinophils, Basophils, and Mast Cells . . . 9 50
Congenital Anomalies of Granulocytopoiesis 10 52
Granulocytopoiesis in Megaloblastic Anemias 11 52
Cells of the Reticulohistiocytic System . . . 12 54
Storage Cells, Epithelial Cells, Endothelial Cells 13 56
XII