Clinical diagnosis a text-book of clinical microscopy and clinical chemistry for medical students, laboratory workers, and practitioners of medicine / by Charles Phillips Emerson.

  • Emerson Charles Phillips, 1872-1938.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Clinical diagnosis a text-book of clinical microscopy and clinical chemistry for medical students, laboratory workers, and practitioners of medicine / by Charles Phillips Emerson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    709/808 (page 647)
    In CHRONIC NEPHRITIS SO many factors come into play that the blood picture is not clear. Yet the influence of nearly all these factors is to cause anaemia. Among them is the condition of the heart; the <]edema and hydrsemia; the wretched condition of the gastro-intes- tinal tract, vomiting, diarrhoea, poor appetite, and the influence of the purges. The result is often a lowered count, a still more lowered haemoglobin, and an hydraemic plasma. In 103 cases of chronic nephritis the red cells were 1,700,000 in one case, between 2,000,000 and 3,000,000 in 13 cases, between 3,000,000 and 4,000,000 in 25, over 5,000,000 in 19; mean, 4,500,000. The haemoglobin in 99 cases was between 20 and 30 per cent, in 3 cases, from .30 to 50 in 29, above 80 per cent, in 17; mean, 62 per cent.; hence the mean color- index, 0.7, which is almost normal. The leucocytes in 80 cases without uraemia were below 5000 in 4 cases, 5000 to 10,000 in 43, above 10,000 in 33, and of these the highest were between 20,000 and 30,000. In 33 cases with uraemia the highest was 25,900, above 10,000 in 15 cases, below 5000 in 2; mean, about 9000. It is seen that in our cases those with uraemia did not differ much from those without. A most interesting group is of the cases somewhat resembling pernicious anaemia, and with only nephritis to explain the condition. A case from this clinic^ is a good illustration of this, or of the simultaneous occurrence of the two diseases. The patient was a man 39 years old; red cells, 1,400,000; haemoglobin, 27 per cent.; leucocytes, 7000 (pmn. n., 88 per cent.; s. m., S per cent.; 1. m., 2 per cent.; eosinophiles, 2 per cent.). There was no poikilocy- tosis, and but one nucleated red found. The urine was of low specific gravity, with much albumin and many casts. Cabot reports such a case with 1,468,000 reds; haemoglobin, 23 per cent.; leu- . •cocytes, 3800 (pmn. n., 70 per cent; s. m., 23 per cent; 1. m., 4.4 per cent.; eosino- philes, 2.6 per cent.; megaloblasts, normoblasts, and poikilocytes). In the case of Labbe the red blood-count was 500,000; haemoglobin, 2 gms.; the cells pale, irregular in form and size; nucleated reds rather small; mono- nuclears, 59 per cent. Recovery was rapid. He suggests that the anaemia was for the most part that of dilution. In another case the red blood-cells were 418,500 and the color-index over i; and in a third the count was 1,000,000. At autopsy in such cases nephritis is the only lesion found. There were practically no signs of blood destruction, nor of regeneration, nor of megaloblastic degeneration of the marrow. It is a question how much of the low count the hydraemia will explain, but there is certainly some relation between the anaemia and the oedema, and the hydraemia which accompanies the anaemia. We mention two other cases with arteriosclerosis and chronic nephritis. One was a woman, fifty-four years of age, with reds, 2,800,000; haemoglobin, 50 per cent.; leucocytes, 6000; no fever. The other was a man thirty-two years old, with reds, 1,772,000; haemoglobin, 22 per cent; leucocytes, 50,000 (of which 91 per cent, were pmn. n.) ; the leucocytes later rose to 116,000; he left the hospital unimproved. In interstitial nephritis the count is normal at first, and sometimes to the end. The condition of the heart is important. During the acute exacerbations, however, a slight lowering of the count is com- mon, perhaps due to the hydraemia. McCrae, Johns Hopkins Hosp. Bull., October, 1902, p. 245.