SECONDARY ANEMIA 249 



salts, and as a consequence the size of the red corpuscles is 

 increased because of imbibition of water; indeed, it is possible 

 that this may even be sufficient to cause hemolysis, which will 

 happen if the isotonic strength of the blood becomes less than 

 that of a 0.46 per cent. NaCl solution (Limbeck), while swelling 

 may occur whenever the strength is below 0.8 per cent. 



Regeneration of the blood begins very soon, and for some 

 time the number of corpuscles exceeds the proportion of hemo- 

 globin. During this time the amount of iron in the liver and 

 spleen is decreased, it being taken up to be used in the formation 

 of new hemoglobin. If the hemorrhages are numerous and the 

 condition of anemia prolonged, secondary changes in the viscera 

 may occur, fatty metamorphosis being most marked, supposedly 

 because of decreased oxidation. Indeed, many observers state that 

 repeated bleedings greatly increase body weight by causing 

 increased fat deposition. 



Metabolic Changes. Gies 1 studied the metabolism of 

 dogs after withdrawing a total amount of blood equal to 11.5 

 per cent, of the body weight during four bleedings, and found 

 that a slight and temporary increase in nitrogenous elimination 

 followed the bleedings, owing to an increased proteid katab- 

 olism. Sugar increases in the blood, while albumin and lactic 

 acid appear in the urine. After each successive hemorrhage the 

 proportion of fibrin and the coagulability of the blood increase, 

 while the proportion of the ash obtained from both blood and 

 serum remains practically unchanged (Meyer and Gies). Bau- 

 mann 2 states that in regeneration after hemorrhage the serum 

 albumins increase more rapidly than the globulins, while others 

 have observed the opposite relation. The urine in secondary 

 anemia shows the effects of increased proteid katabolism, its 

 specific gravity, total solids, and total nitrogen being raised ; the 

 total amount of urine is at first diminished because of lowered 

 blood pressure, but it soon rises above normal and later falls 

 back to normal. The view formerly held that oxidation is 

 decreased in anemia has been considerably modified by more 

 recent investigations. 3 



Secondary anemia due to cachexia, or to malnutrition, 

 is accompanied by a general decrease in all the elements of the 

 blood, both cellular and chemical. The proteids of the plasma, 

 particularly, show a decrease in starvation, being drawn on by 

 the cells for food, and the total quantity of blood as well as of 



1 American Med., 1904 (8), 155 ( resume* of literature). 



2 Jour, of Physiol., 1903 (29), 18. 



3 See Mohr, Zeit. exp. Path., 1906 (2), 435. 



