Lysolecithin and Hemolytic Anemia. The Significance of Lysolecithin Production in the Differentiation of Circulating and Stagnant Blood 1

Abstract

Considerations regarding the etiology of hemolytic jaundice are inextricably bound up with the presence of spherocytosis and the associated increase in hypotonic saline fragility, and the effect of splenectomy in the amelioration of this disorder. Although many different opinions are advanced regarding the etiology of the disease, the outstanding ones are those postulating a faulty bone marrow or an increase in hemolysin production. The theory of faulty bone marrow production, as introduced by Naegeli (1), claims that spherocytes are produced by the bone marrow and that splenectomy does not change the production of abnormal red cells. The dramatic effect of this operation is explained by removal of the inhibitory effect of the spleen on the bone marrow (1). Careful studies of the hemoglobin metabolism in this disorder, however, have revealed that, after splenectomy, increased blood destruction (as measured by the urobilinogen output) and also increased erythrocyte production (as evaluated by the reticulocyte counts) return to normal values despite the continued presence of spherocytes.

Lysolecithin

“…From experiments on incubated mammalian blood, Bergenhem and Fahreus (1 936) reported that lysolecithin was highly adsorbed on red blood cells and was probably responsible for a retardation of the sedimentation rate, reduction in aggregation and a change in shape of the erythrocytes from the biconcave to the spherical form ; the process could be inhibited by quinine in small concentrations whereas sodium arsanilate was inactive. They actually demonstrated that the haemolysing substance could be isolated in larger quantities from incubated serum than from native serum (since confirmed by Singer, 1941, andCollier andWilbur, 1944) and suggested that, in vivo, lysolecithin could be formed by enzymatic action in the relatively stagnant blood of the spleen whilst the rapid movement of blood in the peripheral circulation would inhibit the formation of lysolecithin. This was again confirmed by Singer (1941) and Collier and Wilbur (1944) who also obtained an increased production of lysolecithin in stagnant blood from the splenic vein and varicose veins ; at about the same time Singer (1945) found that splenectomy caused definite alterations in lysolecithin metabolism.…”

“…They actually demonstrated that the haemolysing substance could be isolated in larger quantities from incubated serum than from native serum (since confirmed by Singer, 1941, andCollier andWilbur, 1944) and suggested that, in vivo, lysolecithin could be formed by enzymatic action in the relatively stagnant blood of the spleen whilst the rapid movement of blood in the peripheral circulation would inhibit the formation of lysolecithin. This was again confirmed by Singer (1941) and Collier and Wilbur (1944) who also obtained an increased production of lysolecithin in stagnant blood from the splenic vein and varicose veins ; at about the same time Singer (1945) found that splenectomy caused definite alterations in lysolecithin metabolism.…”

“…Collier (1 952) observed that the presence of lysophosphatide slightly increased the hypotonic fragility of red blood cells but sublytic concentrations of lysolecithin, sufficient to cause disc-sphere transformation, decreased fragility to hypotonicity ; thiourea penetration was also found to increase substantially in the presence of lysolecithin. Singer (1940Singer ( , 1941Singer ( , 1945 has described the extraction of lysolecithin from serum and the quantitative measurement of its haemolytic power in a study of the fragility of various types of red blood cells. He found no parallelism in the resistance of erythrocytes to lysolecithin and to hypotonic salt solutions, suggesting that the corresponding mechanisms of haemolysis via spherocytosis by these haemolytic agents were different.…”

Fat Metabolism

“…There seemed to be somewhat more cephalin than lecithin present, although the extreme variations in the analytical results (lecithin between 0 and 33 per cent, cephalin between 11 and 35 per cent of the total lipids) do not allow final conclusions to be drawn. Singer (126) reported observations on the apparent lysophosphatide content of blood.…”