CHOLINE ESTERASE OF BLOOD CELLS AND PLASMA IN BLOOD DYSCRASIAS, WITH SPECIAL REFERENCE TO PERNICIOUS ANEMIA

Abstract

Choline esterase values for plasma, whole blood and cells were detd. by continuous titration in its blood dyscrasias. The calculated values for cells were more reliable than the detd. values, and the latter were discarded. 3 cases of severe, untreated Addisonian pernicious anemia were followed to complete or partial restoration of the blood picture to normal. All cases with markedly lowered red count showed lowered plasma esterase; no lowering of plasma esterase occurred with moderate lowering of hemato-crit and marked lowering of Hb when the red count remained normal. Whole blood esterase was lowered in patients with markedly lowered red count, but in all cases except untreated pernicious anemia, this lowering was less than would be expected if the cell esterase remained normal. In all cases except untreated pernicious anemia and Hodg-kin''s disease resembling aplastic anemia, there was a marked rise in cell esterase. In untreated pernicious anemia all esterase values were strikingly low. On treatment there occurred a sharp rise in cell esterase to values far above normal, with a gradual return to normal values as the blood picture improved. The plasma esterase gradually rose to normal during treatment. The term "mean corpuscular esterase" is introduced to facilitate interpretation of results on conditions with abnormal M.C.V. A mechanism probably exists for maintaining high esterase values in cells in anemia, and this mechanism fails when marked bonemarrow dysfunction occurs.