Atlas of Clinical Hematology By Herbert Begemann and Johann Rastetter (review)

BOOK REVIEWS Atlas ofClinicalHematobgy. By Herbert Begemann andJohann Rastetter. New York: Springer-Verlag, Inc., 1979. Pp. 275. $168.00. This atlas is devoted primarily to classical hematology. Thus it is composed of drawings and photographs of cell morphology as seen through the light microscope . The book is divided into five major sections. It opens with a briefsection on methodology, including techniques of bone-marrow puncture and stain preparation . This is followed by chapters devoted to peripheral blood films and bone-marrow preparations. A complete section on the morphology of aspirates from lymph nodes, spleen, and tumors is included. The atlas concludes with a brief miscellaneous section on herpes virusand the LE cell and a larger section illustrating involvement of the blood by parasites. Perhaps the best and most well-known feature of this adas is the elegant drawings originally by Hans Dettelbacher. They do indeed demonstrate much more than can be seen with the microscope. Large and careful drawings of all normal cells provide a continuous illustration of the maturation process. Pathologic states are represented with the emphasis placed on the classic features of macrocytic and microcytic states, the leukemias, and the lymphomas. The section on lymph nodes and spleen begins with the quote, "Today, lymph node puncture has become one of the easy, practicable methods of examination anywhere at anytime, which no hematologist would wish to miss." Nowhere have I seen this technique used with any regularity in the United States. However, this section proves to be useful because the aspirate preparations arc similar to those prepared by the touch method used with lymph-node biopsy. The section on tumors was most interesting to me. This section demonstrates the morphology of cancer cells as seen in bone marrow and lymph nodes as well as in direct aspiration of tumor nodules. Drawings and photomicrographs of a variety of tumors were well represented. The techniques of tumor aspiration and the recognition of tumor involvement in bone-marrow and lymph-node preparations have become more important in recent years. The main emphasis throughout the atlas is on morphology. In the introduction it is noted that "hematologic diagnosis is still based on morphology." Even if true today this concept is rapidly changing. Many laboratories already have introduced automated equipment to produce cell counts, but equally important is the ability of these devices to derive the red cell indices which reflect the cell size and shape. The automated leukocyte differential is also becoming commonplace . While some instruments still emulate the morphologist scanning the Permission to reprint a book review printed in this section may be obtained only from the author. Perspectives in Biology and Medicine ¦ Winter 1981 | 335 cells for size, shape, and color, others rely exclusively on elaborate methods to determine size and histochemical properties of the cell. These methods have little to do with classical morphological analysis. Hematologic morphology has advanced beyond the light microscope. While there is a brief section on transmission electron microscopy, there is only a mention of scanning electron microscopy. More important, this section serves mainly to emphasize what can be seen with the light microscope and not to help us understand how the function of the particular cell is related to its ultrastructure . It should also be noted that the hematologist does not simply look at a still photograph but by constantly moving the slide integrates his perception of thousands of cells into a diagnostic pattern. An atlas, on the other hand, tends to focus our attention to a particular cell. There are several apparent omissions from the atlas. I would have liked to see something written on artifacts that are frequently present and may mislead the observer. There was no mention of rouleaux formation, even in the section relating to plasma cell disease. Likewise, basophilic stippling is omitted in the discussion of thalassemia. A minor problem is that the text is translated from German, and many terms are unfamiliar and therefore difficult to find in the index. For example, basophilic stippling is called punctate basophilia. The terms used to describe lymphomas are also unfamiliar. Fortunately there is a handy table to compare the authors' classification (possibly oversimplified) with those of Rappaport and Lukes. Most unfortunately, this...