II. Goproporphyrin I Metabolism and Hematopoietic Activity

In a previous communication concerning the porphyrin excretion in normal individuals 1 we have briefly outlined a concept of the dualism of the porphyrins, stating that in certain pathological conditions increased or decreased Type III porphyrin construction associated with hematopoietic activity may lead to a proportionally increased or decreased Type I porphyrin construction and excretion. This communication presents data which bear out this concept.

A classical case of hemolytic jaundice with 1,600,000 R.B.C., 4.5 gm. of hemoglobin per 100 cc, 21,000 nucleated R.B.C., 5,800 W.B.C., 10% reticulocytes, icterus index 30, Van den Berg (indirect) 3.1 mg.%, and markedly increased R.B.C. fragility was studied. The patient was maintained throughout the period of observation on a bland diet containing small amounts of meat. After 3 blood transfusions splenectomy was performed, following which R.B.C. increased to 2,500,000, hemoglobin to 9.0 gm. per 100 cc., the reticulocytes decreased to 2%, and the icterus index decreased to 10. Porphyrin and stercobilin excretion were followed quantitatively before and after operation.

In the 7 days previous to operation the average daily value for urinary and fecal coproporphyrin was 718 micrograms. The stercobilin averaged 407 mg. during the same period. During the first 6 post-operative days the total coproporphyrin I excretion averaged 648 micrograms per diem. In the same period the stercobilin values fell rapidly to 157 mg. per day. The average coproporphyrin excretion for the next 6 days was 371 micrograms and the stercobilin 73 mg., both within normal range.

These data strongly indicate that physiologically increased hematopoietic activity is accompanied by increased coproporphyrin I excretion. The excretion reverts to normal coincident with decreased hematopoietic activity.

A second patient with hemolytic jaundice, followed for 20 days and not operated upon, showed a daily average total coproporphyrin I excretion of 652 micrograms.