Placental chorioangioma: a rare cause of fetomaternal transfusion with maternal hemolysis and fetal distress

Multiple placental chorioangiomas in a 31-year-old woman led to a severe, acute fetal-to-maternal transfusion and maternal hemoglobinuria from hemolysis of the fetal red blood cells. Fetal distress was manifest by a sine wave fetal monitor pattern. A severely asphyxiated infant was delivered by cesarean section. The infant did well after transfusion therapy.

A study of erythrocyte membrane proteins and urinary polypeptides in conga drumming haemoglobinuria

The erythrocyte membrane proteins and glycoproteins and urinary polypeptides have been examined in a patient exhibiting intermittent pigmenturia associated with conga drumming. Significant excretion of haemoglobin, albumin and probably erythrocyte carbonic anhydrase but not myoglobin occurred during the acute phase of the conga drumming-induced pigmenturia. This usually ceased within 24-48 h. We found no evidence of aberrant erythrocyte membrane components on electrophoresis with either protein staining or a range of 125I-labelled lectins used for detection.

Toxicity of group B Streptococcus agalactiae in adult rats

Several strains of group B Streptococcus agalactiae were found to be lethal for young adult rats. When bacteria were heat killed and then injected intraperitoneally into rats, rapid death (14 to 18 h) of the rats occurred, characterized by labored breathing, hemolyzed serum, hemoglobinuria, and subungual hemorrhages. Sections of tissues from these rats failed to reveal the cause of death. Rats injected with toxic or nontoxic strains of group B S. agalactiae had reduced numbers of circulating leukocytes and low serum C3 levels in comparison with those in control rats. The toxic strains of group B S. agalactiae induced dramatic decreases in platelet numbers, and in plasma fibrinogen levels as well, suggesting that the toxicity was due to disruption of the coagulation system. Rapid death in the absence of infection suggests that group B S. agalactiae may have a cell-associated toxin that induces these changes. Such a toxin may be a contributory factor in the high mortality rate associated with group B streptococcal infections of the human neonate.

Haptoglobin therapy for possible prevention of renal failure following thermal injury: a clinical study

Hemolysis does not necessarily result in acute renal failure in severely burned patients, but free serum hemoglobin may play some important role in the development of renal damage. This controlled study of the effects of haptoglobin administration in severely burned patients presenting with hemoglobinuria produced the following results: As long as free hemoglobin was present in the plasma, free serum haptoglobin remained undetectable. Free serum hemoglobin dropped rapidly after haptoglobin treatment, whereas the free serum hemoglobin levels in control patients remained unchanged for at least 12 hours. The time required for macroscopic hemoglobinuria to clear showed a statistically significant difference between the haptoglobin-treated patients and the control patients. Some patients among the haptoglobin-treated group had prolonged hemolysis and hemoglobinuria which might have cleared with additional doses of haptoglobin.

Transplantation of major ABO-incompatible bone marrow depleted of red cells by hydroxyethyl starch

23 bone marrow transplant recipients whose donors where major ABO-incompatible received marrow depleted of red cells prior to infusion utilizing gravity sedimentation in hydroxyethyl starch. The in vitro red cell-depletion procedure effectively removed 97.8% (mean) of the red cells from the harvested marrows and preserved 86.8% of the nucleated cells and 98.2% of the CFU-C activity in 25.4% of the original volume. All recipients had a significant quantity of isohemagglutinins of both IgM and IgG classes demonstrable in their serum at the time of the marrow infusion. Patients were premedicated and well-hydrated prior to the infusion and tolerated the infusion well. These patients demonstrated bone marrow engraftment at the same rate as did those patients whose marrow donors were either ABO-identical or minor ABO-incompatible. There was no difference in the incidence of or time to development of graft versus host disease, the incidence of graft rejection, or patient survival among the groups. Recipients of red cell-depleted major ABO-incompatible bone marrow transplants demonstrated production of donor-type red cells somewhat later and required slightly more red cell transfusion support that did the other groups of recipients. This red cell-depletion technique is safe and effective in the management of major ABO-incompatible bone marrow transplantation.

Runner's macrocytosis: a clue to footstrike hemolysis. Runner's anemia as a benefit versus runner's hemolysis as a detriment

This report of a runner in whom progressive macrocytosis developed with increasing mileage deals with the hematologic adaptations to exercise, introduces the concept of "runner's macrocytosis" as a compensated hemolysis of older red cells, and makes a case for "runner's anemia" as a benefit versus "runner's hemolysis" as a detriment. It presents the characteristic hematologic profile of footstrike hemolysis and explores the influence of racing, different levels of training, and different shoes. It shows that runner's hemolysis can be reduced by reducing mileage but not necessarily by changing shoes, and it suggests that runner's hemolysis can impair race performance by preventing the attainment of an optimal red cell mass and, in time, by evolving into iron-deficiency anemia.

Exercise and renal function

Exercise induces profound changes in the renal haemodynamics and in electrolyte and protein excretion. Effective renal plasma flow is reduced during exercise. The reduction is related to the intensity of exercise and renal blood flow may fall to 25% of the resting value when strenuous work is performed. The combination of sympathetic nervous activity and the release of catecholamine substances is involved in this process. The reduction of renal blood flow during exercise produces a concomitant effect on the glomerular filtration rate, though the latter decreases relatively less than the former during exertion. However, the degree of hydration has an important influence on the glomerular filtration rate. An antidiuretic effect is observed during intense exercise. Changes in urine flow are dependent on the plasma antidiuretic hormone levels which are increased by intense exercise. Heavy exercise has an inhibitory effect on most electrolytes (Na, Cl, Ca, P). With potassium, however, most studies report that potassium excretion is not consistently affected by moderate to heavy exercise. Increased aldosterone production helps the body to maintain sodium by increasing its reabsorption from the filtered tubular fluid. Recent studies suggest that sympathetic stimulation may be involved during exercise. Strenuous work leads to an increased excretion of erythrocytes and leucocytes in urine. Cylindruria has been regularly found in postexercise urine in different sports. Postexercise proteinuria is a common phenomenon in humans. It seems to be directly related to the intensity of exercise, rather than to its duration. This excretion of proteins in urine is a transient state with a half-time of approximately 1 hour. Postexercise proteinuria has a pattern different from normal physiological proteinuria. Immunochemical techniques demonstrate that postexercise proteinuria is of the mixed glomerular-tubular type, the former being predominant. The increased clearance of plasma proteins suggests an increased glomerular permeability and a partial inhibition of tubular reabsorption of macromolecules. Haemoglobinuria and myoglobinuria may be observed under special exercise conditions. The degree of hydration appears to be important to reduce these abnormalities.

An immediate hemolytic transfusion reaction due to anti-C and a delayed hemolytic transfusion reaction due to anti-Ce+e: hemoglobinemia, hemoglobinuria and transient impaired renal function

A patient with phenotype R2r and anti-C has a hemolytic transfusion reaction (HTR) with hemoglobinemia and hemoglobinuria which occurred within 2 h of receiving an R1r transfusion. Transient impaired renal function ensued. A patient with phenotype R2R2 and anti-Ce+e had the same experience on day 4 after receiving three R1r and one rr units. 2 other patients, 1 R2r with anti-C who received one R1r unit and the other R2R2 with anti-Ce+e who received two R1r units, showed no clinical evidence of HTR. Both anti-C antibodies were entirely IgG while both anti-Ce+e antibodies initially were predominantly IgM. IgG subclassing was unsuccessful and red blood cell-mononuclear phagocyte assays were normal. These cases occurred from 1979 to 1981.

Delayed hemolytic transfusion reactions. Evidence for complement activation involving allogeneic and autologous red cells

Twenty-six patients with delayed hemolytic transfusion reactions ( DHTR ) were investigated. The reaction of hemolysis often was concealed by other disorders that were usually associated with signs of hemolysis or blood loss. Coating of red cells was analyzed with regard to IgG and/or complement bound in vivo. Although many of the alloantibodies involved (K [8]; E [5]; Fya [2]; Fyb [2]; D [1]; c [1]; multiple [7]) are usually thought to be incapable of complement activation, a strongly positive direct antiglobulin test (DAT) due to C3d was found in all cases. On first examination after transfusion, C3d was present on circulating red cells in large amounts and remained discernible for weeks and even months. IgG on red cells was detected by the DAT in only 10 out of 26 cases. By means of a sensitive radioimmunoassay, IgG was demonstrated in 16 out of 17 cases, but usually in small quantities. Despite the low IgG concentrations, the causative alloantibodies could be eluted in 25 of 26 cases, and, as shown by sequential investigations, in six cases were recoverable from circulating red cells for over 100 days posttransfusion. Since the antiglobulin reactions due to anti-complement were usually strong, not of the "mixed-field" type, and in some cases remained detectable on circulating red cells for months, we conclude that complement is regularly activated in DHTR and binds not only to donated but probably also to autologous red cells.

Verdoglobinuria phenomenon in severe electrical burns

Verdoglobinuria is considered to be an ominous sign of Pseudomonas aeruginosa septicaemia in burns. No report of the survival of a case with this phenomenon could be found in the literature. Stone et al. (1964) first reported verdoglobinuria as an important diagnostic basis for P. aeruginosa septicaemia in burns. A patient with high-tension electrical injury was admitted to our hospital burn department in 1977. Verdoglobinuria occurred. This patient is reported as follows. There was a large defect in the left chest wall with exposure of the heart and secondary P. aeruginosa pyothorax which happened during the early stage of injury. It led to septicopyraemic shock. The patient's urine was examined under ultraviolet rays, the fluorescence was ultrapositive. Verdoglobinuria was positive proof. After active measures were administered, the patient was out of danger from this septicopyraemic shock. The metabolism mechanism of verdoglobin, diagnostic effect of verdoglobinuria on P. aeruginosa septicaemia in severe burns and treatment are discussed.

RBC destruction caused by a micropore blood filter

Two infants who received whole blood filtered through commercially available woven stainless steel micropore filters experienced a sudden onset of hemoglobinuria. The plasma hemoglobin level in one child was 200 mg/dL. To investigate whether filters might lead to RBC destruction, we experimentally quantitated filter-induced hemolysis using standard conditions. Our studies in vitro show that hemolysis decreases with increased speed to transfusion. Hemolysis is particularly extensive with blood stored more than 14 days, but measurable hemolysis occurs with blood stored for as little as one day.

Hemoglobinuria after fraternity hazing

We describe a 19-year-old male who presented with traumatic hemoglobinuria. We hypothesize that this patient has a genetic haptoglobin variant with a low hemoglobin binding capacity which resulted in hemoglobinuria after physical fraternity hazing. A review of the literature regarding traumatic hemoglobinuria supports the association between decreased baseline plasma haptoglobin levels and hemoglobinuria after trauma.