Book Review

Color Atlas of Hematological Cytology

Blood: Atlas and Sourcebook of Hematology

N Engl J Med 1993; 328:1504-1505May 20, 1993

Article

Color Atlas of Hematological Cytology
Third edition. By F.G.J. Hayhoe and R.J. Flemans. 384 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $125. ISBN: 0-8151-4218-8

Blood: Atlas and Sourcebook of Hematology
Second edition. By Carola T. Kapff and James H. Jandl. 158 pp., illustrated. Boston, Little, Brown, 1991. $95. ISBN: 0-316-48274-9

New editions of two hematology atlases have appeared within the past two years: one from Cambridge, England, by F.G.J. Hayhoe and R.J. Flemans and one from Boston, by Carola T. Kapff and James H. Jandl. Both are the works of renowned hematologists and teachers. Both succeed superbly. Neither errs on the side of providing overwhelming minutiae, a problem from which many such works suffer, or on the side of undue skimpiness. In both works the text and photographs are balanced well; their close apposition makes reading and viewing easy.

Of the two, the atlas by Hayhoe and Flemans is the more voluminous. The introduction to each chapter is concise and clearly written. The descriptions of the color plates are meticulous, detailed, and easy to follow. The photomicrographs are superb. Linking the cytologic and the histologic pictures, so important in diagnosis, is a great help. This applies especially to the presentation of lymph-node and spleen imprints in conjunction with the histologic features of lymphomas. Unfortunately, some of the photomicrographs, principally those of bone marrows, are too red and at times indistinct, which detracts from their value. The work is full of cytochemistry and histochemistry, perhaps because its senior author is one of the founding and leading experts in the field. This may satisfy the appetites of the cognoscenti and devotees of the field, but it will be less appealing to general readers. It makes the work lengthy and heavy. An appendix on staining techniques is included. Histochemistry, once a promising field, is now on the wane, being supplanted by other techniques of discrimination between cells.

The work by Kapff and Jandl is lighter. The introductions to various segments are succinct and informative; like those in the Cambridge textbook, they constitute good reviews of subjects in themselves. The prose is delightfully light, bouncy, even amusing (with references to morphologic bestiality, hirsute tumor cells, and bedraggled tuft), and very informative. The left-hand page is descriptive, the right illustrative. The descriptions are clear, well directed, and leave little doubt about what is being described. The presentation and discussion of leukemic and other tumor cells in the cerebrospinal fluid will be helpful to many. Histochemical analysis is used judiciously.

Among the many outstanding features of both works is the clear presentation of diverse aberrations found in the foggy and anarchic fields of myelodysplasia: the pince-nez nuclei of polymorphonuclear leukocytes, the triple pawn balls of megakaryocytic nuclei, and the fragmented and twisted nuclei of erythroid precursors, to mention only the most striking. The adjunctive diagnostic tools (in addition to histochemistry), such as analysis of cell antigen markers and cytogenetics, though not strictly part of the field, are incorporated into the textbook and briefly described.

There are a few omissions in both works. One regrets the absence of phase-microscopical pictures of hairy-cell leukemia -- so characteristic, yet so fast and simple to perform. One also misses the images of perinatal and neonatal blood morphology. Many changes occur and vanish quickly during this short period, and frequently they confuse the unwary.

It is a pleasure to go through these atlases, so full of informed color. Is this their last hurrah? Are further editions threatened by a gray tide of printouts with numbers, symbols, and codes that tell us what the cells are without their ever being viewed by a human eye?

Both atlases are strongly recommended to all students of hematology, from first-year medical students to retired experts.

W.J. Mitus, M.D.
Carney Hospital, Boston, MA 02124