Alkaline phosphatase activity (AP) and acid phosphatase activity (SP) were histochemically studied in the neutrophils of healthy individua ls and in those of patients with blood disorders, i.e.acute granulocytic leukemia (AGL), chronic granulocytic leukemia (CGL), m yeloma, aplastic anemia (APA), idiopathic thrombocytopenic purpura (ITP), and essential hypochromie (HA). Neutrophils obtained from the peripheral blood or from the hone marrow by puncture were stained by the azo-dye method.
The results obtained were as follows:
1) Immature neutrophils from the bone mar row of normai individuals showed a lower AP and a higher SP than mature neutrophils. Comparing these activities in mature neutrophils from the bone marrow with those from the peripheral blood, the former showed a lower AP and a higher SP thain the latter.
2) In AGL, the AP varied widely, being high in the non-remissive phase and approachiog normal during remission.
3) CGL patients showed a low AP and a high SP in both the peripheral blood and bone marrow neutrophils.
4) In the bone marrow of myelome, the AP of the mature neutrophils was high, while the SP was similar to the control level.
5) In APA, the AP was high both in the peripheral blood and bone marrow neutrophils, whils the SP was normal in the immature neutrophils and high in the mature ones.
6) ITP and HA patients, the neutrophilic AP and SP were similar to those of the normal controls.

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Neutrophile alkaline phosphatase (N-A. P.) activities in leukemia and the other diseases was studied histochemically.
Upon comparison between Kaplow's method (phosphate ester of α-naphthol) and Naphthol AS-MX phosphate method, the latter was found to be better in the histochemical sensitivity, reproducibility, sharp localization and the easiness with which the positive granules were evaluated. Therefore the author used Naphthol AS-MX phosphate method in evaluating the chronological changes in leukemia and N-A. P. in various diseases.
The following results were obtained :
(1) Chronic myelogenous leukemia
N-A. P. was extremely low except for 1 case with complication before treatment, so that the diagnostic significance was confirmed. The fluctuation of N-A. P. in response to treatment gave following responses.
a) Cases in which normal values were obtained upon remission.
b) Cases in which fluctuations in the subnormal level were seen despite remission.
c) Case in which abnormally high values was seen due to bone marrow hypoplasia.
d) Case in which a rapid elevation was seen due to acute exacerbation.
The significance of fluctuation of N-A. P. was noted in each of the 4 groups.
(2) Acute myelogenous leukemia
Two types, one with high value and one with low value were distinguished. N-A. P. failed to fluctuate along with the course of the disease, unlike the changes in chronic myelogenous leukemia. In cases with a small number of leukocytes, the type of high value and the type of low value were distinguished. In cases with a large number of leukocytes, low values were encountered in one case.
Upon comparison of the prognosis between two types, cases with high values had slightly longer period of survival. One case of low volue type complicated with infections rose to the normal level.
(3) Chronic lymphocytic leukemia
N-A. P. showed high values with scarcely any fluctuations according to the treatment.
(4) In other diseases of blood, aplastic anemia, polycythemia rubra vera and leukemoid reaction revealed high values. No definite tendency was noted in iron-deficiency anemia.
(5) Among various diseases, infections, diebetes mellitus, diseases of the liver, and malignant tumor showed high values. In diabetes mellitus, blood sugar values and N-A. P. showed a positive correlation while a negative correlation was noted between A/G ratio and N-A. P. in liver cirrhosis. In malignant tumor, this appeared to be of value as the auxilliary diagnostic method. Fluctuations of N-A. P. was thus studied in diseases of the blood especially leukemia as a center and other diseases and the clinical significance was studied.

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