THE ANEMIA OF INFECTION. I. HYPOFERREMIA, HYPERCUPREMIA, AND ALTERATIONS IN PORPHYRIN METABOLISM IN PATIENTS 1

Abstract

The anemia associated with infection is usually normocytic and normochromic and is not accompanied by reticulocytosis. The bone marrow is hyperplastic. In all of the cases marked hypoferremia was observed and in a number there was also hypercupremia, an increase in the amt. of protoporphyrin contained in the red cells and coproporphyrinuria. Plasma bilirubin and total plasma proteins were normal. Pronounced alteration in Fe metabolism was also indicated by flat oral Fe absorption curves and rapid disappearance of Fe from the blood stream following intraven. injn. Therapy by various means was ineffective in altering the disturbance in Fe and porphyrin metabolism. In explanation of these observations, the theory is offered that the anemia of infection is due to failure to form heme as the result of a lack of Fe to incorporate into the protoporphyrin molecule. This lack may be due to an abnormality in the intermediate metabolism of Fe which diverts this metal to the tissues and makes it unavailable for Hb synthesis.