Studies in the Osteopathic Sciences
Cells of the Blood: Volume 4
Louisa Burns, M.S., D.O., D.Sc.O.
    A brief list of the changes in the blood cells most commonly reported, with the significance of these, may be of some practical value.  This list is suggestive rather than definite and it is given in the hope that it may serve to call attention to pathognomonic findings easily over-looked.

    Reports of examinations of blood cells made in professional laboratories usually include some discussion of the significance of the findings, especially if the laboratory staff has been consulted in advance, and if the history of the patient and the findings on physical examination have been fully given.  Ordinary commercial laboratories are not usually able to give this service, which is of considerable importance.

    The osteopathic physician who wishes the most efficient assistance from laboratory tests must select his laboratory with care.  Laboratory workers are specialists and consultants; if they are consulted about the patient’s condition they can often advise the most useful tests to be made, and can give instructions concerning the best time for taking the blood and for preparing the patient.  The changes which occur in the blood cells as a result of fatigue, digestion, dietetic peculiarities, changes of altitude and other physiological conditions have been described in previous chapters.  In cases of severe acute or well-marked chronic states, such as acute infections or the leukemias, a diagnosis may be possible no matter when the blood is taken.  But in those cases in which diagnosis is difficult, the patient must be rested,  not recently fed, not menstruating, not recently subject to sexual excitement and not under the influence of any emotional or therapeutic circumstances.  Under certain conditions it is best to have the patient come for blood-cell examinations just after an osteopathic treatment; this is especially true in cases of malaria and in early leukemias.

    The indications are here given very briefly and further study is necessary in order to verify the correct diagnosis and to eliminate other possibilities.

    Diminished hemoglobin suggests the anemias, malnutrition, dilution of the blood.  Increased hemoglobin suggests dessication, concentration of the blood, cardiac disease, certain pulmonary disorders, polycythemia, diabetes insipidus or mellitus.  Abnormal tint of blood suggests carbon monoxide poisoning, cholemia, carotinemia, other more rare conditions.
    Diminished red cell count suggests the anemias, malnutrition, dilution of the blood.  Increased red cell count suggests cardiac or pulmonary disease, diabetes mellitus or insipidus, dessication, polycythemia.
    Low color index suggests secondary anemia or chlorosis, malnutrition, disturbance of the circulation through the red bone marrow.  Present also in atypical primary anemias, High color index with low hemoglobin indicates pernicious rather than secondary anemia; is resent also in certain poisonings and in secondary anemia due to certain parasites; occasionally also in malignancy.
    Poikilocytes are especially abundant in chlorosis, sickle-cell anemia, secondary anemias.  Anisocytosis is especially marked in pernicious anemia.  Normoblasts are abundant after hemorrhages and during rapid blood regeneration.  Megaloblasts are especially abundant in pernicious anemia and lead poisoning; may be present in severe anemia of any type.

    Anisocytosis more marked than poikilocytosis, suggests pernicious rather than secondary anemia.  Megaloblasts more numerous than normoblasts suggests pernicious rather than secondary anemia.  Oval forms indicate long-continued secondary anemia of mild degree or a developmental anomaly.  Basophilic reticulation indicates immaturity; present abundantly when blood is being rapidly regenerated.  Basophilic degeneration indicates senility of blood cells, present in toxemia with alkalosis.

    Increased in dessication and in polycythemia.  Diminished in purpura, in the blood of certain “bleeders,” in pernicious and aplastic anemias, malnutrition, and certain conditions affecting the nutrition of the red bone marrow.  Diminished when food lacks proper amounts of vitamin A.
    When coagulation time is increased, hemophilia, purpura, malnutrition, and certain developmental peculiarities are suggested  When the clot is soft and inefficient hepatic disease or malnutrition is indicated.  Delayed or imperfect coagulation present in many abnormal conditions.
    Increased moderately during early afternoon and as a result of many physiological conditions.  Increased in infections, especially pyogenic states, in dessication, cardiac and pulmonary disease, non-infectious irritation of peritoneum or pleurisy, leukemias, secondary anemias, after surgical operations and after dressing of wounds.

    Leucopenia suggests pernicious anemia, aplastic anemia, effects of radium or X-ray therapy or of certain poisons.  Is usually present during recovery from infectious diseases.

    Never absolutely reduced excessively except by radium, X-rays or drugs.  Relatively reduced when neutrophiles are absolutely increased.  Absolutely and relatively increased in pernicious and aplastic anemias, certain deficient diets, fasting, toxemias, typhoid fever, pertussis, rickets, measles, paresis, tuberculosis, persistent thymus, at certain stages in many acute infectious diseases and in influenza, malaria, blastomycosis, lymphatic leukemia.

    Lymphocytosis plus eosinophilia suggests syphilis, tuberculosis or malignancy; also complications of two or several pathogenic conditions.

    Abnormal hyaline cells, especially immature forms, suggest chronic inflammatory processes involving lymphoid tissues.  Hyaline cells of extravascular origin include those derived from the placenta, cancers and sarcomas.

    Hyaline cells of normal structure increased, with no other findings abnormal, may be a developmental anomaly or may be due to excessive carbohydrate feeding.

    Diminished after infection, after treatment by X-rays or radium, after use of certain drugs.  Diminished in pernicious and aplastic anemias and in diseases of the red bone marrow, in measles, typhoid fever, influenza, malaria, splenic anemias and certain forms of tuberculosis.  Relatively diminished in lymphatic leukemia.

    Increased moderately in certain physiological states and in early morning and early afternoon hours.  Increased in nearly all acute infections and in pyogenic processes.  Increased very rapidly in pneumonia, meningitis, diphtheria, rheumatic fever, peritonitis and leukemia.

    Neutrophiles of immature form including many myelocytes, total count from subnormal to great numbers, indicates splenomedullary leukemia.  Immature and atavistic forms are a developmental anomaly in some cases; immaturity increases with severe acute or chronic disease.

    Neutrophilia without eosinophiles, “septic factor,” indicates pyogenic infection.  Neutrophilia with eosinophilia suggests gonorrheal infection, tuberculosis, ovarian or tubal disease, complication of pathogenic agencies.

    Below 2.4 in adults suggests rapid development of neutrophiles as in early infections or in the leukemias.  Above 2.55 in adults, suggests rapid degeneration of neutrophiles, as in late infections or virulent infection with inadequate reaction, in toxemias, late severe fatigue and late severe malnutrition.  Nuclear average is lower in children and the figures must be interpreted according to age.
    Eosinophiles are diminished in all ordinary pyogenic infections.  Leucocytosis plus normal or increased eosinophiles suggests that pyogenic infections may be gonorrheal.

    Eosinophiles are increased usually after subsidence of pyogenic infections and during active infections of gonorrhea, scarlatina and nearly all infectious eruptive diseases.  Nearly all animal parasite and all conditions causing irritation of the skin or the mucous membranes cause eosinophilia.  Splenomedullary leukemia and bronchial asthma are associated with marked eosinophilia.

    Eosinophiles of immature form and eosinophilic myelocytes indicate some disorder of ovaries or testes.  These are present also when bony lesions affect the red bone marrow, ovaries, testes and spleen.

    Basophiles are not abnormally diminished.  Increased in the leukemias, diseases affecting the thyroid and pancreas, in Asiatic cholera and sometimes in hepatic disease.  Increased when bony lesions affect the circulation through the red bone marrow.
    Neutrophilic myelocytes are especially abundant in splenomedullary leukemia.   Present in acute infections, especially after long and exhausting infectious diseases.  Present in pernicious anemia and in severe secondary anemias, and in lesions affecting the circulation and innervation of the red bone marrow.
    Inflammation is indicated when many endothelial cells are found.  Abundant in certain leukemias.  The location of the inflammatory process may be indicated by other findings.
    Iodophilic cells and granules indicate degeneration of protein materials, usually derived from pyogenic foci, tumors, or intestinal contents undergoing putrefaction.  Present in severe anemias and acute leukemias.
    Leucocytes inactive; toxemia, fatigue and malnutrition of long standing are indicated.  Leucocytes show increased activity; early fatigue, recent, mild toxemia, early days of fasting or starvation suggested.  Leucocytes die quickly in all these conditions.

    Fibrin threads long, heavy, regular in outline, formed very speedily, usually at once.  This suggests pneumonia or other acute pulmonary infections.  Less abundant in other acute infectious diseases.

    Fibrin threads formed at once, heavy, irregular in outline or beaded, radiating arrangements.  Malignancy is suggested, may be some other protein degenerative processes.

    Fibrin threads abundant, formed at once or later, arranged in vague, irregular net-like structure.  Marked disturbance in protein katabolism, absorption of products of pyogenic foci or of degenerating tumors suspected.

    Red cells fragile and lake quickly; Cholemia, or other toxemias, malnutrition, all of severe degree are suspected.

    Rouleaux delayed or abnormal, malnutrition or toxemia of almost any form is indicated.  Red cells form islet-like groups instead of rouleaux in severe toxemia, especially that due to disturbances in protein metabolism; malignancy suggested.

    Pseudopodia long, slender, erratic in development, non-purposive; some irritant toxic substance is present.  Hyperthyroidism suggested.  Early fatigue, moderate fevers, irritating drugs might be considered.

    Pseudopodia short, flat, blunt, inert; toxemia of long standing, late malnutrition.  In marked inactivity, hypothyroidism suggested.

    Cells arranged in groups; suspect cardiac disease; some considerable area with disturbed circulation, bony lesions affecting the spleen, liver and red bone marrow.
    Normal fibrinolysis probably protects against development of malignant neoplasms.  Absent fibrinolysis probably means lack of such protection.  Fibrinolysis is masked by undifferentiated proteolysis in late malignance, high fevers, severe malarias, severe intestinal toxemias.
    Red cells more resistant to saponin, weak acetic acid or hypotonic salt solutions.  This suggests secondary anemias, syphilis, tuberculosis myeloid leukemia, polycythemia; noted after splenectomy and in certain disease of the spleen and the liver.

    Red cells are normally resistant to such solutions in pernicious anemia, diabetes, exophthalmic goiter and most infections.

    Red cells show diminished resistance to such solutions in high fevers and in jaundice or cholemia.

    Very pale; secondary or aplastic anemias suggested.  Starvation may be cause.

    Brownish; anemia probably pernicious; Cholemia, severe malaria, certain rare tumors are suggested.

    Greenish; carotinemia or cholemia is indicated.

    Reddish; chronic carbon monoxide poisoning, hemolytic infections; hemolytic drugs or certain rare poisons or hemoglobinemic diseases.