310 DISTURBANCES OF CIRCULATION 



to understand the poor coagulability of leukemic blood, but study of the factors of 

 coagulation by modern methods may clear this up, for in one case so[studied VSTiip- 

 ple'^ found an increase in antithrombin. 



Decomposition Products. — Of particular interest is the finding" in the blood 

 of decomposition products of the leucocytes, which are probably produced by 

 autolysis of the leucocytes. (See Leucocytic Enzymes, Chapter iii.) Normal 

 leucocytes are rich in autolytic enzymes, which under ordinary circumstances seem^ 

 to' be held in check by the antienzymes of the blood. In leukemia this antienzyme 

 action seems to be insufficient to prevent leucocytic autolysis, for even in freshly 

 drawn blood proteoses for at least non-coagulable proteins) may be present.'' 

 According to Erben, this is true only of myelogenous leukemia, the fresh blood in 

 lymphatic leukemia not only being free from non-coagulable protein, but further- 

 more this product of proteolysis does not soon develop when the blood is kept 

 aseptically at incubator temperature. This is, of course, what one wouldi expect 

 in^view of the well-known enzyme-richness of the polymorphonuclear leucocj'tes 

 neutrophile cells seem to be the chief source of proteoses, since their granules soon 

 and the scarcity of proteolytic enzymes in lymphocytes. Erben states that the 

 disappear in blood that is undergoing autolysis, whereas the eosinophiles preserve 

 their granules well, and true proteoses are not present in blood rich in mast cells 

 (i. e., myeloma). The marrow, spleen and lymph glands are found strongly pro- 

 teolytic (according to the plate method), in myelogenous leukemia, but in lym- 

 phatic leukemia and pseudoleukemia, only the marrow shows a slight acti^Hty.-<' 

 Schumm^i found in the blood in a case of myelogenous leukemia several varieties 

 of proteoses, most abundant being the so-called deutero-albumose; in another he 

 also found peptone, leucine, and tyrosine. In addition he demonstrated the auto- 

 lytic nature of the changes that occur in leukemic blood after death (see also 

 "Autolysis in Leukemia," Chap. iii). Most observers have failed to find alhumose 

 in the urine in leukemia. Because of the involvement of the bone marrow, small 

 amounts of Bence-Jones protein, as well as Morner's bodj"-, may be found in the 

 urine. -^ Kolisch and Burian^^ not only found nucleoprotein constantly, and albu- 

 mose frequently, but in one case of lymphatic leukemia they found histon in the 

 urine, which undoubtedly came from nucleoprotein decomposition. 



The oxidase reaction is conspicuous in certain of the cells of myeloid leukemia, 

 especially the large, non-granular cells of acute leukemia,-* but it is not known 

 that these oxidases influence the chemistry of the disease. In spite of the richness 

 of leucocytes in lipases the serum shows no increased lipolytic activity.-^ 



Protein Metabolism. — Stejskal and Erben-*^ studied the metabolism of a case 

 of myelogenous and of a case of lymphatic leukemia, and found the nitrogen loss 

 much greater in the myelogenous form, although food-absorption was better than 

 in the lymphatic ; they consider that protein-destroying forces are at work in myelo- 

 genous leukemia, similar to those of cancer cachexia, so that nitrogenous equi- 

 librium cannot be attained. 



As the most characteristic products of decomposition of nucleoproteins are 

 the purine bases, one would also expect to find them present in leukemia, and early 

 writers mention the finding of purine bases and uric acid in the blood and spleen. 

 The urinary findings in this respect have been very variable. Ebstein" observed 

 the complication of leukemia with gout which he considered a coincidence, and 

 also noted uric-acid concretions in the urinary passages in four cases. Numerous 

 other authors have described increased uric-acid elimination, while some have 

 observed increase in the purine bases, either with or without uric-acid increase. 

 Magnus-Levy^^ observed a particularly large uric-acid output in acute leukemias, 



i« Arch. Int. Med., 1913 (12), 637. 



19 For literature see Erben, Zeit. f. Ileilk. (Int. Mod. Abt.), 1903 (24), 70. 



20 Jochmann and Zicglor, Mlinch. med. Woch., 190G (53), 2093. 



2' Ilofmeister's Hcitr., 1903 (4), 442; Dcut. med. Woch., 1905 (31), 183. 



" Boggsand (iuthrie, Hull. .lohns IIoi)kins Hosp., 1913 (24), 3GS. 



23 Zeit. kliii. Med., l.Si)G (29), 374 (literature on albuminuria in leukemia). 



" Dunn, Ouart. Jour. Med., 1913 (ti), 293. 



" Caro, Zeit. klin. Med., 1913 (78), 28(j. 



"Zeit. f. klin. Med., 1900 (39), 151. 



" For lit(M-ature see resume 1)V Walz in Cent. f. Patiiol., 1901 (12), 985. 



2sVirchow's Arch., 189S (152), 107. 



