Clinical experience with the recently wounded during World War II again emphasized that a deficiency of hemoglobin, among all the body proteins, is of particular surgical significance. It is our purpose in this discussion to focus attention on hemoglobin deficiency as a constant feature of systemic depletion in many types of chronic illness. In such progressive protein depletion the reduction in total circulating mass of red blood cells is masked at first by constriction of the plasma volume. This phase of protein deficiency, characterized by loss of weight, reduced blood volume and increased interstitial fluid volume, has been designated as chronic shock.1 Obvious anemia and gross edema are later evidences of exhaustion of protein reserves.
In a study of battle casualties with chronically suppurating wounds, loss of weight as great as 50 pounds (23 Kg.) and obvious protein depletion were not associated with edema or apparent anemia.2 The
LYONS C, MAYERSON HS. THE SURGICAL SIGNIFICANCE OF HEMOGLOBIN DEFICIENCY IN PROTEIN DEPLETION. JAMA. 1947;135(1):9–11. doi:10.1001/jama.1947.02890010011003