Clinical and hematological studies were performed on ten homozygous and seven heterozytous individuals with pyruvate kinase deficiency, aged between 2 and 71 years. Five of the homozygotes were splenectomized. With the exception of a decreased enzyme activity between 41 and 55 per cent and minor changes in their red cell metabolism the heterozygotes showed no abnormal results. In the homozygotes the following results could be demonstrated: 1. Pyruvate kinase activity was decreased to 11 to 35 per cent of normal enzyme activity. 2. There is no relation between the severity of hemolysis and the degree of the enzyme defect. 3. The reticulocyte counts correlated inversely with the hemoglobin concentrations. 4. There is a close correlation between the activities of hexokinase, phosphofructokinase, glucose-6-phosphate dehydrogenase and glutamate oxalacetate transaminase on the one side and reticulocyte counts on the other. 5. Adenosine triphosphate or adenosine reduced the increased autohemolysis in all cases. 6. Following splenectomy, anemia was less pronounced than before. Splenectomized patients did not need further transfusions, though hemolysis persisted.