Book Review

Blood: Textbook of hematology

N Engl J Med 1996; 335:1694-1695November 28, 1996

Article

Blood: Textbook of hematology
Second edition. Edited by James H. Jandl. 1510 pp., illustrated. Boston, Little, Brown, 1996. $175.95. ISBN: 0-316-45731-0

It would take a mixture of hubris and chutzpah for one person to attempt to master enough of the vast literature of hematology to write a comprehensive textbook on the topic. Not only has one person, James Jandl, done so in his Blood, but he has also achieved his goal with élan, wit, and grace. Outwardly, this book has the ominous features of a Handbuch: massive length and burdensome weight, a combination that threatens the reader with overload, obfuscation, and awkward handling. But there the resemblance ends. All of us have endured the gigantic textbook, freighted with leaden prose: the medi-write of late-20th-century academia. These books bore and confuse us with the passive voice, stacked nouns, jargon, and contradictory information. They consist of contributions from dozens of authors — sometimes more than 100 — whose variable literary skills and inattentive scholarship fail to receive adequate attention from their editors and publishers. All too often they offer readers ambiguity rather than clarity, quantity instead of quality.

Jandl's Blood therefore comes upon us like a bracing Nordic gust, blowing away all competitors. Its crystal-clear explanations of all aspects of hematology in words that hold, even grab, the reader's attention have no parallel in any other major textbook of hematology in the English language. The writing is colorful (“Blood cells, like leaves of grass, do not last”), sometimes overripe (“Most senile or otherwise doomed red cells are engulfed whole or piecemeal by littoral macrophages that are hungrily aligned along the hepatic and splenic sinus walls”) or overwrought (“The unfairness of childhood ALL and the implication in infants that their chromosomes are guilty of original sin arouse melancholy thoughts”), and occasionally inexact (“The Winner and Current Champion: Hydroxyurea,” a heading in the section on the treatment of sickle cell anemia). Nevertheless, this uniformly interesting book is as intelligible and comprehensive as anyone seeking a bible of hematology would want.

The book emphasizes mechanisms. Jandl extensively reviews the molecular and cellular events of normal hematopoiesis, with up-to-date expositions on growth factors and cytokines (up to interleukin-13), the fundamentals of molecular genetics, and all aspects of immunology relevant to hematology. All forms of hemolytic anemia are discussed here, with an outstanding section on the immunohemolytic anemias. Jandl, who with A.F. LoBuglio discovered the Fc receptor, is at his best in dealing with this topic. The section on immunodeficiency diseases includes recent information on btk (the mutated gene for Bruton's tyrosine kinase in X-linked agammaglobulinemia) and the mutations in the gene for the γ-chain of the interleukin-2 receptor that cause the X-linked form of severe combined immunodeficiency disease. AIDS (Jandl calls it “the gray plague”) receives thorough attention in 26 pages. The analysis of oncogenes, leukemia viruses, and chemical- and radiation-induced leukemogenesis is clear, informative, and timely. There is an extensive exegesis — more than 400 pages long — of all the leukemias, myelodysplastic syndromes, monoclonal gammopathies, and lymphomas. And in 250 pages one has all the information one needs to understand, diagnose, and treat disorders of hemostasis. Amusing headlines signal new turns in the discussion: “The Specter of Spectrin Loss,” “Thymic Selection Rounds up the Usual Suspects,” “Perforins and Granzymes: The Double Whammy,” “Imprints Can Be Reprints” (in the section on genomic imprinting), and “The Dantesque World of Intravenous Drug Use.” The bibliography alone, containing about 20,000 citations, is worth the price of the book.

There are minor faults, all forgivable in a book of this size. The section on antiphospholipid antibodies is neither up to date nor well organized. As would be expected in a textbook, the sections on bone marrow transplantation, the cytogenetics of leukemia, and other rapidly moving fields lag behind recent advances. There are no color pictures, some of the photomicrographs are fuzzy, and there is the occasional clumsy cartoon. But despite its few warts, this book is the textbook of hematology, strongly recommended to everyone who favors literacy and scholarship.

Robert S. Schwartz, M.D.