308 DISTURBANCES OF CIRCULATION 



duction ill antibody production in leukemia,""'' presumablj^ 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. — Considering the quantitative alterations in the con- 

 stitUL-nts of tlie lihxxl, wo find the specific gravity lowered, Ijut not so much as 

 it would be in a simple anemia with equally low hemoglobin, for tlie loss of 

 hemoglobin is partly compensated by the increase in leucocytes and their products. 

 Fibrinogen is usually increased in myelogenous leukemia.'i Tlie serum sliows 

 but slight change in specific gravity, a slight decrease in proteins "la lieing com- 

 pensated by an increase in the NaCl. Tlie freezing-point of the lilood is lowered 

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

 cellular decompositlun. Erben "3 found that in lymphatic leukemia the serum 

 contains less cholesterol tlian 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 PjO-, in the ash is increased because of tiie 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 fixed 

 alkali of the proteins. There is an increased excretion of iron in the urine and 

 feces.'* 



The poor coagulation of 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 in- 

 creased. 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 

 lymphatic 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 fibrinogen and the rapidity 

 of clotting are increased. It is, therefore, extremely difficult to under- 

 stand the poor coagulability of leukemic blood, but study of the fac- 

 tors of coagulation by modern methods may clear this up, for in one 

 ease so studied Whipple '^^ 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 



TOaKotkv, Zent. inn. Med., 1014 (35), 9r),3. 



-1 Erben^, Zeit. klin. Med., 1008 (6G), 278; full details on composition of the 

 Idood in leukemia. 



71a Little change was found in the protein content of the serum b\ UciKlorfcr, 

 Zeit. klin. Med., 1913 (70), 103. 



T2:Mitteil, aus dem Crenzgeb. ]\led. u. Chir., 1000 (15), 11. 1. 



73 Zeit. klin. Med., 1000 (40), 282. 



74 Kennerknecht, Vircliow's Arch.. 1011 (205). 80. 

 7.-. Cent. f. inn. Med., 1904 (25), 800. 



76 Arch. Int. Med., 1913 (12), 637. 



