Hematology: A Pathophysiologic Approach

222 Pages·2012·8.905 MB·English

by  S. David Hudnall

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Hematology: A
Pathophysiologic
Approach
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Hematology: A
Pathophysiologic
Approach
n n n n n n n n n n n
S. DAVID HUDNALL, MD
Professor of Pathology and Laboratory Medicine
Yale University School of Medicine
Director of Hematopathology Yale-New Haven Hospital
New Haven, Connecticut
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899
HEMATOLOGY: A PATHOPHYSIOLOGIC APPROACH ISBN: 978-0-323-04311-3
Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my parents, Stanley and Marjorie Hudnall
My wife, Amy
And my children, Katie and Molly
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P R E F A C E
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Hematology: A Pathophysiologic Approach is designed references. Although some expert advice was sought,
as an introductory hematology text for all students and I have for the most part been able to draw on my
trainees, including medical students, biomedical grad- own experience as a course designer/director and
uate students, pathology residents, and fellows in teacher of hematology to present a single unified
hematology/oncology and hematopathology. This overview of the field. Because reference materials are
book is based on my 26 years of experience practicing readily available on the Internet, I decided not to
laboratory hematology and teaching hematology to clutter the text with references that are seldom used
medical students, residents, fellows, and graduate stu- by students. Instead, the student interested in more
dents at four medical schools in the United States. The depth of any topic can easily access the most recent
idea of writing a textbook crystallized during my years literature online.
as course director of an innovative 2-year, small group This is a book that first and foremost approaches
problem-based course in hematology at the University hematology from a pathophysiologic perspective, with
of Texas Medical Branch (UTMB) in Galveston. mechanistic explanations of normal and abnormal
During that time I was disappointed by the choice of function. Hematopoiesis, blood physiology, immunol-
hematology textbooks suitable for medical students. ogy, neoplasia, transplantation, and hemostasis are
Over the years we tried several texts and, while some presented as interrelated subjects. Because the practice
were quite good, both faculty and students expressed of hematology is highly dependent upon a relatively
dissatisfaction with one thing or another. The possibil- large number of diagnostic lab tests, fairly detailed
ity of writing a textbook suddenly became a reality descriptions of blood counting, histopathology,
when I was approached by Mosby to write a hemato- immunohistochemistry, flow cytometry, cytogenetics,
logic physiology text for their Physiology Series—an and coagulation testing are provided. Numerous color
opportunity that I undertook with gusto. photomicrographs of both normal and abnormal his-
It is important to state what this text is not. It is not tology are also provided in full color.
a comprehensive textbook of clinical hematology. Over many years of teaching hematology and
Clinical hematology is a vast, complex field that, to be designing/directing a hematology course, I have for-
thoroughly and expertly covered, requires many mulated a good idea of what students need to know
authors, many pages, and tracts of up-to-date refer- about this complex subject. But, with the primary
ences. To meet this demand, several excellent, large, goal of imparting an understanding of the subject
and generously referenced 1000+ page textbooks by the student in mind, I have done my best to
written by multiple expert contributors are available. resist the temptation to assume that if I present the
However, these textbooks are not appropriate as intro- material, it will be understood. To this end, I have
ductory texts. They are far too detailed, often presum- always encouraged students to question the material
ing prior knowledge of basic anatomy and physiology and contact me directly with their questions. Over
of the hematologic system. the years, this has proven to be immensely valuable.
The text you are about to read is radically different. Literally hundreds of insightful questions received
It is written by a single author and contains no from students have challenged me to provide more
vii
viii PREFACE
accurate, lucid explanations of difficult topics. In other concerns. With your help, the text can be continually
cases, questions have led to my discovery that some improved.
facts we take for granted may be flawed, incomplete,
or illogical. Based on this experience, I have tried to I do hope you enjoy the book.
anticipate many of the issues that often lead to confu-
sion and to provide a more explicit explanation than S. David Hudnall, MD
is usually offered. But as perfection is an elusive goal, [email protected]
I urge all readers of this text, whether expert or novice,
to contact me with your questions, corrections, or