[Acute intravasal hemolysis in Clostridium perfringens sepsis. Differential diagnosis of hemolytic episodes].
A 19-year-old man with acute lymphoblastic leukaemia developed fever, general deterioration and somnolence 3 days after a cycle of cytostatic treatment. He had anaemia (haemoglobin 6.6 g/dl), leukopenia (100/microliters) and thrombocytopenia (7,000/microliters). As an acute septicaemia was suspected he received broad spectrum antibiotic therapy, together with two units of red cell and platelet concentrates. However, his condition worsened rapidly over the next 5 hours (meningism, seizures, fever to 41.1 degrees C, dyspnoea). Another blood count revealed severe haemolysis. Computed tomography of the skull demonstrated multilocular intraparenchymal gas formation. Although the antibiotic treatment was extended the patient died several hours later. Retrospective examination for suspected transfusion mismatch provided no evidence for erythrocyte incompatibility. But there was liberation of T-antigen as sign of a bacterial cause of erythrocyte damage. An anaerobic blood culture grew Clostridium perfringens. This case demonstrates that acute intravascular haemolysis in septicaemia should be considered in the differential diagnosis of transfusion mismatch.
Strobel
E
E
Institut für Medizinische Mikrobiologie, Immunologie und Krankenhaushygiene,Technischen Universität, München-Schwabing.
Nathrath
M
M
Peters
J
J
Abele-Horn
M
M
Wüllenweber
J
J
D000328:Adult; D000740:Anemia / Q000209:etiology / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000209:etiology; D001787:Blood Group Incompatibility / Q000175:diagnosis*; D003015:Clostridium Infections / Q000175:diagnosis* / Q000209:etiology; D003016:Clostridium perfringens / Q000302:isolation & purification* / Q000378:metabolism; D003937:Diagnosis, Differential; D017707:Erythrocyte Transfusion; D006461:Hemolysis; D006801:Humans; D007970:Leukopenia / Q000209:etiology / Q000628:therapy; D008297:Male; D017713:Platelet Transfusion; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000209:etiology / Q000628:therapy; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents
Akute intravasale Hämolyse bei Clostridium-perfringens-Sepsis. Differentialdiagnose des hämolytischen Transfusionszwischenfalls.