LEUKEMIA 255 



perhaps the best of grounds, would ascribe pernicious anemia to 

 a multiplicity of causes, which produce a protracted slight hem- 

 olysis that continues until the hematogenetic organs give out, 

 their exhaustion being perhaps hastened by the influence of the 

 toxic substances in the blood ; hematogenesis then becomes 

 insufficient to replace the lost corpuscles, and the picture of per- 

 nicious anemia is established. 1 



LEUKEMIA 



In leukemia the chemical changes in the red corpuscles take 

 a less prominent position, resembling either those of a secondary 

 anemia or chlorosis, while the enormous number of leucocytes 

 is the prominent feature and causes marked alterations in the 

 composition of the blood. Large quantities of nucleoproteids 

 and also of the intracellular enzymes are introduced into the 

 blood by the excessive leucocytes. As the leucocytes are 

 constantly breaking down, more or less of the products of their 

 decomposition are present in the blood and appear in the urine. 

 Because of the relatively slight metabolic activity of the lympho- 

 cytes the various chemical alterations are all less marked in 

 lymphatic than in myelogenous leukemia. 2 



Chemistry of the Blood. Considering the quantitative alterations 

 in the constituents of the blood, we find the specific gravity lowered, 

 but not so much as it would be in a simple anemia with equally low 

 hemoglobin, for the loss of hemoglobin is partly compensated by the 

 increase in leucocytes and their products. The serum shows but slight 

 change in specific gravity, a slight decrease in proteids being compensated 

 by an increase in the NaCl. The freezing-point of the blood is lowered 

 (Cohn 3 ), which is probably due to the increase in crystalloidal products 

 of cellular decomposition. Erben 4 found that in lymphatic leukemia 

 the serum contains less cholesterin than 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 is decreased as is also that of the cholesterin, that 

 of the lecithin being somewhat increased. The total amount of potassium 

 and iron in the blood is decreased, but the P 2 O 5 in the ash is increased 

 because of the large amount of nucleoproteid 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 proteids. Scherer and 

 others have reported the finding of lactic, formic, and acetic acids in 

 leukemic blood. 



1 See also Bunting, Johns Hopkins Hosp. Bull., 1905^(16), 222. 



2 Stern and Eppenstein have observed that the striking proteolytic power 

 of the leucocytes from the blood in myelogenous leukemia is not shown by 

 the leucocytes in lymphatic leukemia (Sitz. d. Schles. Ges. f. vaterland. 

 Cultur, June 29, 1906). 



3 Mitteil. aus dem Grenzgeb. Med. u. Chir., 1906 (15), H. 1. 



4 Zeit. klin. Med., 1900 (40), 282. 



