Indiana University School of Medicine - Caduceus Yearbook (Indianapolis, IN)

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11 Ground Rounds in Hematology Talking ’Bout Bad Blood by Jim Lee, M.D. (Stanford University School of Medicine) with Elton John Basil Basophil stared absent-mindedly at his dinner. “What’s the matter, dear?” asked his mother, Emma Erythrocyte. “Aw, everything, Ma,” said Basil. “Why the heck did I have to be born a basophil anyway? I don’t fit in any- where. Why couldn't 1 have been a normal red cell like all the other kids?” “Basil, dear. I've told you time and again, not everyone can be a heme man. Now, please, clean your platelet. “But even if I do have to be a basophil, when will I ever reach myelopuberty? I haven’t got a specific granule in my body.” “Be patient, Basil, “said the understandingerythromomma. “The time will come when you will shrink down to be a normal sized basophil like your father, and then you'll even stop having kids. And get your hands away from your face! she scolded. “Big basophils who pyknosis never shrink down to be little basophils. Now, go out and play and let me finish my ironning. And don't forget your buffy coat!” she yelled in vein as he squeezed out of their modest but tastefully furnished sinusoid. “Blast! There's never anything to do around here. I'm really Bohred,” thought Basil as he cruised through the lung for the third time. “Burr, it’s cold in here. Maybe I'll go down to the Inferior Vena Cava and marginate for a while.” On his way down the descending aorta, Basil heard music coming from the spleen. “Oh, boy. sounds like a party. Maybe I can meet a girl there. I've heard there's usually a lot of nymphocytes at these parties,” he thought, hanging a quick left. When he squeezed into the party, lie couldn't believe his eyes. It seemed like the entire erythron was there. A lot of neutrophils were there, too. “I hate phag parties,” thought Basil. Basil circulated for a while, but was too shy to talk to any girls. “No girl would want to talk to me anyway,” he muttered under his breath. “I have a Dohle body.” “What did you say?” asked a feminine voice, and Basil turned to sec the most beautiful neutrophil he’d ever seen. “Hi, my name's Polly. What's yours?” “B-B-Basil” “You’re a cytc for sore eyes, Basil. I've been looking for a guy like you for the longest time. How old arc you, anyway?” “I'll Bj 2 tomorrow. “You’re pulling my seg!” exclaimed Polly. “You look much older. You’re quite pernicious for your age. You have magnificent granules.” Basil didn’t know quite what to make of this. “She must be talking to someone else,” he thought. He looked down in shame, but, lo and behold, his body was filled with exquisite deep blue granules. Basil thought fast. “Enough about my granules. Let's get specific. How about if we go to my place and coagulate for a while?” “Sounds great, little fella,” said Polly, and they flowed off together, lobe in lobe, to live happily ever after. Isn’t that hcmatopoetic? OCOJRED glRSTfiECORDED iji|H TRANSFUSION FROvi AN AN!ML (lAMB)TOA HUMAN (A 80V) WAS DONE BY JEAN BAPTISTE DENIS IN 1667.

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10 THE NEW ENNUI JURINAL OF SCUT May 15, 1977

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12 THE NEW ENNUI CASE RECORDS OF THE American College of Scut Weekly Clinicopathological Exercises TESTOSTERONE STORM A 33 year-old male was referred to the AC of S emer- gency room with a diagnosis of “priapism, acute onset.” He had been referred from an outlying hospital where initial treatments of massive doses of estrogens, cold showers, and ad lib readings of Goodhousekeeping maga- zine had been administered without clinical remission. On arriving at the AC of S, the patient was noted to be agitated, tachypncic, and moaning. A Swan-Glans catheter was rapidly inserted via a dorsal vein cutdown and Salt- petre (generic name: sodium nitrate) was continuously infused (reference — Anals of Medicine: 192, 17). The central penous pressure fell to 14.7 mmHg from a pre- Saltpctrc reading of 21.4. Following these resuscitative measures, the patient was able to report the following history. He had been entirely healthy and for 25 years had never deviated from a daily routine of waking, shaving his face and hands, and clean- ing the stables of his father’s mink farm. On the day of admission, while caring for a female mink sick with “the heat,” the patient glanced down at himself and noted “a little lump which I thought would go away. But, seconds later, it was still enlarging.” The patient was reprimanded for not coming earlier. He also reported a diet high in the preservatives mono- sodium glutamate and sodium benzoate. Concerning family history the patient noted, “My mother was a tailor; she sewed my blue jeans. My father was a gambling man, down in New Orleans.” Physical exam was negative except for a large, mobile, soft tissue mass in the inguinal area. Serum testosterone was 475 Pudansky units (normal 75-125). Flat plate ab- dominal films revealed a positive Throck-Morton sign. Computed axial tomography (CAT scan), at a cost of $250, revealed “soft tissue mass, large.” Sonogram of .inguinal region “soft tissue mass, large.” Biopsy of the mass was undertaken (it was decided a big tip should be left) and showed a “large tissue mass, hard.” Despite two hours of Saltpetre, the patients condition remained unchanged after two hours. A decision was made to stop the Saltpetre infusion and administer a wheat germ and natural cereal suppository in an effort to dilute the blood level of preservatives. Rales then aus- JURINAL OF SCUT May 15. 1977 cultated over the inguinal canal were optimistically inter- preted as early signs of hard failure. Within four minutes, CPP fell to 2 and the soft tissue mass regressed to a tiny little lump. The patient was ob- served for two days and released. Followup was post- poned till the patient returned from his tryout for the Vienna Boys’ Choir. Differential Diagnosis DR. VEINER: “Though, in a case of acute onset of priapism, hard failure is clearly a desirable outcome, I must take issue with several features of the manage- ment. First, with history of mink exposure and priapism, progressive mink encephalopathy must be entertained as a probable diagnosis. Saltpetre may achieve remission, but the patient remains a carrier! We have a duty to warn any minks that may have known him intimately, or even used the same toilet seat, to take prophylactic Saltpetre. “Second, the reference article advises Saltpetre infu- sion for no longer than one hour since longer infusions may produce permanent drops in serum testosterone levels. Third, preventive medicine is crucial in priapism where excessive pooling of blood in the periphery may cause irreversible brain damage. So, if you find a lump, see your doctor. Early treatment saves lives!” The prodromal signs of Testosterone storm are well illustrated in the above photograph (photo contributed by the Harry Reems Research Center for Erection Disorders.)