Hematology E-Book , livre ebook

Hematology
A Pathophysiologic Approach

S. David Hudnall, MD
Professor of Pathology and Laboratory Medicine, Yale University School of Medicine; Director of Hematopathology Yale-New Haven Hospital, New Haven, Connecticut
Mosby
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Front Matter

Hematology: A Pathophysiologic Approach
S. DAVID HUDNALL, MD
Professor of Pathology and Laboratory Medicine
Yale University School of Medicine
Director of Hematopathology Yale-New Haven Hospital
New Haven, Connecticut
Copyright

1600 John F. Kennedy Blvd.
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HEMATOLOGY: A PATHOPHYSIOLOGIC APPROACH
ISBN: 978-0-323-04311-3
Copyright © 2012 by Mosby, an imprint of Elsevier Inc.
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Notices
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International Standard Book Number: 978-0-323-04311-3
Acquisitions Editor: William Schmitt
Developmental Editor: Barbara Cicalese
Publishing Services Manager: Patricia Tannian
Project Manager: Sarah Wunderly
Design Direction: Steven Stave
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Dedication
To my parents, Stanley and Marjorie Hudnall
My wife, Amy
And my children, Katie and Molly
Preface
Hematology: A Pathophysiologic Approach is designed as an introductory hematology text for all students and trainees, including medical students, biomedical graduate students, pathology residents, and fellows in hematology/oncology and hematopathology. This book is based on my 26 years of experience practicing laboratory hematology and teaching hematology to medical students, residents, fellows, and graduate students at four medical schools in the United States. The idea of writing a textbook crystallized during my years as course director of an innovative 2-year, small group problem-based course in hematology at the University of Texas Medical Branch (UTMB) in Galveston. During that time I was disappointed by the choice of hematology textbooks suitable for medical students. Over the years we tried several texts and, while some were quite good, both faculty and students expressed dissatisfaction with one thing or another. The possibility of writing a textbook suddenly became a reality when I was approached by Mosby to write a hematologic physiology text for their Physiology Series—an opportunity that I undertook with gusto.
It is important to state what this text is not. It is not a comprehensive textbook of clinical hematology. Clinical hematology is a vast, complex field that, to be thoroughly and expertly covered, requires many authors, many pages, and tracts of up-to-date references. To meet this demand, several excellent, large, and generously referenced 1000+ page textbooks written by multiple expert contributors are available. However, these textbooks are not appropriate as introductory texts. They are far too detailed, often presuming prior knowledge of basic anatomy and physiology of the hematologic system.
The text you are about to read is radically different. It is written by a single author and contains no references. Although some expert advice was sought, I have for the most part been able to draw on my own experience as a course designer/director and teacher of hematology to present a single unified overview of the field. Because reference materials are readily available on the Internet, I decided not to clutter the text with references that are seldom used by students. Instead, the student interested in more depth of any topic can easily access the most recent literature online.
This is a book that first and foremost approaches hematology from a pathophysiologic perspective, with mechanistic explanations of normal and abnormal function. Hematopoiesis, blood physiology, immunology, neoplasia, transplantation, and hemostasis are presented as interrelated subjects. Because the practice of hematology is highly dependent upon a relatively large number of diagnostic lab tests, fairly detailed descriptions of blood counting, histopathology, immunohistochemistry, flow cytometry, cytogenetics, and coagulation testing are provided. Numerous color photomicrographs of both normal and abnormal histology are also provided in full color.
Over many years of teaching hematology and designing/directing a hematology course, I have formulated a good idea of what students need to know about this complex subject. But, with the primary goal of imparting an understanding of the subject by the student in mind, I have done my best to resist the temptation to assume that if I present the material, it will be understood. To this end, I have always encouraged students to question the material and contact me directly with their questions. Over the years, this has proven to be immensely valuable. Literally hundreds of insightful questions received from students have challenged me to provide more accurate, lucid explanations of difficult topics. In other cases, questions have led to my discovery that some facts we take for granted may be flawed, incomplete, or illogical. Based on this experience, I have tried to anticipate many of the issues that often lead to confusion and to provide a more explicit explanation than is usually offered. But as perfection is an elusive goal, I urge all readers of this text, whether expert or novice, to contact me with your questions, corrections, or concerns. With your help, the text can be continually improved.
I do hope you enjoy the book.

S. David Hudnall, MD
hematologyhelp@gmail.com
Acknowledgments
I would like to thank some special people who have played important roles in furthering my understanding of the science and practice of hematology and in bringing this book to life.
The list rightly begins with my late father-in-law Abner H. Levkoff, MD, who unselfishly shared his interest in physiology, read the first drafts of the text, and provided me with incisive critiques and sage advice.
I am very grateful to my early mentors in immunology and hematology, Drs. Abul Abbas and Faramarz Naeim, for providing me with a strong foundation to build upon.
Many thanks to my former colleagues at UTMB, Drs. Jack Alperin, David Bessman, Tarek Elghetany, and Frank Gardner, for their collective expertise regarding selected topics in hematology.
I would also like to thank my good friends and colleagues Drs. Rolf Konig, Malcolm Brodwick, and Peter Rady for their invaluable opinions about academic life, biomedical science, and the joys and challenges of teaching medical and graduate students.
And, of course, thanks go to the hundreds of second-year medical students at UTMB, who took the course in hematology during my tenure as a Course Director, for all your wonderful questions—questions that always begged for more lucid answers and sometimes highlighted the incompleteness of our knowledge.
And finally, I would like to thank William R. (Bill) Schmitt, Barbara C