

PATHOLOGICAL METABOLISM OF THE BLOOD 579 



leukemia. In a patient with chronic myelogenous leukemia, von Stejskal 

 and Erben found the nitrogen loss much greater than in the lymphatic 

 form, and Murphy, Means and Aub could maintain their patient with 

 chronic lymphatic leukemia in nitrogen equilibrium on a nitrogenous in- 

 take of 13 to 15 grams per day. It has been suggested that the greater 

 protein combustion in myelogenous leukemia may be due to richness of 

 the polymorphonuclear leukocytes in autolytic enzymes, which gives these 

 cells greater metabolic activity than the lymphocytes. 



TABLE 5 

 NITROGEN AND PUBIN METABOLISM IN A PATIENT WITH CHRONIC LYMPHATIC LEUKEMIA 



* Excreta Nitrogen calculated as urine nitrogen plus 10 per cent of food nitrogen. 

 After Murphy, J. B., Means, J. H. and Aub, J. C.: Arch. Int Med., 1917, xix, 902. 



In acute leukemia, on the other hand, Magnus-Levy and also Edsall 

 have noted an enormous increase in protein metabolism. The former 

 observed repeatedly an elimination of nitrogen which exceeded the intake, 

 in some instances, by as much as 40 grams per day ; whereas Edsall reports 

 a negative balance of 22.28 grams a day on a nitrogen intake of 7.25 

 grams. 



It is possible that the great variations which different workers have 

 found in the protein metabolism in the leukemias may depend, in part 

 at least, upon the fluctuations which are known to occur in the course 

 of the pathological processes of this disease. When it is considered how 

 greatly the number of leukocytes, the size of the lymphatic organs, and 

 the general condition of the patient may vary from time to time, it is 

 not surprising that the excretion of the products of metabolic activity 

 should show corresponding fluctuations. During the ordinary course of 

 the disease, the total nitrogen elimination, as a rule, corresponds closely 

 to the protein of the diet ; while, during periods of rapid leukocyte forma- 

 tion or more especially during periods of rapid leukocyte destruction the 

 change may be indicated by the nitrogen output. 



Purin Metabolism. The purin metabolism in anemia and leukemia 

 has been extensively studied. This phase of metabolism is of particular 



