The concentration of hemoglobin and the number of red cells in the blood are normally kept fairly constant as the result of two opposing forces: blood formation in the bone marrow and blood destruction, presumably in the reticuloendothelial system. The degree of red cell formation can be fairly well judged not only by the erythrocyte count but by such factors as polychromatophilia and the reticulocyte count or more directly by biopsy of bone marrow. The degree of blood destruction may be estimated by determination of the various hemoglobin derivatives, such as bilirubin in the blood and urobilinogen in the urine and the feces. The output of the latter pigment, which is formed directly from bilirubin in the intestines, has been shown to be useful as an index of hemoglobin destruction. On its formation in the intestines urobilinogen may be said to undergo one of three processes: (1) absorption by the
MILLER EB, SINGER K, DAMESHEK W. USE OF THE DAILY FECAL OUTPUT OF UROBILINOGEN AND THE HEMOLYTIC INDEX IN THE MEASUREMENT OF HEMOLYSIS. Arch Intern Med (Chic). 1942;70(5):722–737. doi:10.1001/archinte.1942.00200230035003
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