DISEASES OF THE BLOOD 30'.) 



Leukemia 



In Icukoinia the chciiiical changes in the red corpuscles take a less 

 prominent position, resenil)ling cither those of a secondary anemia 

 or chlorosis, while the enormous numl)er of leucocytes is the prominent 

 feature and causes marked alterations in the composition of the l)lood. 

 Large quantities of nucleoprotcins and also of the intracellular enzymes 

 are introduced into the blood by the excessive leucocytes. As the 

 leucocytes are constantly breaking down, more or less of the products 

 of their decomposition are present in the blood and appear in the urine. 

 Because of the relatively slight metabolic activity of the lymphocytes 

 tiio various chemical alterations are all less marked in Ijmiphatic than 

 in myelogenous leukemia.^" There is a notable reduction in antibody 

 production in leukemia, ^^ presumably because of the changes in 

 the bone marrow; it is said that typhoid infection in leukemics may fail 

 to result in agglutinin formation. 



Chemistry of the Blood.— Co n.sidering the quantitative alterations in the con- 

 stituents of the blood, we find the specific gravity lowered, but not so much as 

 itjwould be in a simple anemia with equally low hemoglobin, for the loss of hemo- 

 globin is partly compensated bj" the increase in leucocytes and their products. 

 Fibrinogen is usually increased in myelogenous leukemia.'- The serum shows 

 but slight change in specific gravity, a slight decrease in proteins'^ being com- 

 pensated by an increase in the NaCl. The freezing-point of the blood is lowered 

 (Cohn^*), which is probably due to the increase in crystalloidal products of cel- 

 lular decomposition. Erben" found that in lymphatic leukemia the serum 

 contains less cholesterol than normal, although the fat content may be rather 

 high. Calcium is frequently found increased, probably because of destruction 

 of the bone tissue. In the red corpuscles the proportion of iron, protein and 

 potassium is decreased as is also that of the cholesterol, that of the lecithin and 

 water being somewhat increased. The total amount of potassium and iron in the 

 blood is decreased, but the P2O5 in the ash is increased because of the large amount 

 of nucleoprotein in the blood. A number of the earlier writers describe a decreased 

 alkalescence which probably is due to the deficiency in the fLxed alkali of the pro- 

 teins. There is an increased excretion of iron in the urine and feces.'"' 



The poor coagulation 0/ leukemic blood has long been known, but the reason 

 for it has not yet been ascertained. Some investigators have reported a deficiency 

 in fibrin, while others have found it increased. More recent reports, however, 

 indicate that there is no marked change in either the amount of fibrinogen or of the 

 fibrin-ferments. Erben'- found a normal amount of fibrin in the blood in lym- 

 phatic leukemia; and in three cases of myelogenous and one of lymphatic leukemia, 

 Pfeiffer'" found the amount of fibrinogen nearly normal. This is quite remarkable 

 in view of the fact that in ordinary forms of leucocytosis both the amount of fibrin- 

 ogen and the rapidity of clotting are increased. It is, therefore, extremely difficult 



1° Stern and Eppenstein have observed that the striking proteolytic power of 

 the leucocytes from the blood in myelogenous leukemia is not shown by the 

 leucocytes in lymphatic leukemia (Sitz. d. Schles. Ges. f. vaterland. Kultur, 

 June 29, 1906). 



" Rotky, Zent. inn. Med., 1914 (35), 953. 



12 Erben, Zeit. klin. Med., 1908 (66), 278; full details on composition of the 

 blood in leukemia. 



" Little change was found in the protein content of the serum by Heudorfer.. 

 Zeit. klin. Med., 1913 (79), 103. 



"Mitteil. aus dem Grenzgeb. Med. u. Chir., 1906 (15), H. 1. 



1* Zeit. klin. Med., 1900 (40), 282. 



'«Kennerknecht, \ irchow's Arch., 1911 (205), 89. 



" Cent. f. inn. Med., 1904 (25), 809. 



