Classification of Anemias.pdf

168 PORTO RICO JOURNAL OF PUBI,IC HEALTH A..~D TROP. MEDICINE
oeratie spirit which should inspire one who attempts to suggest to
his colleagues a plan of action which must be feas ible, and which
should at the same time satisfy their scientific scr uples. That is
to say, it opens the door to all over-wor ked physicians to say how
much or how little clinical laboratory work must needs be performed
before it is possible to arrive at ;.a fairly reliable diagnosis and
treatment" of these anemias.
The method employed by the writer, with exceptions imposed by
an unusual pressure of work, has been as follows:
( - 1. All persons suffering from clinical sprue or its preceding nutritional
unbalance have their hemoglobin percentage estimated by the
Dare instrument (two minutes).
2. All cases with a hemoglobin of less than seventy per cent receive
a red cell and often a white cell count (ten to twelve minutes).
3. All cases coming under thc latter category with a color index
of plus 1. or over and with a hemoglobin below fifty per cent, r eceive
in addition a differential count of Jeucoeytes and a careful measurement
of ten erythrocytes in a field enabling one to take these ten
cells as they come, one after the other in the same traverse, without
selecting cells that are interestingly large or small (a dangerous
pitfall for an honest average). 'I'hese measurements should be made
with the best filar eye-piece micrometer obtainable ; that is to say, one
which will distinguish one-tenth of a micron. In addition, this must
always be supplemented by a count of reticulocytes. Both procedures
can be accomplished on the same slide by Jetting a drop of a 0.3%
solution of cresyl blue in absolute alcohol, fall on the end of II glass
slide and when it dries, working the drop of blood, caught on the edge
of the end of another slide, back and forth until it incorporates the
stain before making the smea~. It is now stained by Wright's or
Leishman's method and is ready for cell measurement, reticulocyte
count, and (although the cresyl blue changes some differential characteristics
of the leucocyte) a differential count. This should not reo
quire over twenty minutes, and less, if the following technique is
followed:
Let into the eye-piece of th e microscope a glass disk enclosing
about 250 cells in a well spread smear. If the cells are unusually
large or small, one circle-full can be counted as a standard fOI" the
other three. The reticulocytes are now counted in four of such
circles considering each circle to contain 250 cells, or more or less
circles if a standard count demands it_ One is sure to make a ten
per cent, and possibly a twenty-five per cent error, but this will
not prevent the possibility of deducing that there has, or there has