CHLOROSIS 303 



slight loss of hemoglobin and an increased coagulability, but practi- 

 cally no other changes/'' In aplastic anemias the prothrombin and 

 platelet content are likely to be low, with normal fibrinogen/^ 



Anemia due to hemolytic agencies presents quite different fea- 

 tures, in that red corpuscles are almost solely attacked and the prod- 

 ucts of their disintegration are present in the plasma. As a result, 

 the plasma or serum may contain free hemoglobin, and if the hemo- 

 globin is in large amounts, it may escape into the urine. Thus par- 

 oxysmal hemoglobinuria is probably due to the presence in the blood of 

 hemolytic substances, which can be demonstrated in the blood of the 

 patients during the attack. (See Chapter ix.) The products of the 

 decomposition of the hemoglobin set free by hemolysis are present not 

 only in the blood, but also in the organs, particularly the liver and 

 spleen, which become rich in iron. In acute anemia produced by 

 hemolytic sera, with destruction of more than half the blood in three 

 days, nearly all the iron from the destroj^ed hemoglobin can be found 

 in the liver, spleen and kidneys, there being but little lost through the 

 urine even in so severe an anemia as this (IMuir and Dunn).^^ Excre- 

 tion of bile-pigments increases, and ^^hematogenous jaundice" may 

 result, the bile-pigments that are present in the blood being derived 

 from the hematoidin of the hemoglobin molecule. Changes in metab- 

 olism occur which are quite similar to those observed in other forms 

 of anemia, with fatty changes in all the parenchymatous organs, in- 

 creased protein katabolism, and an excessive quantity of pigmentary 

 substances, particularly urobilin, in the urine. The plasma chlorides 

 are increased. ^^ i 



[Chlorosis 



The characteristic feature of the blood in chlorosis is the rela- 

 tively small amount of hemoglobin in proportion to the number of 

 corpuscles. Apparently, therefore, the fault lies rather in the manu- 

 facture of hemoglobin than in either a destruction or a deficient forma- 

 tion of red corpuscles. Erben's^^ analyses of chlorotic blood showed 

 that the total amount of protein is decreased, chiefly because of the 

 deficiency of hemoglobin; the relation of serum globulins and serum 

 •albumin is unchanged, while the proportion of fibrinogen is increased. 

 There is much more fatty substance than normal in both the serum 

 and the erythrocytes, but the lecitliin is decreased both in the serum 



" Ash, Arch. Int. Med., 1914 (14), 8. 



" Drinker and Hurwitz, Arch. Int. Med., 1915 (15J, 733; Jour. Exp. Med., 

 1915 (21), 401. 



" Jour. Path, and Bact., 1915 (19), 417. See also Dubin and Pearce, Jour. Exp. 

 Med., 1918 (27), 479. 



" Steinfield, Arch. Int. Med.. 1919 (23), 511. 



" Zeit. klin. Med., 1902 (47), 302. See also Frohmaier, Folia Hematol., 1915 

 (20), 115; Beumer and Burger, Zeit. exp. Path., 1913 (13\ 351. 



