In reviewing the literature, no description of a lipemia occurring in relation to simple hemorrhage was found, so that the observation of the phenomenon here recorded would seem to be new.
Very high percentages of fat have been found in the blood of diabetics. Fischer's case showed 18.1 per cent total ether extract. Of this very little was free fat (0.0018 gm. potassium hydroxide per gram of fat); iodine absorption was 60.6 per cent.; cholesterin, 2.6 per cent. Chatin's case, cited by Fischer, showed 1.2 per cent. cholesterin, 66.5 per cent. olein, 32.2 per cent. margarin in the fat. Neisser and Derlin in the ether extract of blood from a patient with diabetic coma found 19.7 per cent. fat, with melting point of from 39° to 41° C.; iodine absorption was 53.6 per cent. Javal in a similar case found 25.4 per cent. of fat in ether extract of dry serum (perhaps by Soxhlet method); 21 per cent. of the fat was lecithin.
Bleibtreu produced alimentary lipemia in geese by feeding barley and butter. Ether extract of serum showed 6 per cent. of fat. The serum was milky with invisible droplets. Iodine absorption was 57 to 58 per cent. The fat was quite different, chemically, from the fat in the food. Lipemia disappeared a few days after discontinuing the forced feeding.
Our experiments suggest, by analogy, the possible occurrence of lipemia in human anemias. In this connection it is of interest to note that we have recently demonstrated a moderate lipemia in a case of marked secondary anemia from hemorrhoids. The emaciation in such cases, as contrasted with the well-recognized conservation of the fat in pernicious anemia, suggests in human pathology a still further analogy which we now have under investigation.
The fat in our lipemic rabbits differs from fats described above in its insolubility, as well as in its "constants." The change after precipitation of calcium from the serum suggests that the fat may be present in the serum as a protein-calcium-lecithin combination which is decomposed by decalcifying.
While we are not prepared to offer an explanation of the mechanism of this lipemia, it is possible that the great loss of tissue proteins may have some influence on the abnormal fat metabolism. That the fat is derived from the tissues is a fair inference when its occurrence in connection with the loss of weight and the previous disappearance of the body fat are taken into consideration. A more careful study of the lipase in the blood and tissues is desirable. It may be that lowered oxidation following great loss of red cells plays a part.