The specific activity of glycine‐2‐14C into haem and globin has been studied in normal marrow, in cases of thalassaemia and refractory normoblastic anaemia, in patients with iron deficiency anaemia and porphyria of erythropoietic origin. In controls the ratio of haem to globin was less than 1.0. This ratio was reduced in the 2 cases of thalassaemia probably due to the associated reduced activity in ALA synthetase and haem synthetase enzymes. Haem synthesis by iron deficient erythroid precursors can be stimulated by iron with corresponding increase in globin synthesis. There is apparently a mechanism controlling the relationship between haem and globin. Some cases of sideroblastic anaemia resemble patients with thalassaemia in the reduction of the ratio of haem to globin and in the marked reduction of the synthesis of haemoglobin when related to cell counts.
When the ratio of the specific activity of haem to globin is reduced the in vitro addition of pyridoxine to the duplicate may allow one to determine whether it will be effective in therapy.
Reduced globin synthesis in pre‐leukaemic sideroblastic anaemia may carry a poor prognosis but conversely adequate globin production in relationship to cell counts may be associated with a rapidly fatal outcome.
Only in the patient with erythropoietic porphyria was the specific activity of glycine‐2‐14C into haem synthesis greater than into globin. This finding was in contrast to that of erythropoietic protoporphyria where the ratio was normal.