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McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright © 2006 W. B. Saunders Company Henry's Clinical Diagnosis and Management by Laboratory Methods Twenty-First Edition Richard A. McPherson, MD Harry P. Dalton Professor and Chairman, Division of Clinical Pathology, Virginia Commonwealth University Director, Clinical Pathology, Medical College of Virginia Hospitals, Richmond, Virginia, USA Matthew R. Pincus, MD PhD Professor, Department of Pathology, State University of New York Health Sciences Center at Brooklyn Chairman, Department of Pathology and Laboratory Medicine, New York Harbor Veterans Affairs Health Care System, Brooklyn and New York, New York, USA Associate Editors: Naif Z. Abraham Jr, MD PhD Staff Pathologist, Director of Chemistry, Hematology, Immunology, and Microbiology, Department of Pathology, Veterans Affairs Medical Center Assistant Professor, Upstate Medical University, Syracuse, NY, USA Martin H. Bluth, MD PhD Director of Research, Assistant Professor, Departments of Surgery and Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA Robert E. Hutchison, MD Professor of Pathology, Director of Clinical Pathology and Director of Hematopathology, Department of Pathology, Upstate Medical University, Syracuse, NY, USA Mark S. Lifshitz, MD Director, Clinical Laboratories, NYU Medical Center Clinical Professor, Department of Pathology, New York University School of Medicine, New York, NY, USA H. Davis Massey, MD PhD Assistant Professor of Pathology, Virginia Commonwealth University, Richmond, VA, USA Jonathan L. Miller, MD PhD Professor and Vice Chairman, Department of Pathology, The University of Chicago, Chicago, IL, USA Gregory A. Threatte, MD Professor of Pathology, Director of Core Laboratories and Outreach, Upstate Medical University, Syracuse, NY, USA Elizabeth Unger, MD PhD Team Leader, Human Papillomavirus Laboratory, National Center for Infectious Diseases, Atlanta, GA, USA Gail L. Woods, MD Professor of Pathology, Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA Dedication Dedication To our wives, Stephanie Sammartino McPherson and Naomi Pincus and children, Jennifer and Marianne McPherson for their love and support in the undertaking of this work, for which we are deeply grateful. SAUNDERS ELSEVIER An imprint of Elsevier Inc. © 2007 21st Edition © 2001, 1996, 1991, 1984, 1979, 1974, 1969, 1962 by W.B. Saunders Company © 1953, 1948, 1943, 1939, 1935, 1931, 1927, 1923, 1918, 1914, 1912, 1908 by W.B. Saunders Company Copyright renewed 1990 by Israel Davidsohn and Benjamin B. Wells Copyright renewed 1975 by Mrs. Anne Ophelia Todd Dowden Copyright renewed 1970, 1967, 1963 by Mrs. Arthur Hawley Sanford Copyright renewed 1958, 1955 by Arthur Hawley Sanford Copyright renewed 1951, 1946, 1942, 1940, 1936 by Edith B. Todd No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the Publishers. Permissions may be sought directly from Elsevier's Health Sciences Rights Department, 1600 John F. Kennedy Boulevard, Suite 1800, Philadelphia, PA 19103-2899, USA: phone: (+1) 215 239 3804; fax: (+1) 215 239 3805; or, e-mail: also complete your request on-line via the Elsevier homepage (http://www.elsevier.com ), by selecting ‘Support and contact’ and then ‘Copyright and Permission’. ISBN-13: 978-1-4160-0287-1 ISBN-10: 1-4160-0287-1 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notice Medical knowledge is constantly changing. Standard safety precautions must be followed, but as new research and clinical experience broaden our knowledge, changes in treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current product information provided by the manufacturer of each drug to be administered to verify the recommended dose, the method and duration of administration, and contraindications. It is the responsibility of the practitioner, relying on experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property arising from this publication. The Publisher Commissioning Editor: Michael Houston Development Editor: Russell Gabbedy Project Manager: Kathryn Mason Editorial Assistants: Sven Pinczewski and Katie Sotiris Designer: Stewart Larking Illustration Manager: Bruce Hogarth Illustrators: Anne Erickson and Oxford Illustrators Marketing Managers (UK/USA): Leontine Treur and Kathy Neely Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 1 Copyright © 2007 Elsevier Inc. All rights reserved. - www.mdconsult.com McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright © 2006 W. B. Saunders Company Dr John Bernard Henry: A Tribute Henry's Clinical Diagnosis and Management by Laboratory Methods is a highly acclaimed text in the field of clinical pathology and has served as a major resource for practitioners in all fields of medicine. It has chronicled the dramatic and revolutionary changes in diagnostic medicine for almost a century. It was first written under the title A Manual of Clinical Diagnosis in 1908 by the legendary James C. Todd MD, who edited the first six editions, and was joined on the sixth edition by Dr Arthur H. Sanford MD. Dr Sanford continued with four more editions of this book on his own and was joined on the 11th edition by Dr George G. Stillwell and on the 12th edition by Dr Benjamin B. Wells. The 13th edition was edited by Dr Wells and Dr Israel Davidsohn, a pioneer in the field of clinical and diagnostic immunology, and was renamed Clinical Diagnosis by Laboratory Methods. This change in title reflected the major shift in medical diagnostic testing from disparate laboratories, many using indigenous methodologies, to the central diagnostic laboratories using standardized testing with appropriate method verification. In 1969, Dr John Bernard Henry joined Dr Davidsohn in the editorship of the 14th edition of this textbook. This was a most fortunate development. Dr Henry, as Professor of Pathology at the State University of New York Upstate Medical Center in Syracuse and Director of the Clinical Pathology service at this medical center, was a pioneer in the organization of the clinical pathology laboratories and an innovator in introducing state-of-the-art methods into the centralized diagnostic laboratory. Dr Henry has been and continues to be an outstanding teacher who has been central to the training of multiple generations of leaders in the field of laboratory medicine. His major focus has always been on the patient, and he established the principle that the ultimate verification of the validity of the result of any test is whether it leads to appropriate and effective therapeutic intervention. This principle requires close interactions between the clinical pathologist and the clinician. Thus, as an editor of this textbook, in addition to promoting discussions of the exciting new developments in testing methodologies that span a vast panorama from spectrophotometry to microscopic diagnosis to molecular biological approaches such as polymerase chain reaction, Dr Henry also emphasized the clinical aspects of the diseases that are diagnosed by them. This synthesis and the broad coverage of the vast area encompassing the field of clinical pathology ensured that this book succeeded in serving as the standard reference text for both laboratorians and clinicians. Both Drs Davidsohn and Henry edited the 15th edition of this book, published in 1974. Dr Davidsohn died in 1979 at the age of 84, and Dr Henry became the editor for the 16th-20th editions. In the 16th edition, reflecting his emphasis on patient care and the emerging importance of using laboratory tests to follow the progression of disease and the efficacy of therapy, Dr Henry gave this book its current title, Clinical Diagnosis and Management by Laboratory Methods. Under his guidance, this textbook has continued to maintain and expand its tradition of informing the reader of the most recent developments in laboratory testing for the diagnosis and treatment of diseases and of describing how testing is used both to screen for the presence of disease and to monitor progress in the management of disease. It is a great honor for both of us that we have inherited the mantle of so prolific and distinguished a medical scholar as Dr John Bernard Henry. Both of us have benefited immensely from our close association with him over the past several decades. It is with great humility and respect that we assume editorship of this flagship textbook that has been molded by him and by all of the other outstanding leaders in the field of diagnostic medicine. We feel most fortunate to be able to continue to interact with Dr Henry. We are and will always be deeply indebted to him for his massive contributions to the fields of clinical pathology and diagnostic medicine, his outstanding example as a physician and teacher, and his profound contributions as editor of this textbook that have ensured that this book has taken its place among the most significant textbook contributions in modern medicine. In tribute to him and his leadership over the last seven editions of this book, it will henceforth be permanently titled Henry's Clinical Diagnosis and Management by Laboratory Methods. Richard A. McPherson, MD Matthew R. Pincus, MD PhD Copyright © 2007 Elsevier Inc. All rights reserved. - www.mdconsult.com McPherson & Pincus: Henry's Clinical Diagnosis and Management by Laboratory Methods, 21st ed. Copyright © 2006 W. B. Saunders Company List of Contributors Naif Z. Abraham Jr, MD PhD Staff Pathologist, Director of Chemistry, Hematology, Immunology, and Microbiology, Department, of Pathology, Veterans Affairs Medical Center Assistant Professor, Upstate Medical University, Syracuse, NY, USA Yoshihiro Ashihara, PhD Vice President, Board Member, Research & Development Division, Fujirebio Inc., Tokyo, Japan Katalin Banki, MD Assistant Professor of Pathology, Director of Special Hematology, Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, USA Wendy V. Beadling, MS MT(ASCP)SBB Assistant Supervisor, Blood Bank, Clinical Pathology, SUNY Upstate Medical University, Syracuse, NY, USA Jennifer Beane, BA BE PhD Candidate, Bioinformatics Program, Boston University, Boston, MA, USA Sylva Bem, MD Clinical Assistant Professor, Department of Pathology, Division of Hematopathology, SUNY Upstate Medical University, Syracuse, NY, USA Jonathan Ben-Ezra, MD Professor of Pathology, Department of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA Gary E. Blank, PhD Associate Professor of Clinical Chemistry, Department of Pathology, University of Pittsburgh, Pittsburgh, PA, USA Martin H. Bluth, MD PhD Director of Research, Assistant Professor, Departments of Surgery and Pathology, SUNY Downstate Medical Center, Brooklyn, NY, USA Jay L. Bock, MD PhD Professor and Acting Chair, Department of Pathology, State University of New York at Stony Brook, Stony Brook, NY, USA Michael J. Borowitz, MD PhD Professor of Pathology, Department of Pathology, Johns Hopkins University/Medical Center, Baltimore, MD, USA Paul W. Brandt-Rauf, MD PhD DPH Chairman, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia College of Physicians and Surgeons, New York, NY, USA David J. Bylund, MD Staff Pathologist, Department of Pathology, Scripps Clinic - Torrey Pines, La Jolla, CA, USA Robert P. Carty, PhD Associate Professor, Department of Biochemistry, SUNY Health Science Center at Brooklyn, Brooklyn, NY, USA Laura Cooling, MD MS Clinical Assistant Professor, Associate Director, Transfusion Medicine, Department of Pathology, University of Michigan Hospitals, Ann Arbor, MI, USA Michael Costello, PhD Technical Director, Advocate Shared Services Laboratory, Advocate Lutheran General Hospital, Park Ridge, IL, USA Ann C. Croft, MT(ASCP) Supervisor, Bacteriology Laboratory, ARUP Laboratories, Salt Lake City, UT, USA Judy A. Daly, PhD Clinical Professor, Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA Robertson D. Davenport, MD Associate Professor of Pathology, Medical Director, Blood Bank and Transfusion Service, Ann Arbor, MI, USA Robert P. De Cresce, MD MBA MPH Chairman, Department of Pathology Director, Rush Medical Laboratories, Rush University Medical Center, Chicago, IL, USA Julio C. Delgado, MD Assistant Professor of Pathology, University of Utah Associate Director, Laboratory of Immunology, ARUP Laboratories, Salt Lake City, UT, USA Charles DeLisi, PhD Professor, Senior Associate Provost, Curriculum & Teaching, Boston University, Boston, MA, USA D. Robert Dufour, MD Chief, Pathology and Laboratory Medicine Service, Veteran Affairs Medical Center, Washington, DC, USA M. Tarek Elghetany, MD Professor and Vice-Chairman, Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA Amal F. Farag, MD Assistant Professor of Medicine, Department of Endocrinology, New York Harbour Healthcare System, Brooklyn, NY, USA Andrea Ferreira-Gonzalez, PhD Professor and Director, Molecular Diagnostics Laboratory, Department of Pathology, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA Daniel Fink, MD Associate Clinical Professor of Pathology, Department of Pathology, Columbia University Medical Center, New York, NY, USA Louis M. Fink, MD Director, Core Laboratory Services, Nevada Cancer Institute, Las Vegas, NV, USA Thomas R. Fritsche, PhD MD ABMM Director of Laboratories, JMI Laboratories, North Liberty, IA, USA Carleton T. Garrett, MD PhD Division Chief, Pathology, Virginia Commonwealth University, Richmond, VA, USA Susan S. Graham, MS MT(ASCP)SH Associate Professor and Chair, Department of Clinical Laboratory Science, SUNY Upstate Medical University, Syracuse, NY, USA Wayne W. Grody, MD PhD Professor, Division of Molecular Pathology and Medical Genetics, Director, Diagnostic Molecular Pathology Laboratory, Departments of Pathology & Laboratory Medicine, Pediatrics, and Human Genetics, UCLA School of Medicine, Los Angeles, CA, USA Helena A. Guber, MD Assistant Professor of Medicine, Department of Endocrinology, New York Harbour Healthcare System, Brooklyn, NY, USA Geraldine S. Hall, PhD Professor of Pathology, Division of Pathology and Laboratory Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA Rosemarie E. Hardin, MD Resident, Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA