The anemia of infection; the influence of cobalt on the anemia associated with inflammation.

LTHOUGH the bone marrow usually appears to be normal or even hyperplastic in cases of anemia associated with infection,’ the anemia is refractory to therapy, being relieved only when the underlying infection is successfully eradicated. The anemia is accompanied by a profound metabolic disturbance as indicated by the finding of hypoferremia, hypercupremia, and elevated erythrocyte protoporphyrin levels.’ It is recognized, also, that infection is associated with a disturbance in protein metabolism; thus the serum albumin decreases, and increased excretion of urea in the urine has been reported.3 As part of a study of the pathogenesis of the anemia associated with inflammation, and in an attempt to find a means whereby the failure to form hemoglobin might be overcome, it was considered of interest to study the effect of cobalt. By the administration of cobalt, polycythemia can be produced in many laboratory animals.4’5 The increase in red cells and hemoglobin has been reported as being due to an actual increase in red cell mass,6’7 and an increase in reticulocytes in the blood has been observed. The mean corpuscular volume was found increased, owing mainly to greater cell thickness,7 the bone marrow becomes hyperplastic,’.9 and metaplasia occurs in the spleen, liver, and kidneys.9’10 The administration of cobalt was found to overcome the anemia produced by the toxic action of benzol in rabbits’ and that caused by protein deficiency in rats” and was even reported to relieve the physiologic and nutritional anemia of children.” Kleinberg and his associates’ found that in rabbits made anemic by the injection of 0.5 to 1.0 ml. of benzene for a period of weeks, the daily administration of 50 ml. of cobalt nitrate overcame the anemia despite the continued administration of benzene. The marrow of the control benzene rats was fatty and aplastic, while the marrow of the rats treated with cobalt and benzene was hyperplastic. It has been shown by Dorrance et al)#{176} that the work performance of rats having cobalt polycythemia is increased under conditions of anoxia, thus indicating that the increased hemoglobin is useful for oxygen carriage.