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Hæmatological Technique Part : NAPIER DAS GUPTA July, 1941] HEMATOLOGICAL TECHNIQUE & 427 some measurement of the red cells, and, as in our experience clinical halometers are very in- Special Articles accurate, the mean cell diameter should be measured by the modification of Price-Jones V J method that we have described. HEMATOLOGICAL TECHNIQUE The inclusion of the erythrocyte sedimenta- rate Part XII* tion (ESR) in the minimum procedures might be questioned, but, if a Wintrobe's tube By L. EVERARD NAPIER, f.k.c.p. (Lond.) is used for cell-volume estimations, the ESR and requires no additional apparatus and entails no extra the of a at C. R. DAS GUPTA, m.b. (Cal.), d.t.m. labour, except taking reading the end of an and the information it (From the School of Tropical Medicine, Calcutta) hour, gives is often useful. The investigation of a case and the reporting of Gastric analysis is important when the ques- results tion of pernicious anaemia arises and in some cases of anaemia of doubtful question that we are frequently asked is, microcytic aetiology, but we would not it a in the i^IlEdo you consider the minimum examinations give high place .j^t order of in the of cases should be carried out in a case of anaemia ? importance, investigation e of anaemia in this should be forced to reply that, with the country. of those in part which apply For the complete investigation of the aetiol- pa^P^011 X, factors other will have in hemorrhagic diseases, at least ogical many examinations '^uladyexaminations that have described to be carried out, e.g., the urine for albumin, in +K- been his and ova; the stools for hel- in series should be made for the proper blood, protozoa, and for fat of a patient. minths, pathogenic bacteria, content, jes"gationactual blood and for the presence of occult blood; and the 11. practice, alL the ' nearly blood for blood can be carried a grouping', the Wassermann s ^^ations out from single teoh11^11 blood and do not take a good reaction, cholesterol, albumin/globulin ratio, etc. nician more an Controlling 'progress.?Circumstances will c than hour, if the Price-Jones *S exc^uded. A certain amount of time usually dictate how often blood examinations car?K out saved by omitting the Arneth count, the should be carried during treatment, but there fr .^.e are we will here. ty test, and the enumeration of thrombo- certain points which consider cyt In the first when a anc^ there are many circumstances in which place, seriously-ill patient thp?8' tests is admitted into he is often suffering ti will give little information of prac- hospital, T value. esti- from some degree of haemo-concentration, and a ^ This leaves the haemoglobin and the second examination made a few days after retj ^i1' total red white cell counts, cell volume esti- admission shows a marked drop in haemoglobin ttiat ?Cyte count, percentage Van1^11 (hematocrit) and sedimentation rate, percentage, whereas the patient's condition may n ^ergh's reaction, and white cell'differ- have improved considerably. If allowance is enti i not made for this the effect of the first C0Unt, to be done as a minimum routine fact, Pro ,1 treatment that is be and cedure in every case. given may misjudged, these we have always adopted the practice of ex ? findings will indicate whether making ^'Nations should be supplemented. Sternal a second examination before prescribing specific treatment in cases where an re ^ives very valuable additional infor- (except urgent ^at blood but it not be as a short immediate transfusion is indicated). cut must considered will of Further, there are many nutritional anaemias vali ^agnosis for it seldom be any India in which a th?, without, a complete blood count, and fur- in there is steady im- of the cells is very provement directly the patient is put to bed and i identification various skil] a diet. Allowance must also be made pvy-. work that necessitates considerable given good for this fact, if the value of any special form of Thlence'. is in such cir- is (;re will be occasions when electric current treatment being estimated and, available and in these circumstances it cumstances, at least two weeks of rest and diet win n?t should be allowed before the treatment per be possible to estimate the cell volume specific is started. Cor entage satisfactorily. Although the mean Scu^ar runs We make a practice of repeating the blood ttiore haemoglobin (MCH) usually v0i? ""0r-less parallel with the mean corpuscular examination, including haemoglobin percentage, trie (MCV), it will be advisable to make red cell count, reticulocytes, cell volume per- van den and ESR, * centage, Bergh's reaction, It and examination of the film for abnormal cells, the original intention to publish another articje^as n?k a or a is ^is series. These notes were written as the once week, earlier if setback suspected final pi111 In refe,T !aPter of Hcematolocjical Technique, the booklet or if the treatment is to be changed. special our note in number. 9nZaJ? > editorial the May cases other examinations, such as the platelet we have decided that it will make are also S* Sl8ideriltion> we and and leucocyte counts, repeated._ the fnries rnore complete, if reprint these notes is here. When any specific form of treatment given HceZ^ now from the 4th be ohf^tol?aical Technique is on sale, and may a reticulocyte count is done daily Ltd ^rom Messrs. Thacker, Spink and Co. (1933), until about the 12th day, or, in a case where ^Planade, East, Calcutta. 42? THE INDIAN MEDICAL GAZETTE [July, 1941 there is a until the reticulo- reticulocyte crisis, Form 2 is the sternal form, has fallen to its level. puncture report cyte percentage previous sent to the ward and attached to the The forms that we use in the School similarly printed notes; a resume of this is entered on the reverse are shown below. There is quite room possibly of form 3 (size 8^ by 5^ inches). for improvement in these forms, and we have modified them from time to time, but we find Form 3 is the card which we keep in the that, without being cumbersome, they are suffi- laboratory. The important data on which cient for our purpose. progress is judged are entered on the face of the Form 1 is the ordinary report form which is card, and other data and records of examination sent to the ward and attached to the notes that are not usually repeated, on the reverse (size 8^ by 6^ inches). (size 8^ by inches?stiff card). FORM 1 FORM 2 S. T. M. ANAEMIA DEPT. S. T. M. ANAEMIA DEPT. BLOOD REPORT STERNAL PUNCTURE REPORT Name.. Sex*. Age Ward Bed... Name . Age Ward Bed Hcemoglobin (Hellige normal percent Total nucleated cells Reticulocytes. haemometer). Endothelial cells: Red cell series: Gm. per 100 c.cm. Megaloblast. Red blood cells: per c.mm. Erythroblast Macroblast : Reticulocytes per cent Normoblast Cell volume: percent While cell series: Mean corp. volume: Cu./u. Granular series? Mean corp. haemoglobin: yy Myeloblast..... ,, Mean corp. haem. conc.: per cent Pre-myelocyte (A White blood cells: c.mm. per Neutro. myelocyte [B percent per c.mm. ? meta-myelocyte.. Neutrophils ? band Lymphocytes ? segmented Large mononuclears Eosino. myelocyte Eosinophils ? meta-myelocyte. ? band Basophils ? segmented Arneth count, I II III IV V Weighted Blood group. mean. Basophil Non-granular series? Abnormal cells. Lymphoblast : Platelets per c.mm. (A Lymphocyte Coagulation time. Bleeding time. (B. Fragility of red cells. Prothrombin time. Plasma cell Capillary resistance. Monoblast SedimentationS Observed Pre-monocyte rate (1 hour) 1 Corrected Large mononuclear Van den Bergh's ( Direct Megakaryocyte 100 c.cm. test \ Indirect mg. per Undifferentiated ....... ' Opinion: Parasites.... Date-*.? ? Date ? POISONING : THOMAS 429 July, 1941] CASES OF POISONING & SUSPECTED FORM 3 ANAEMIA DEPX. S. x M ANEMIA CARD Ward ?ed Name : ?ex? A?e Leucocytes Abnormal Xreatment Xotal v.d.B ESR n?iate Hb RBC Ret, CV MCV MCH MCHC cell and diet N L M E B FORM 3 (reverse) Blood res. Prothrombin time ?n r^ntm timeime Bleeding time Cap. Platelets Wtmean W. R. Blood group Arneth count: I STivTII iff IV V _ Sternal puncture:? , , A ,, ,T . ~ Mac. Normo. Ret. rr. , >T T?pd Mgbt. Erbt. Total: Gran. Non-gran. Kea. Spleen puncture:? ? , 2> 2i' 2i> 3 hrs" ' Gastric F. i, I, %, 1, U- analysis:- Price-Jones curve pont;? Mean corpuscular diam. (MCD) Peptic digestion Standard deviation (a) Coefficient variation (v) Urjne. Per cent macrocytosis " ? microc>"osis Stool: -[Protozoa(Occult blood Other data Clinical notes Spleen: Liver: Weight: Epidemiological data Economic status Oietary habits Residence?malarious or not Occupation family history .
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