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Haematology: A pathophysiological approach
Leukemia Research Vol. 9, No. 9. p. 1213. 1985. Pergamon Press Lid Printed in Great Britain.
BOOK REVIEW Haematology: A Pathophysiological
Approach, by BERNARD M . BAaJOR a n d THOMAS P. STOSSEL
( C h u r c h i l l L i v i n g s t o n e , A p r i l 1984). The close connection between altered physiology and disease is one of tile attractions o f tile discipline of hematology. Iii m a n y instances, study of hematological disease has defined normal mechanisms; examples include pernicious anemia and the insight it gave into selective gastro-intestinal absorption, sickle cell anemia as the first molecular disease, the nornlal roles o f proto-oncogenes which have emerged from studies o f leukemia, the details o f the hemoslatic pathway which have been revealed by the study of individuals u n f o r t u n a t e enough to lack unique factors, and so on. The title of this book thus promises a great deal, and in most respects this promise is fulfilled. C o m p a r e d with the rest of the book, however, tile chapters on leukemia, l y m p h o m a and other malignant hematological disorders are disappointing. The book is apparently intended for undergraduate students and the authors have felt obliged to inchlde sections on treatment with each of the diseases discussed. While the chapter on 'Principles of Treatment o f Hematologic Malignancies' is quite reasonable, the sections on treatment elsewhere are not relevant to pathophysiology. There are some glaring omissions. Hyperuricemia is mentioned briefly in the chapter on treatment, but not as a primary manifestation o f acute leukemia or even of chronic granulocytic leukemia. Likewise, electrolyte imbalance and renal tubular defects following hyperlysozymuria in leukemia are not mentioned. Immunodeficiency and anergy in Hodgkin's disease are ignored, there is no description o f the mechanism of bone destruction in myeloma, and while c h r o m o s o m e s are mentioned in the context o f chronic granulocytic leukemia, the hypereosinophilic syndrome and the H L A genes, no description can be found of the normal h u m a n karyotype. There are some rather unusual statements including for example 'the leukemic disorders uniquely characterize their presence in the blood by the presence o f mature polymorphonuclear leukocytes and very i m m a t u r e cells with an absence o f maturational stages in between'. While this is presumably an attempt to describe the hiatus leukemicus, the student could be excused for gaining the impression from it that mature polymorphs are one o f the hallmarks o f acute leukemia. In the chapter On myeloma, the authors state 'The renal failure in and o f itself can cause metabolic and serum electrolyte abnormalities, such as hypercalcemia and hyperuricemia'. In the chapter on n o n - H o d g k i n ' s l y m p h o m a , the impression is given that immunoblastic sarcoma occurs in immunosuppressed patients ('This disease in this setting is also called immunoblastic sarcoma'). Pancytopenia and aplastic anemia are confused with each other a n d the possibility that s o m e cases o f aplastic anemia might be immunologically mediated is not adequately considered. Metastatic cancer and leukemia are lumped together with aplastic anemia. The English style in places gives way to hyperbole. Organs are 'ravaged', cells 'prefer to reside', a clinical syndrome is 'dismal' a n d the consequences o f pancytopenia are 'depressingly' straightforward. The terminology is inconsistent, switching back and forth for example between acute lymphatic and acute lymphocytic leukemia. This might seem carping criticism, but it is the sort o f thing which can cause students immense confusion. The black and white figures, except for the drawings intend to show cell morphology, succeed in illustrating quite well the points the authors wish to make. Figure 17-5 was missing, at least in the review copy. ' H e m a t o l o g y i a pathophysiologic approach' should provide students with a reasonable grounding in the subject and a useful insight into the mechanisms underlying disorders o f the blood. Compared with the chapters describing nonmalignant diseases however, those dealing with leukemia, l y m p h o m a and myeloma are disappointing. P. C. VINCENT The Kanematsu Laboratories Royal Prince Alfred Hospital Camperdown Australia
1213
BOOK REVIEW Haematology: A Pathophysiological
Approach, by BERNARD M . BAaJOR a n d THOMAS P. STOSSEL
( C h u r c h i l l L i v i n g s t o n e , A p r i l 1984). The close connection between altered physiology and disease is one of tile attractions o f tile discipline of hematology. Iii m a n y instances, study of hematological disease has defined normal mechanisms; examples include pernicious anemia and the insight it gave into selective gastro-intestinal absorption, sickle cell anemia as the first molecular disease, the nornlal roles o f proto-oncogenes which have emerged from studies o f leukemia, the details o f the hemoslatic pathway which have been revealed by the study of individuals u n f o r t u n a t e enough to lack unique factors, and so on. The title of this book thus promises a great deal, and in most respects this promise is fulfilled. C o m p a r e d with the rest of the book, however, tile chapters on leukemia, l y m p h o m a and other malignant hematological disorders are disappointing. The book is apparently intended for undergraduate students and the authors have felt obliged to inchlde sections on treatment with each of the diseases discussed. While the chapter on 'Principles of Treatment o f Hematologic Malignancies' is quite reasonable, the sections on treatment elsewhere are not relevant to pathophysiology. There are some glaring omissions. Hyperuricemia is mentioned briefly in the chapter on treatment, but not as a primary manifestation o f acute leukemia or even of chronic granulocytic leukemia. Likewise, electrolyte imbalance and renal tubular defects following hyperlysozymuria in leukemia are not mentioned. Immunodeficiency and anergy in Hodgkin's disease are ignored, there is no description o f the mechanism of bone destruction in myeloma, and while c h r o m o s o m e s are mentioned in the context o f chronic granulocytic leukemia, the hypereosinophilic syndrome and the H L A genes, no description can be found of the normal h u m a n karyotype. There are some rather unusual statements including for example 'the leukemic disorders uniquely characterize their presence in the blood by the presence o f mature polymorphonuclear leukocytes and very i m m a t u r e cells with an absence o f maturational stages in between'. While this is presumably an attempt to describe the hiatus leukemicus, the student could be excused for gaining the impression from it that mature polymorphs are one o f the hallmarks o f acute leukemia. In the chapter On myeloma, the authors state 'The renal failure in and o f itself can cause metabolic and serum electrolyte abnormalities, such as hypercalcemia and hyperuricemia'. In the chapter on n o n - H o d g k i n ' s l y m p h o m a , the impression is given that immunoblastic sarcoma occurs in immunosuppressed patients ('This disease in this setting is also called immunoblastic sarcoma'). Pancytopenia and aplastic anemia are confused with each other a n d the possibility that s o m e cases o f aplastic anemia might be immunologically mediated is not adequately considered. Metastatic cancer and leukemia are lumped together with aplastic anemia. The English style in places gives way to hyperbole. Organs are 'ravaged', cells 'prefer to reside', a clinical syndrome is 'dismal' a n d the consequences o f pancytopenia are 'depressingly' straightforward. The terminology is inconsistent, switching back and forth for example between acute lymphatic and acute lymphocytic leukemia. This might seem carping criticism, but it is the sort o f thing which can cause students immense confusion. The black and white figures, except for the drawings intend to show cell morphology, succeed in illustrating quite well the points the authors wish to make. Figure 17-5 was missing, at least in the review copy. ' H e m a t o l o g y i a pathophysiologic approach' should provide students with a reasonable grounding in the subject and a useful insight into the mechanisms underlying disorders o f the blood. Compared with the chapters describing nonmalignant diseases however, those dealing with leukemia, l y m p h o m a and myeloma are disappointing. P. C. VINCENT The Kanematsu Laboratories Royal Prince Alfred Hospital Camperdown Australia
1213