title: Acute Hemolysis in the Emergency Department: Think about Clostridium perfringens!
abstract: Clostridium perfringens (CP) gives several clinical settings, from an asymptomatic to a massive intravascular hemolysis. We report a case of fatal intravascular hemolysis due to CP septicemia having a hepatic supposed starting point in the emergency department. Like in many cases, the diagnosis was made when patient had already gone into shock and died. The CP septicemia often complicated the course of the digestive or genital pathologies. The alpha toxin can damage the structural integrity of the red cell membrane by means of a phospholipase activity. Nevertheless, a massive intravascular hemolysis arises only rarely in this septicemia, only from 7 to 15% of the cases. The emergency physician has to think about this complication in case of hemoglobinuria and/or signs of hemolysis associated with a septic syndrome. An immediate antibiotic treatment adapted as well as the symptomatic treatment of the spread intravascular coagulation could improve the survival of these patients.
authors.affiliation: Department of Emergency Medicine, SAMU/SMUR, Pellegrin Medical University Hospital, 33 000 Bordeaux, France.
authors.forename: Roustit
authors.initials: R
authors.lastname: Cécilia
authors.forename: Vallé
authors.initials: V
authors.lastname: Baptiste
authors.forename: Clouzeau
authors.initials: C
authors.lastname: Benjamin
authors.forename: Heydel
authors.initials: H
authors.lastname: Virginie
authors.forename: Valdenaire
authors.initials: V
authors.lastname: Guillaume
authors.forename: Revel
authors.initials: R
authors.lastname: Philippe
authors.forename: Biais
authors.initials: B
authors.lastname: Matthieu