Book Review

Blood: Principles and practice of hematology

N Engl J Med 1996; 334:1343-1344May 16, 1996

Article

Blood: Principles and practice of hematology
Edited by Robert I. Handin, Samuel E. Lux, and Thomas P. Stossel. 2304 pp., illustrated. Philadelphia, Lippincott–Raven, 1995. $169.95. ISBN: 0-397-50944-8

This is a weighty book — approximately 11 1/4 lb on my bathroom scale. It is cast in the classic form of a large-scale medical reference work, and its size and organization discourage browsing. Consequently, this book is not the best place to seek guidance on the workup of anemia. On the other hand, it is a splendid place to look up the currently known functions of the bcl-2 gene.

It is hard to find serious fault with this book as a reference work, although it does have a surprising limitation if you want to use it to solve a diagnostic problem. Laboratory tests are exceedingly important in hematology. To say that they constitute the lifeblood of modern hematology would not be overstating the case. Herein lies the principal weakness of this book. Unlike several of its competitors, it does not have a well-organized section on how laboratory tests are performed, the principles behind the tests, their interpretation, their limitations, and normal values. Instead, laboratory data are scattered throughout the book, and discussions of principles and interpretation are spotty — sometimes good, sometimes poor, and sometimes nonexistent. For example, to find out how to do a Schilling test, it would be best to use another book, since consulting the index in this one leads to a dead end. Moreover, unnecessary duplications are frequent because of this erratic organization of laboratory data. For example, references to leukocyte CD antigens are found in tables in chapter 2, in the appendix, and in chapter 18, and leukemic cell markers are in a table in chapter 2, a figure in a chapter on leukemias, and so forth. Nowhere are all the data pulled together for easy access.

Multiauthored textbooks often suffer from unevenness of presentation, and this book is no exception. On the positive side, all the sections that the editors view as their personal domains are splendid, whether the subjects addressed are common or arcane. In my view, there is no better place to look up the membrane-protein defect in hereditary pyropoikilocytosis or a list of abnormalities in phagocyte motility. Other sections, however, are not always up to this high standard. I decided to look up some common topics in hematology. I looked up pernicious anemia and found the aforementioned results on the Schilling test. I looked up the clinical staging of Hodgkin's disease and found a table in which the recommended staging procedures include pedal lymphangiography and laparotomy for a selection of clinical stages. This surprised me and prompted a call to a couple of local lymphoma experts, who noted that although a staging laparotomy can provide important information in some patients, it is now more uncommon than not. Moreover, lymphangiography has not been routine for several years, and some consider it to be of questionable value in staging. The book provides a discussion of this minimally controversial area that is complex and inconclusive.

Discouraged by this result, I consulted the book for a discussion of another topic, this one moderately arcane and sophisticated: the treatment of thrombotic thrombocytopenic purpura. The discussion is good, brief, and crisp. My conclusion: the coverage is strong in basic science but uneven in clinical matters. It should also be noted that the illustrations are excellent, and the tables are clear and simple.

As befits a reference work of this magnitude, the index is very detailed and in general very good, although it does have some quirky aspects. The index will not provide much help with a workup of leukopenia, and following the entry for “reactive leukocytosis” puts you on the wrong freeway. Do not try to find “acute lymphoblastic leukemia” (the most common form of childhood leukemia) under the heading “leukemia.” You will not find it listed there, although several rare forms, including acute megakaryoblastic leukemia, are listed. I suggest you look up “acute lymphoblastic leukemia” under “acute.”

This book is looking for a place on a crowded bookshelf. There are four relatively recent major works in the category of hematology textbooks and reference works, published by McGraw-Hill, Lea and Febiger, Mosby, and Churchill–Livingstone. All aspire to be definitive and cover much the same subject matter as that covered in this book. In addition, there are several large works on subspecialty areas, such as coagulation and bone marrow transplantation. Small, comprehensive hematology textbooks for students are also numerous. I counted eight on two shelves of the student bookstore at my university, and I am aware of others that did not find shelf space.

This book seems expensive. It costs $181 in our store, or about $16.10 per pound. This is considerably more than the cost of filet mignon or even lobster at my local market. However, when I looked at the competition, I found that the price of this book is right in the middle of the price range for three of the four other primary textbooks ($169 to $197). The fourth, which costs a mere $144 plus tax, weighs only 6 lb and may have to be considered in a separate welterweight division of hematology textbooks.

This book is impressively comprehensive and enhanced by lovely illustrations but is diminished by the unevenness of its content and presentation and the scattered information on laboratory diagnosis. If you are looking for a new reference work in hematology, this is a good choice, but if you already have one published after 1990, stick with it.

Martin J. Cline, M.D.
UCLA School of Medicine, Los Angeles, CA 90024-1678