Appearance, properties, and origin of altered human hemoglobin in feces

Altered hemoglobin (Hb) has been found in the feces as a sequel to an upper gastrointestinal bleed. Active Hb antigen of increased anodic mobility was detected on immunoelectrophoresis of melena stools using a goat anti-Hb. The Hb derivative was also identified in polyacrylamide gel electrophoresis using 412 nm. absorbance. The alteration could be simulated in vitro by incubation of hemolysate with duodenal juice or purified carboxypeptidase B alone, or by a mixture of carboxypeptidases A and B. Treatment of hemolysate or purified Hb with acid, gastric juice, pepsin, pancreatic juice, bile, trypsin, or chymotrypsin failed to produce the characteristic alteration. Instead, no change, or production of alpha and beta chains, or gradual but complete elimination of the Hb antigen was seen. This latter all or none pattern is presumed to prevail in the large bowel on the basis of incubations of hemoglobin-feces mixtures. Individuals documented to be bleeding into the colon were found to have at least a portion of their Hb antigen in the unaltered form by immunoelectrophoresis. This finding may be of value in identifying the general origin of a gastrointestinal bleed.