256 DISEASES OF THE BLOOD 



The poor coagulation of leukemic blood has been long known, 

 but the reason for it has not yet been ascertained. Some investi- 

 gators have reported a deficiency in fibrin, while others have 

 found it increased. More recent reports, however, indicate that 

 there is no marked change in either the amount of fibrinogen 

 or of the fibrin-ferments. Erben l found a normal amount of 

 fibrin in the blood in lymphatic leukemia ; and in three cases of 

 myelogenous and one of lymphatic leukemia, Pfeiffer 2 found 

 the amount of fibrinogen nearly normal. This is quite remark- 

 able 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 understand 

 the poor coagulability of leukemic blood. 



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. 

 Normal leucocytes are rich in autolytic enzymes, which under 

 ordinary circumstances seem to be held in check by the anti- 

 enzymes of the blood. In leukemia this anti-enzyme action 

 seems to be insufficient to prevent leucocytic autolysis, for even 

 in freshly drawn blood proteoses (or at least non-coagulable 

 proteids) may be present. 3 According to Erben, this is true 

 only of myelogenous leukemia, the fresh blood in lymphatic 

 leukemia not only being free from non-coagulable proteid, but 

 furthermore this product of proteolysis does not soon develop 

 when the blood is kept aseptically at incubator temperature. 

 This is, of course, what one would expect in view of the well- 

 known enzyme-richness of the polymorphonuclear leucocytes 

 and the scarcity of enzymes in lymphocytes. Erben states that 

 the neutrophile cells seem to be the chief source of proteoses, 

 since their granules soon disappear in blood that is undergoing 

 autolysis, whereas the eosinophiles preserve their granules well, 

 and true proteoses are not present in blood rich in mast cells 

 (i. e. 9 myeloma). Schumm 4 found in the blood in a case of 

 myelogenous leukemia several varieties of proteoses, most 

 abundant being the so-called detitero-albumose ; in another he 

 also found peptone, leucin, and ty rosin. In addition he demon- 

 strated the autolytic nature of the changes that occur in leukemic 

 blood after death (see also " Autolysis in Leukemia," Chap. iii). 

 Most observers have failed to find albumose in the urine in 



1 Loc. cit. 



2 Cent. f. inn. Med., 1904 (25), 809. 



3 For literature see Erben, Zeit. f. Heilk. (Int. Med. Abt.), 1903 (24), 70. 



4 Hofmeister's Beitr., 1903 (4), 442 ; Deut. med. Woch., 1905 (31), 183. 



