Hemoglobin and red corpuscles are always greatly diminished. In none of Cabot's 139 cases did the count exceed 2,500,000, the average being about 1,200,000. In more than two-thirds of the cases hemoglobin was reduced to less extent than the red corpuscles: the color-index was, therefore, high. A low color-index probably indicates a mild type of the disease.
The leukocyte count may be normal, but is commonly diminished to about 3000. The decrease affects chiefly the polymorphonuclear cells, so that the lymphocytes are relatively increased. In some cases a decided absolute increase of lymphocytes occurs. Polymorphonuclear leukocytosis, when present, is due to some complication.
| FIG. 84.—A, Normal blood; B, chlorosis; C, pernicious anemia. The plate shows the sharp contrast between cells rich in hemoglobin and the pale cell of chlorosis, and also the poikilocytosis and marked variations in size noted in pernicious anemia. A normoblast and megaloblast also appear. Stained smears (from Greene's "Medical Diagnosis"). |
| PLATE VIII |
| EXPLANATION OF PLATE VIII. |
|
Fig. 1.—Preparation from an advanced case of progressive pernicious
anemia from unknown cause: a, Megaloblasts or gigantoblasts; the
protoplasm shows marked polychromasia; b, stained granules in
erythrocytes with normally stained protoplasm; c and d,
polychromatophilic degeneration; e, megalocytes; f, normocytes. Fig. 2.—Preparation from the same case taken some time later while the patient was subjectively and objectively in perfect health: a, Punctate erythrocytes with normal and anemic degenerated protoplasm; b, polynuclear leukocyte; c, normal red blood-corpuscles; d, somewhat enlarged erythrocytes. Fig. 3.—Series of cells from a case of severe progressive pernicious anemia of unknown etiology; preparation made two days antemortem: a, Nucleated red blood-corpuscles characterized as normoblasts by the intense staining of the nuclei; a' and a", karyokinetic figures in erythrocytes; the protoplasm finely punctate; b, beginning karyolysis in a megaloblast; c, erythroblasts with coarse granulation of the protoplasm; d, nuclear remains (?) and fine granulation of the protoplasm; e and f, finely punctate red blood-corpuscles; g, megalocyte with two blue nuclei; nuclear remains (?) in the polychrome protoplasm. |
| (Nothnagel-Lazarus.) |
The red corpuscles show marked variation in size and shape (Plate VIII and Fig. 84). There is a decided tendency to large oval forms, and despite the abundance of microcytes, the average size of the corpuscles is generally strikingly increased. Polychromatophilia and basophilic degeneration are common. Nucleated red cells are always present, although in many instances careful search is required to find them. In the great majority of cases megaloblasts exceed normoblasts in number. This ratio constitutes one of the most important points in diagnosis, since it is practically unknown in other diseases. Blood-plaques are diminished.
The rare and rapidly fatal anemia which has been described under the name of aplastic anemia is probably a variety of pernicious anemia. Absence of any attempt at blood regeneration explains the marked difference in the blood picture. Red corpuscles and hemoglobin are rapidly diminished to an extreme degree. The color index is normal or low. The leukocyte count is normal or low, with relative increase of lymphocytes. Stained smears show only slight variations in size, shape, and staining properties of the red cells. There are no megaloblasts, and few or no normoblasts.
(2) Chlorosis.—The clinical symptoms furnish the most important data for diagnosis. The blood resembles that of secondary anemia in many respects.
The most conspicuous feature is a decided decrease of hemoglobin (down to 30 or 40 per cent. in marked cases), accompanied by a slight decrease in number of red corpuscles. The color-index is thus almost invariably low, the average being about 0.5.
As in pernicious anemia, the leukocytes are normal or decreased in number, with a relative increase of lymphocytes.