Book Reviews

Abstract

Blood Cells, A Practical Guide, 3rd edn. Barbara J. Bain. Blackwell Science, 2001. 408 pp. £59·50. Once upon a time, long, long ago, bright and eager first-year medical students armed themselves with microscopes to begin their arduous journey. Over the next few painful years, they acquired other tools of the trade but, sadly, the once-revered microscope was relegated to a quiescent role of dust collection, superseded by stethoscopes and RT-PCR Tacman. As an old-timer haematologist who learned much haematology behind and through the eyepiece of my microscope, reviewing Dr Bain's Blood Cells, A Practical Guide was a refreshing return to a bygone era of microscopy which, as Dr Bain states in her preface, ‘not only provides the essential basis for our haematological practice, but can also lead to the excitement of discovery’. This book is aimed at the trainee in haematology and biomedical science as well as the clinical haematologist. It provides a comprehensive guide for the diagnostic clinical haematology laboratory and covers practical areas such as blood sample collection and preparation, performance of routine and more specialized laboratory tests and their clinical relevance and shortcomings. Much of this material is hard to find elsewhere. The piece de resistance/tour de force of this clearly written book is morphology, the forgotten art of haematology. The reader will find many pearls of wisdom scattered throughout the text. These nuances and practical tips are not usually in standard textbooks but are passed on from master to student in the course of patient care by doing, not reading (an example is how to find a good vein in a patient who has been through too many venepunctures). The author provides a detailed comparison of the available automated haematology instruments and offers important information on their unique strengths and weaknesses. The chapter on morphology is beautifully illustrated with photomicrographs of unusual clarity and consistency regarding magnification and staining characteristics. The completeness of the photomicrographs alone would provide enough material for a useful atlas of blood cells. Additional chapters present normal values in infants, children and adults, erroneous blood counts, quantitative changes in blood cells and important supplemental texts. The final two chapters review disorders of red blood cells, platelets and leucocytes, again comprehensively illustrated. Many tables throughout the text provide exhaustive lists of entities associated with specific morphological (e.g. spherocytosis) or clinical (e.g. splenomegaly) abnormalities. The student/trainee preparing for a board examination will find the quizzes after each chapter particularly useful. The multiple choice and extended matching questions are not easy and simulate the board examination in its most difficult, nastiest and meanest format. The coverage of tropical medicine is a bit more than the London or New York haematologist may need for his/her day-to-day clinical activities (25 illustrations of Plasmodium malaria in all its stages), but coverage of immunophenotyping, specific cytogenetic and molecular genetic abnormalities in leukaemias and lymphomas is a bit light. The reader is referred to a text published in 1999 for a more complete review of immunophenotyping, but rapid advances in the field would render a 1999 text somewhat obsolete. This edition contains many newer references. For example, in Chapter 8, 95/200 references (48%) were published since the first edition (1995). The many tables are well designed and complement the clearly written text. Some additional tables to consider for future editions might be (1) cytokine-associated morphological abnormalities; (2) histochemical differentiation of various leukaemias; and (3) cytogenetic and molecular genetic findings in different lymphomas and leukaemias. One would hope to see important new data on molecular genetic profiling and gene arrays in leukaemias, lymphomas and myeloproliferative/myelodysplastic disorders, an area that will drive therapeutic strategies in these entities in the near future. Dr Bain's measure of success for her book was to send ‘the reader back to the microscope with renewed interest and enthusiasm’. With this third edition of a gem of a text, she has succeeded brilliantly. This book will find a useful place on the bookshelf right above the haematologist's trusty microscope.