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Access to the eBook is limited to the first individual who redeems the PIN, located on the inside cover of this book, at studentconsult.inkling.com and may not be transferred to another party by resale, lending, or other means. 2015v1.0 mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Davidson’s Principles and Practice of Medicine mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Sir Stanley Davidson (1894–1981) This famous textbook was the brainchild of one of the great Professors of Medicine of the 20th century. Stanley Davidson was born in Sri Lanka and began his medical undergraduate training at Trinity College, Cambridge; this was interrupted by World War I and later resumed in Edinburgh. He was seriously wounded in battle, and the carnage and shocking waste of young life that he encountered at that time had a profound effect on his subsequent attitudes and values. mebooksfree.com mebooksfree.comIn 1930 Stanleymebooksfree.com Davidson was appointed Professor of Medicinemebooksfree.com at the University of Aberdeen, one of the first full-time Chairs of Medicine anywhere and the first in Scotland. In 1938 he took up the Chair of Medicine at Edinburgh and was to remain in this post until retirement in 1959. He was a renowned educator and a particularly gifted teacher at the bedside, where he taught that everything had to be questioned and explained. He himself gave most of the systematic lectures in Medicine, which were made available as typewritten notes that emphasised the essentials and far surpassed any textbook available at the time. Principles and Practice of Medicine was conceived in the late 1940s with its origins in those lecture notes. The first edition, published in 1952, was a masterpiece of clarity and uniformity of style. It was of modest size and price, but sufficiently comprehensive and up to date to provide students with the mebooksfree.com mebooksfree.commain elements ofmebooksfree.com sound medical practice. Although the formatmebooksfree.com and presentation have seen many changes in 22 subsequent editions, Sir Stanley’s original vision and objectives remain. More than half a century after its first publication, his book continues to inform and educate students, doctors and health professionals all over the world. mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Davidson’s Principles and Practice of Medicine 23rd Edition Edited by mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Stuart H Ralston MD, FRCP, FMedSci, FRSE, FFPM(Hon) Arthritis Research UK Professor of Rheumatology, University of Edinburgh; Honorary Consultant Rheumatologist, Western General Hospital, Edinburgh, UK Ian D Penman BSc(Hons), MD, FRCPE Consultant Gastroenterologist, Royal Infirmary of Edinburgh; Honorary Senior Lecturer, University of Edinburgh, UK mebooksfree.comMark WJ Strachan mebooksfree.com mebooksfree.com mebooksfree.com BSc(Hons), MD, FRCPE Consultant Endocrinologist, Metabolic Unit, Western General Hospital, Edinburgh; Honorary Professor, University of Edinburgh, UK Richard P Hobson LLM, PhD, MRCP(UK), FRCPath Consultant Microbiologist, Harrogate and District NHS Foundation Trust; Honorary Senior Lecturer, University of Leeds, UK mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Illustrations by Robert Britton Edinburgh London New York Oxford Philadelphia St Louis Sydney 2018 mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com © 2018 Elsevier Ltd. All rights reserved. Illustrations and boxes in Chapter 8 © Julian White. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the publisher (other than as may be noted herein). First edition 1952 Ninth edition 1968 Seventeenth edition 1995 Second edition 1954 Tenth edition 1971 Eighteenth edition 1999 Third edition 1956 Eleventh edition 1974 Nineteenth edition 2002 Fourth edition 1958 Twelfth edition 1977 Twentieth edition 2006 mebooksfree.comFifth edition 1960 Thirteenthmebooksfree.com edition 1981 Twenty-first editionmebooksfree.com 2010 mebooksfree.com Sixth edition 1962 Fourteenth edition 1984 Twenty-second edition 2014 Seventh edition 1964 Fifteenth edition 1987 Twenty-third edition 2018 Eighth edition 1966 Sixteenth edition 1991 ISBN 978-0-7020-7028-0 International ISBN 978-0-7020-7027-3 Notices Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com The publisher’s policy is to use paper manufactured from sustainable forests mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Content Strategist: Laurence Hunter Content Development Specialist: Wendy Lee Content Coordinator: Susan Jansons Printed in China Project Manager: Louisa Talbott Last digit is the print number: 9 8 7 6 5 4 3 2 1 Designer: Miles Hitchen mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com HG Watson DJ Culligan LM Manson 23 mebooksfree.com mebooksfree.com mebooksfree.com mebooksfree.com Haematology and transfusion medicine Clinical examination in blood disease 912 Anaemias 940 Functional anatomy and physiology 914 Iron deficiency anaemia 940 Haematopoiesis 914 Anaemia of chronic disease 943 Blood cells and their functions 915 Megaloblastic anaemia 943 mebooksfree.comHaemostasis 917 mebooksfree.comHaemolytic anaemiamebooksfree.com 945 mebooksfree.com Investigation of diseases of the blood 919 Haemoglobinopathies 951 The full blood count 919 Sickle-cell anaemia 951 Blood film examination 920 Other abnormal haemoglobins 953 Bone marrow examination 920 Thalassaemias 953 Investigation of coagulation 920 Haematological malignancies 954 Presenting problems in blood disease 923 Leukaemias 954 Anaemia 923 Lymphomas 961 High haemoglobin 925 Paraproteinaemias 966 Leucopenia (low white cell count) 925 Aplastic anaemias 968 Leucocytosis (high white cell count) 926 Myeloproliferative neoplasms 969 Lymphadenopathy 927 Bleeding disorders 970 Splenomegaly 927 Disorders of primary haemostasis 970 Bleeding 927 Coagulation disorders 971 Thrombocytopenia (low platelet count) 929 Thrombocytosis (high platelet count) 929 Thrombotic disorders 975 mebooksfree.comPancytopenia 930 mebooksfree.comVenous thromboembolicmebooksfree.com disease (venous thromboembolism) 975 mebooksfree.com Infection 930 Inherited and acquired thrombophilia and prothrombotic states 977 Principles of management of haematological disease 930 Blood products and transfusion 930 Chemotherapy 936 Haematopoietic stem cell transplantation 936 Anticoagulant