PERNICIOUS ANEMIA 305 



PERNICIOUS ANEMIA 



111 contrast to chlorosis many evidences of hematolysis may be 

 found in pernicious anemia, particularly the increased amounts of 

 iron in the liver, spleen, and kidneys; hemoglobinemia and hemoglo- 

 binuria; increase in ur()l)ilin, and not infreqneiitly icterus. 



Chemical Changes. — l-'rlicn's i" analyses of tlie blood in ])ornici()us anemia prave 

 the f(>ilo\\inu- losiilts: Tlic proteins are decreased, both in the sernm *'a and in 

 the blood as a whole: part ieularly in the latter, because of the <.'reat decrease in 

 the number of corpuscles. The <|uantity of proteins in the individual corpuscles 

 is increased, correspondintj to their increased size. Fibrin is decreased in total 

 amount, but is relatively normal as compared with the total proteins: alliuniin is 

 normal ; serum olobulin much decreased. The proportion of water is much in- 

 creased, both in the serum and in tlie corjiuscles. Fat is present in normal 

 amounts; cholesterol is decreased, althoujjh in relatively normal quantities in 

 the corpuscles. Lecithin is decreased in the total blood, but increased propor- 

 tionately in the corpuscles. The total ash is increased, owin<r chiefly to an 

 excessively lar^e jiroportion of XaCl and a slight increase in calcium and map- 

 jiesiimi ; potassium and ])hosphoric acid are decreased because f)f the small num- 

 ber of corpuscles: but the serum itself contains more P^jO. and potassium than 

 normal. Although the total iron is, of course, much decreased, there is iron in 

 the serum (indicating hemolysis) and the proportion of iron in the corpuscles is 

 increased; but as the amount of iron in the corpuscles is even greater than cor- 

 responds to the hemoglobin increase, it would seem that either the hemoglobin 

 in pernicious anemia is very rich in iron, or that the corpuscles c(mtain iron 

 bound in some form other than hemoglobin. 



The analyses of Rumpf ^^ agree quite closely with those of Erben, and. taken 

 jointly with other analyses in the literature, show the large proportion of Mater 

 in the blood, the small amount of solids, the large amount of NaCl. and the 

 decrease in potassium and iron. Rumpf also examined the brain, liver, heart, 

 and spleen in one ease. Water was found increased in the heart, decreased in 

 the other organs, the solids not being decreased in any of the organs. Tiiere was 

 little fat in any of the organs or in the blood, but NaCl was generally increased. 

 The liver contained four or five times as much iron as normal : the spleen three 

 or four times. Rumpf is inclined to lay great stress on the general jioverty of 

 the body in potassium, and suggests its therapeutic application. Svllaba *" 

 found bilirubin and also free hemoglol)in in the l)lood of seven patients. Fowell so 

 found a considerable excess of iron in the blood over tlie amount combined with 

 hemoglobin. Schimim 5i could lind no proteoses or other evidences of protein 

 decomposition in the blood in a case of pernicious anemia, but he did find free 

 hematin.sia The tendency to hemorrhage observed in this disease may dejiend on 

 a slight decrease in the prothrombin and a reduction in the numl)er of platelets. ''ib 



V. Jaksch and also v. Limbeck ^>^ have foiuid some decrease in total alkalinity, 

 which probably depends on the loss of proteins and their fixed alkali. ■'''•'' The red 

 corpuscles are very susceptible to hemolysis by lowering of osmotic pressure 

 ("high isotonicity," equal to 0.;')4 per cent. XaCl — v. Limbeck). The specific 

 gravity of the whole blood is, of course, decreased, but the corpuscles themselves 



*" Zeit. klin. :Med., 1900 (40), 266. Reumer and Riirger. Zeit. exp. Path.. 1013 

 (13), 343. 

 *"a See also Heudorfer, Zeit. klin. IMed., 1!)1.3 (70), 103. 

 ■t^Rerl. klin. ^Yoch.. 1001 (38), 477. 

 40 Abst. in Folia Ilematnl.. 1004 (1), 2S3 and 580. 

 •'i'l Quart. Jour. :Med.. 1013 (6). 170. 

 ■"■1 Ilofmeister's Reitr., 1003 (4). 4r)3. 

 siaZeit. physiol. Chem., 1016 (07), 32. 

 ■"■ih Drinker and Hurwitz, Arch. Int. Med., 1915 (15), 733. 



52 "Klin. Pathol, des Blutes," Jena. 1896, p. 311. 



53 See Brandenburg, Zeit. klin. Med.. 1902 (45), 157. 



20 



