Hemogram

HEMOGRAM, an image of the blood picture, a record of the results of possibly complete and precise determination of the quantity and quality of all formed elements (erythrocytes, leukocytes, and thrombocytes) and Hb of the blood. Detailed repeated study of the blood picture of the patient should bring the physician closer to an understanding of the condition of his blood-forming organs, the course of the disease, and the effect of therapy. The very name "hemogram" was proposed by V. Schilling. Schilling's hemogram is a scheme for recording an approximate count of the total number of leukocytes (evaluation from a smear), the differential picture of leukocytes with a nuclear shift of neutrophilic leukocytes, and data from the study of a thick drop. Schilling's hemogram in normal conditions is presented as follows: Hemogram Name.. Line. diagnosis. Number. Day of disease In normal... Ai 6,000 8,000 Neutrophils 2Kb 1! Notes. Thick drop 63 23 p + b.p. Atypical forms: ..... * p + indicates the presence of polychromatophilic erythrocytes; b.p. - erythrocytes with basophilic stippling (see Erythrocytes). Thus, G. gives a picture of the condition of almost only leukocytes. Schilling does not claim to provide a complete blood examination. His methodology of hemograms, requiring minimal expenditure of time and material, the author recommends for wide application in daily clinical work and outpatient practice. For the accessibility of hematological methodology, he has introduced a number of simplifications. Precise counting of erythro-, leuko-, and thrombocytes and determination of the amount of Hb are performed only in exceptional cases. The leukocyte formula itself is derived from the count of 100-200 cells in four fields of the smear and is presented exclusively in relative percentages. The picture of neutrophilic blood is a simplification of the cumbersome Arnet classification. The 5 classes of Arnet's scheme, including 80 subclasses, Schilling summarizes into four types of neutrophils: myelocytes, juvenile, stab, and segmented neutrophils, with the first three types of Schilling corresponding to the three subclasses of the first class of Arnet (namely: myelocytes, neutrophils with slightly indented and deeply indented nuclei), while segmented neutrophils correspond to all four subsequent classes of Arnet. Regarding the nuclear shift of the neutrophilic blood picture, Schilling speaks on the basis of the presence and fluctuations in quantity, mainly of juvenile and stab neutrophils. Thus, the phenomenon of the nuclear shift of Arnet is presented by Schilling in a significantly simplified and most acceptable form for wide use. The study of the thick drop of the patient's blood, Schilling considers a control method, a necessary addition to the blood picture obtained from the study of a regular blood smear. Based on its study, conclusions are drawn only about certain qualitative changes in erythrocytes - the presence and degree of polychromatophilia, the presence of erythrocytes with basophilic stippling. Thanks to the simplified methodology of blood examination and the presentation of the blood picture within strictly limited frameworks, it becomes possible to compare similar material from different researchers. The comprehensive study of similar hemograms under various physiological and pathological conditions makes it possible to identify certain types of blood pictures. "Biological curves of leukocytes" by Schilling, constructed from the sum of G. of a given case throughout the entire disease (hemographic curves), represent the formalization of previously known regular dynamic changes in the leukocyte formula during certain diseases, mainly acute infectious ones. In the biological curve, common to most acute infectious diseases, Schilling conditionally distinguishes four parts corresponding to four periods of the disease. The "neutrophilic phase of struggle," corresponding to the height of the disease, is characterized by neutrophilic hyperleukocytosis with a left nuclear shift, aneosinophilia, and lymphomonopenia. The period of beginning recovery, sometimes a crisis, corresponds to the so-called monocytic, or "protective phase." Continuing recovery corresponds to a decrease in the left nuclear shift, the appearance and increase in the number of eosinophils. The "lymphocytic phase of recovery," characterized by lymphocytosis and hypereosinophilia, signifies the end of the disease. The blood picture is one of the symptoms of a given disease. Schilling, comparing G. with other data of clinical observation, considers it possible to conclude about the belonging of the case to a certain group of diseases, about the phase of the disease, and about the severity of the given case. In itself, G. cannot have complete diagnostic value; it is only an additional clinical examination. The advantages of G. Schilling and his methodology G. consist: 1) in the desire to place the study of the blood picture within certain limits, to make this study accessible to all, to establish uniformity in the methodology of blood examination and interpretation of hematological pictures; 2) in the formalization of certain types of leukocyte blood picture for each group of diseases and in revealing the dynamics of it for certain infectious diseases. However, the methodology of G. Schilling is in no way acceptable (which the author himself acknowledges) for special diseases of the blood and blood-forming organs. Ignorance of information about the exact quantity of formed elements, construction of the picture of the entire blood based only on data from the study of one smear and the "control" thick drop, the four-field method of counting leukocytes (with the entire central part of the smear remaining unused), and the presentation of data from the differential count of leukocytes only in relative numbers significantly reduce the value of the proposed methodology of G., not meeting the tasks of possibly complete examination of the patient in the clinic.