Chinese Medical Journal

Se eens!

RHEUMATIC HEART DISEASE WITH VASCULAR ENDOTHELIOSIS 59

Leukocyte count ----- % of macrophage . o—o— % of large macrophage

—---- % of immature macrophage

40% 160,000 140,000 W% 120,000 100,000 20% 80,000

-= 20090 Date WH 2% A 3% He Mp '2 We 242

Fig. 3. Changes in leukocyte count and differential count (blood taken from the ear lobe) during the course of observation.

From these data, it was evident that:

1. Although the total number of white blood cells varied a great deal, in general it tended to decrease until it reached the normal value.

2. The number of macrophages was directly proportional to the total white cell count. Both of them showed the tendency of gradual reduction in number. The high leukocyte count of the blood taken from the ear lobe was not merely due to the presence of macrophages, but also to the absolute increase in the number of granulocytes and lymphocytes. .

3. The greater the number of macrophages, the greater was the proportion of the immature type. :

4, As the macrophages were reduced in number, they became smaller and smaller in size, and showed less phagocytic power and finally resembled the ordinary monocytes.

Observations on morphological characteristics of macrophages. Most of the large macrophages were 7-8 times the size of the neutrophils and appeared to have irregular contour with bleb-like or filiform pseudopodia. When stained with Wright’s stain the cytoplasm was seen to be abundant, light blue in color, containing numerous red granules and ingested blood cells and debris. Often the cell appeared to be broken up with only one naked nucleus present. The nucleus was not uniform in shape and often appeared to be elongated, round or kidneyshaped, or twisted into several lobes. Occasionally there were 2-3 nuclei in one cell. The nuclear chromatin was spongy. The nucleus contained 1-3 nucleoli.

The small macrophage was only slightly larger than a neutrophil, its cytoplasm was scanty, stained sky-blue with Wright’s stain and studded with a small amount of reddish granules.

The white blood cell count of the venous blood was normal. No macrophage was found in the smear. In order to determine whether the presence of macrophages was due to local changes of the ear lobe, blood smears were taken from the finger tips, face and arm at the same time, and examination of these smears showed that all of them were positive for macrophages.

Sternal puncture was done on January 25, 1954. The bone marrow was quite active. There were hyperplasia and a ‘left shift’ of the granular series, with 7 per cent myeloblasts and only 4 per cent segmented neutrophils. No macrophage was found in the bone marrow smear.

Skin tissue biopsies taken from the ear lobe, face and arm on April 17, 1954 showed nothing abnormal.