Studies on anemia of disseminated malignant neoplastic disease. I. The hemolytic factor.

With the Technical Assistance of JANE 14. HARVEY M ULTIPLE FACTORS may (OmitmiI)Ilte to the amiemia of cancer. Chromiic 1)100(1 boss due to tumor ulceration particularly in the gastroimitestinal tract amid the genitounimiary systems is importamit and easily umiderstood. Less ell documemited as a cause of cancer amiemia is depression of erythropoiesis. It. is certainly true that imihibition of bomie marrow function can 1)e produced by radiotherapy amid i y antitumor drugs such as nitrogemi mustard, the folic acid antagomiists, urethamie, punimie analogs, amid others. Imi the natural history of neoplastic disease, decreased red cell productiomi has been ascribed to a tumor toximi, to replacement of bone niarroiv cells by tumor, to disturbances in protein synthesis imstludimig globin, to imiade(luate imstake or storage of hematimiic factors such as vitamin 13i:i, iromi, om folic acid due to malnutritiomi or extemisive liver met.a.stases. All of these latter appeal theoretically reasonable ; however, their impom’tamsce has not been estalbished. l ecemitly amiother mechanism in the developmemit of anemia has been studied by Ross amid his associates.’ These imivestigations described the frequency of acreberate(l red cell destructiomi in patients with leukemia and malignamit bymphoma. Overt hemolytic phemiomena have previously been reported in patients with mseoplastic disease.tm2 However, the application of the Ashhy technic in the SttI(ly of the survival of transfused (ebbs revealed a greater frequemicy of this o((lmm mem1te iii patients with 1)100(1 dyscrasias amid malignant tumors of the reticuboemidothelial system thami had heretofore beemi appreciated. The present investigatioms was undertaken to determimie whether hemolysis occurred itt patiemits with tarcimiomas as well as imi those with leukemias and lymphomas.