Blood levels of ascorbic acid, vitamin A, folic acid, and amino acids were studied in patients at the South Texas Comprehensive Hemophilia Center, San Antonio, TX. The mean plasma ascorbic acid level in hemophiliacs was significantly lower than controls (p less than 0.0001). This was observed despite a dietary ascorbic acid intake in excess of 66% of the Recommended Dietary Allowances (RDA). However, those subjects receiving specific factor replacement therapy at home and consuming at least 66% RDA of ascorbic acid maintained a mean plasma ascorbic acid level not significantly less than controls. Hemophilic subjects not on home therapy, on the other hand, had a mean plasma ascorbic acid level significantly below that of controls while receiving optimal dietary ascorbic acid. With prompt adequate medical care of bleeding episodes and with optimal nutrition, the demand for ascorbic acid needed for tissue repair in hemophilic patients may be lessened. Hemophiliacs had mean serum vitamin A, mean serum folate, and mean red cell folate levels that were not significantly different from controls. Significantly higher mean plasma arginine and lower, but not significantly lower, mean plasma ornithine levels were found in hemophilic subjects, suggesting altered arginase activity.

The solvents were removed by vacuum distillation. The residual yellow solid was dissolved in 110 ml. of hot water, cooled by adding 100 g. of ice, and acidified with 30 ml. of concent,rated HOI. The white solid product was filtered, washed well with water, and dried to constant weight; yield 16.1 g. (88%•), imp. 318-320°, sealed tube (copper block, corrected). This material was suitable for nitration. For purification for analysis the product was dissolved in dilute ammonium hydroxide, treated with charcoal, and reprecipitated with acid. The melting point was unchanged.