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Biomedical subjects

P C Ward

Publications and source records attributed to P C Ward.

At least 37 records · Page 2Linked to original sources
PubMed1980

The lymphoid leukocytoses.

The experienced morphologist can be extremely helpful to the clinician by virtue of his or her ability to distinguish among the various subtypes of reactive lymphocytoses. An awareness on the part of the clinician as to the nuances of subclassification may lead to earlier diagnosis of a disease process. Broadly, proliferations of normal lymphocytes point to infectious lymphocytosis or Bordetella pertussis infection. Proliferations of atypical lymphocytes, especially when minimum diagnostic criteria are present or there are four or more Downey III forms per 100 WBCs, suggest infectious mononucleosis. Proliferations of immunoblasts reflect hypersensitivity reactions to drugs or autoimmune disease. Proliferations of proplasmacytes or plasma cells favor viral hepatitis, drug reactions (notably to sulfa drugs), or rubella. Quantitative data may help refine the morphologic implications. Cumulatively, qualitative and quantitative data should lead the clinician to a judicious selection of confirmatory serologic tests and hence to earlier diagnosis.

Adolescent↗
PubMed1980

Interpretation of synovial fluid data.

The routine battery of tests for synovial fluid analysis includes culture and Gram staining, polarizing microscopy, and total WBC and differential counts. If the volume of fluid collected is low, culture and polarizing microscopy have highest priority. Synovial fluid data are diagnostic in only two diseases: septic arthritis and crystal-induced arthritis. In traumatic arthritis, degenerative joint disease, rheumatoid arthritis, and systemic lupus erythematosus, synovial fluid data may provide evidence supporting the diagnosis.

Arthritis↗
PubMed1980

Cerebrospinal fluid data. 1. Interpretation in intracranial hemorrhage and meningitis.

In substantiating a diagnosis of intracranial hemorrhage, the most important laboratory findings are RBCs, free hemoglobin, or hemoglobin breakdown products in the CSF. When the Gram stain is negative and results of bacterial, viral, and fungal cultures are pending. CSF WBC and differential counts and glucose and lactic acid levels may provide clues to the cause of meningitis. In addition, counterimmuno-electrophoresis and other immunologic techniques that facilitate the diagnosis of meningitis are now becoming more widely available.

Adult↗
PubMed1980

Cerebrospinal fluid data. 2. Interpretation in intracranial malignancy and multiple sclerosis.

In malignancies involving the CNS, notably leukemia, malignant cells may be readily demonstrated in the CSF, directly confirming the diagnosis. Advances in cell isolation techniques have significantly increased the diagnostic yield of CSF cytology. A variety of CSF protein studies and both WBC and differential counts are central to the diagnosis of multiple sclerosis. Protein studies include total protein levels, gamma globulin levels, and electrophoretic techniques designed to demonstrate the fine structure of gamma globulin, ie, its separation into two to ten (or more) oligoclonal bands. Although by no means specific for multiple sclerosis, such bands are strongly supportive of the diagnosis in the correct clinical setting.

Adolescent↗
PubMed1979

Investigation of microcytic anemia.

This article on microcytic anemia is the first of several on laboratory investigation of anemia. Microcytic anemia, characterized by a mean corpuscular volume of less than 80 cu mu, is usually due to iron deficiency or chronic disease but may signify thalassemia minor. Exact identification of the cause is important, since inappropriate iron therapy may be useless or even dangerous.

Anemia↗
PubMed1979

Investigation of macrocytic anemia.

The three most common causes of macrocytosis--vitamin B12 or folate deficiency, liver disease, and reticulocytosis--usually can be differentiated on the basis of red cell indexes and morphologic findings. Bone marrow studies are not indicated. In reticulocytosis, the mean corpuscular volume (MCV) rarely exceeds ll0 cu mu and a reticulocyte count quickly establishes the diagnosis. In liver disease, macrocytosis is also mild and uniform. The RBCs are round. In megaloblastic anemia, the MCV may exceed 150 cu mu. The RBCs vary considerably in size and shape. The macrocytes tend to be oval. Serum vitamin B12 determination remains the best test for unmasking vitamin B12 deficiency. It should be ordered in conjunction with serum and red cell folate determinations in the course of investigating a macrocytic anemia. When vitamin B12 deficiency has been established, a Schilling test or plasma uptake test is indicated to pinpoint the cause.

Aged↗
PubMed1979

Investigation of nonpoikilocytic normochromic normocytic anemia.

When the mean corpuscular volume is normal in an anemic patient, examination of a blood smear becomes of paramount importance. When the RBCs are normochronic, normocytic, and nonpoikilocytic, the reticulocyte count determines the line of investigation. When the count is increased, either hemorrhage or hemolysis is present. When the count is not increased (ie, normal or low), the differential diagnosis includes anemias due to iron deficiency, chronic disease, renal disease, hemodilution, marrow infiltration, and marrow failure (aplastic anemia). Some morphologic clues to cause other than those pertaining to RBC morphology are discussed and illustrated. A working approach to the investigation of nonpoikilocytic normochromic normocytic anemia is suggested.

Anemia↗
PubMed1979

Investigation of poikilocytic normochromic normocytic anemia. 1. Round and elongated forms.

Occasional nonspecific poikilocytes are found in most normal blood smears, but dominance of one or more forms of poikilocytes usually is indicative of a specific anemia or disease in an organ or organ system. For example, stomatocytes are most commonly associated with acute alcoholism, while teardrop cells classically reflect "spent" polycythemia vera or myelofibrosis. The clinical significance of the various round poikilocytes (spherocytes, stomatocytes, target cells) and elongated poikilocytes (ovalocytes and elliptocytes, teardrop cells, sickle cells) is discussed.

Anemia↗
PubMed1979

Investigation of poikilocytic normochromic normocytic anemia. 2. Spiculated forms.

Spiculated poikilocytes occur in several different forms. Each form is associated with certain types of diseases or conditions. Identification of a dominant form in a blood smear provides a clue to diagnosis. Helmet cells, triangular cells, and schistocytes most commonly suggest disease in the microvasculature. "Bite" cells are usually a product of drug-induced hemolysis. Keratocytes are variants of helmet cells and therefore occur in the same clinical circumstances as helmet cells. Echinocytes are usually artifacts; true echinocytosis is rare and associated mainly with uremia. Acanthocytosis occurs most commonly after splenectomy but may be encountered in severe liver disease.

Anemia↗
PubMed1979

Erythrocytic ecdysis. An unusual morphologic finding in a case of sickle cell anemia with intercurrent cold-agglutinin syndrome.

Examination of peripheral blood smears from a patient with sickle cell disease during crisis associated with an upper respiratory tract infection, pneumonia, a positive Coombs test, and an elevated cold agglutinin titer revealed unique abnormalities associated with her erythrocytes, which have not been reported previously. In addition to the usual changes in peripheral blood occurring during crisis in sickle cell anemia, large numbers of free, filamentous forms that appeared to be derived from erythrocytes were present on repeated Wright's-stained smears. Erythrocytes were markedly distorted and had single and multiple surface protrusions that appeared to be antecedents of the free filamentous forms. Scanning electron microscopy confirmed the marked changes in the erythrocytes and revealed membrane alterations not apparent by use of the light microscope. It is suggested that the membrane stripping observed in this case was due to cold agglutinin--complement-mediated surface injury superimposed on the known abnormalities of the membranes of sickle erythrocytes.

Agglutinins↗
PubMed1979

Persistent falsely positive rapid tests for infectious mononucleosis. Report of five cases with four--six-year follow-up data.

In many laboratories, rapid slide tests incorporating differential absorption have replaced heterophil antibody tube tests in the investigation of suspect infectious mononucleosis. The present report describes serologic data from five individuals whose Monospot tests remained falsely positive for four years or more without other evidence of infectious mononucleosis or underlying disease states. Three of the five had never been infected with the Epstein-Barr virus. All five had negative results when studied with the ox cell hemolysin and the horse cell differential absorption tube tests. False-positive test results have also been encountered in healthy controls, as frequently as in patients with underlying disease states. The authors are unable to attach any clinical significance to the findings of an isolated falsely positive Monospot test even when it persists for many months or years.

Adolescent↗
PubMed1979

Chemical profiles of disease.

Chemical profiles have been used successfully in teaching the interpretation of laboratory test values. The profiles have a visual impact that assists in making associative and correlative observations about disease processes. Profiles are most useful in attempts to integrate multiple test abnormalities in a given disease process. Representative profiles are illustrated and discussed as examples of the effectiveness of this mode of analysis of clinical laboratory data in laboratory medicine.

Adult↗
PubMed1976

Clinical and laboratory evaluation of elderly patients with heterophil-antibody positive infectious mononucleosis. Report of seven patients, ages 40 to 78.

Clinical, hematologic, biochemical and serologic data are recorded in seven patients aged 40 to 78 years with heterophil-antibody positive infectious mononucleosis (HA+IM). Clinical observations included fever of 22 to 30 days' duration (five of seven patients), sore throat (six of seven patients), myalgia (five of seven patients) and prominent lymph adenopathy (two of seven patients). Initial blood smears revealed significant numbers of atypical lymphocytes in only five of seven patients; however, or serial testing, in the remaining two patients Downey cells developed to a degree seen in most young adult patients with infectious mononucleosis. Comparison of liver function data from these and younger patients suggests that abnormalities tend to be more marked in those in the older than in those in the younger age range. Serologic tests confirmed primary Epstein-Barr virus (EBV) infections in all seven patients based on detection of IgM antibodies to EB viral capsid antigen in specimens obtained early, but not late, in the course of the infection, transitory antibody responses to the D (diffuse) component of the EMB-induced early antigen complex, and the initial absence and later development of antibodies to the EBV-associated nuclear antigen. Thus, the serologic data did not differ from those seen in younger patients. These results show that infectious mononucleosis should be included in the differential diagnosis of fever, sore throat and myalgia with or without significant cervical adenopathy in elderly persons.

Adolescent↗
PubMed1976

Systematic instruction in interpretive aspects of laboratory medicine.

It is increasingly important for physicians to develop competence in ordering and interpreting laboratory tests. A review of the literature revealed no formal discussion of systematic instruction in the interpretive aspects of laboratory medicine. The goals, organization, instructional approaches, and assessment of a course offering such instruction are described here. Students are expected to develop an algorithmic approach to ordering and interpreting laboratory tests in the course of diagnosing and managing clinical problems in the major areas of medicine. Instructional approaches include lectures, case problem-solving sessions, and independent study. There has been an exponential growth in the number of students electing to take this course. Students respond enthusiastically to most aspects of the course. They are rated significantly higher on appropriate criterion measures in subsequent clinical electives than students who have not had such formal instruction in laboratory medicine during the senior years.

Clinical Laboratory Techniques↗
PubMed1976

Sudden disappearance of electrocardiographic pattern of anteroseptal myocardial infarction. Result of superimposed acute posterior myocardial infarction.

In a 76-year-old man an electrocardiographic pattern of acute anteroseptal myocardial infarction disappeared suudenly. At necropsy, a more recent posterior myocardial infarct was found, in addition to an acute anteroseptal infarct. "Normalization" of the electrocardiogram from the pattern of anteroseptal myocardial infarction in this case resulted from the loss of opposing electromotive forces in the posterior wall because of posterior infarction.

Aged↗