Causes of hemoglobinuria after AngioJet mechanical thrombectomy / 中国介入影像与治疗学

Objective To investigate the causes and factors of hemoglobinuria in patients with thrombosis after AngioJet mechanical thrombectomy.Methods The clinical data of 16 patients with thrombosis treated by AngioJet thrombectomy system were retrospectively analyzed.Nine patients with hemoglobinuria during the procedure were included in group A,while 7 patients without hemoglobinuria in group B.The type of surgical procedure,time of intraoperative aspiration and the thrombus volume were compared between both groups.Results Nine (9/16,56.23 ％) of 16 patients were found hemoglobinuria during and after AngioJet mechanical thrombectomy.There were no statistically significant differences in surgical approaches (x2 =1.667,P=0.197),the time of intraoperative aspiration ([320.11±108.80]s vs [265.29±31.46]s,t=0.741,P=0.457),the thrombus volume (x2=0.442,P=0.506) between both groups.No renal function failure were noted directly relating to the use of the AngioJet thrombectomy device.Condusion There are many factors influenced the occurrence of hemoglobinuria in the patients after AngioJet thrombectomy.It can be reduced by using reasonable type of intraoperative aspiration,controled time of aspiration and active perioperative symptomatic treatment.

Hemólisis inducida por el ejercicio: relación entre el nivel de actividad de la glucosa-6-fosfato deshidrogenasa y el grado de hemólisis / Exercise induced hemolysis: relation between the activity of glucose-6-phosphate dehydrogenase and the magnitude of the hemolysis

Introducción: La oxidación, al igual que la hemólisis asociadas con el ejercicio tanto moderado como extenuante han sido condiciones objeto de múltiples estudios, pero sólo en algunos recientes se evaluó cómo las variaciones en la capacidad de los mecanismos antioxidantes enzimßticos eritrocitarios específicos y genéticamente determinados, condicionan distintos grados de susceptibilidad a la hemólisis inducida por el ejercicio, pero esos trabajos se han hecho sobre todo en individuos no sedentarios y con deficiencia franca de la enzima G6PD. Objetivo: El propósito de este trabajo fue determinar si existe o no relación entre el nivel de actividad de la enzima eritrocitaria G6PD y el grado de hemólisis inducida por el ejercicio en hombres adultos sedentarios en apariencia sanos, luego de un tiempo experimental de ejercicio moderado pre-extenuante y equivalente en modalidad y magnitud. Metodología: Se evaluaron 25 voluntarios hombres, sedentarios, en apariencia sanos; se les aplicó una sesión de ejercicio, sobre un cicloergómetro, de una hora de duración, a 70% del VO2pico previamente hallado. Sobre la base de la concentración de hemoglobina plasmßtica se calculó el porcentaje de hemólisis y la haptoglobina consumida, tomando en cuenta la variación en el plasma de la haptoglobina y la hemólisis intravascular inmediatamente después y hasta tres horas luego del ejercicio. Resultados: Se pudo determinar que los individuos presentaron, con base en la determinación de Hb plasmßtica libre, % de hemólisis y consumo de haptoglobina, hemólisis intravascular durante y hasta por lo menos tres horas post-ejercicio.

Introduction: Oxidation and hemolysis associated with physical exercise, moderate and severe, have been studied by several investigations, but only in the most recent have been evaluated how the variations of the genetic determined mechanisms for antioxidative enzymatic erytrocytic capacity, contribute to establish different levels of susceptibility to the hemolysis induced trough exercise, however, those studies have mainly been made on non sedentary subjects with deficiency of enzyme G6PD. Purpose: The objective of this study was to establish if there is either yes or not a relationship between the activity level of erythrocytic activity of the enzyme G6PD and the hemolysis grade, induced by exercise in adult healthy sedentary men and after an experimental bout of moderate exercise pre-exhaustive and equivalent in modality and intensity. Methods: Twenty five men, sedentary and seemingly healthy, were evaluated after an exercise session of 1 hour over a cycloergometer, with 70% of VO2peak previously founded. On the basis of plasmatic Hb, the proportion of hemolysis and haptoglobin consumed, taking in account the variation of plasma haptoglobin and intravascular hemolysis after and at least three hours post-exercise, were calculated. Results: The experimental subjects presented laboratory evidence (free plasma hemoglobin, percentage of hemolysis and haptoglobin) of intravascular hemolysis immediately after and at least past three hours of exercise bouts.

Two Cases of Acute Renal Failure Complicating Paroxysmal Nocturnal Hemoglobinuria in Children

Paroxysmal nocturnal hemoglobinuria(PNH) is an acquired hematologic disorder characterized by intravascular hemolysis, nocturnal hemoglobinuria, thrombotic events and bone marrow failure. It rarely occurs in children and can be complicated by acute renal failure(ARF). Here, we present two cases of ARF complicating PNH which has not been reported yet in Korean children. We suggest that PNH should be considered in differential diagnosis of ARF in children associated with intravascular hemolysis.

Insuficiencia renal aguda por picadura de hormigas del palo santo (pseudomyrmex spp) / Acute renal failure due to the bite of ants of palo santo (pseudomyrmex spp)

La Insuficiencia Renal Aguda (IRA) es una complicación inusual de la picadura por hormigas secundaria a un daño tóxico isquémico con Necrosis Tubular Aguda. Los 2 pacientes presentados fueron transferidos del trópico Cochabambino al Hospital Clínico Viedma, experimentaron una reacción alérgica, hemólisis intravascular, rabdomiólisis e IRA posterior a un masivo ataque de las hormigas que habitan en el tronco del "Palo Santo" al que fueron atados por varias horas. Se dispone de pocos reportes acerca del compromiso renal en estos casos, así como de los mecanismos patogénicos implicados. Gracias al apoyo dialítico oportuno los pacientes mejoraron su condición clínica recuperando ambos la función renal en el lapso de 2 semanas de iniciada la hemodiálisis.

Acute Renal Insufficiency (ARI) is an unusual complication caused by the puncture of ants that falls into a secondary ischemic toxic damage with an Acute Tubular Necrosis. The two patients presented were transferred from the tropic of Cochabamba state to the Viedma Hospital, they have experienced an allergic reaction, intravascular hemolysis, rhabdomyolysis and ARI caused by the massive attack of ants that inhabit the trunk of the "Palo Santo" where they were tied by several hours. Few reports are known about the affectedness of the kidney organ, as well as the implied pathogenic mechanisms. The patients improved their clinical condition thanks to the opportune support; both recovered the kidney function after 2 weeks from the initiated hemodialysis.

A Case of Massive Intravascular Hemolysis Associated with Clostiridium perfringens Sepsis

Clostridium perfringens is an anaerobic, gram-positive rod that inhabits the soil and the intestinal tracts of many animals, including humans. C. perfringens is a major cause of food poisoning, traumatic or nontraumatic myonecrosis, clostridial cellulitis, gangrenous cholecystitis, sepsis or bacteremia, and intravascular hemolysis. Massive intravascular hemolysis is a rare complication of C. perfringens septicemia and has a high mortality rate with an extremely rapid progression. Therefore, aggressive treatment is required as soon as the diagnosis is made. In this study, we report a case of massive intravascular hemolysis due to C. perfringens septicemia in a 34-year-old man with liver cirrhosis.

Death due to Sepsis in Emphysematous Cholecystitis

Emphysematous cholecystitis is an uncommon but life-threatening form of acute cholecystitis that is caused by gas- forming organisms such as Clostridia species, Escherichia coli, Klebsiella, and anaerobic streptococci. Emphysematous cholecystitis frequently affects elderly men, and is associated with diabetes mellitus. The risk of gangrene and perforation of the gallbladder is relatively high in emphysematous cholecystitis patients, and there is a 15% mortality compared with the 4% for acute cholecystitis. We report here a case of emphysematous cholecystitis in a 56-year-old woman, who had diabetes for 10 months. The patient presented with right upper abdominal pain and chills. The abdominal plain film showed a mottled gas pattern in the right upper quadrant. The laboratory value revealed massive intravascular hemolysis. The patient deteriorated rapidly during the course of the evaluation and required cardiopulmonary resuscitation. Despite the attempts to resuscitate the patient, she died 9 hours after the onset of symptoms.

Measurement of Plasma Hemoglobin in Hyperbilirubinemia / 대한진단검사의학회지

BACKGROUND: Plasma hemoglobin has usually been determined by the spectrophotometric method of Harboe. This method is known to show interference by bilirubin and turbidity, although the method is easy. In order to correct the spurious increase of plasma hemoglobin concentration caused by hyper-bilirubinemia, we compared plasma hemoglobin assays by using various spectrophotometry methods and tried to select the method of minimal interference. METHODS: We performed five plasma hemoglobin assays based on spectrophotometry (Harboe, Noe, Kahn, Fairbanks 1, and Fairbanks 2) and three bilirubin assays (Fairbanks 1, Fairbanks 2, and bilirubin oxidase) on 100 patients without hemolysis and lipemia. RESULTS: The method of Kahn, et al. and the method 2 of Fairbanks, et al. of the plasma hemoglobinassay seemed to minimally interfere with the bilirubin. Only plasma oxyhemoglobin was measured by the method of Kahn, et al .; on the other hand, plasma hemoglobin and bilirubin could be measured one at a time by the method 2 of Fairbanks, et al. Method 1 of Fairbanks, et al. seemed to interfere extremely with bilirubin. CONCLUSIONS: Method 2 of Fairbanks, et al. is the first choice for the plasma hemoglobin assay considering the interference with bilirubin.

Effect of increases in plasma lactate concentration on intravascular hemolysis during exhaustive exercise / 体力科学

A study was performed to examine the effect of plasma lactate concentration on intravascular hemolysis during exercise. Seven men performed maximal and submaximal exercise on a cycle ergometer. The maximal exercise was performed as a graded exercise until exhaustion. The mean performance time of the maximal exercise was 15 min and 4 s. The submaximal exercise was performed for 30 min at 50% HRmax. Blood samples were obtained before, immediately after, and one hour after exercise. Plasma lactate concentration, hematocrit (Ht), and serum haptoglobin concentration (Hp) were measured. Hp was corrected by Ht for hemoconcentration and expressed as HpC. Plasma lactate concentration was elevated significantly (p<0.05) immediately after maximal exercise, and returned to the baseline values one hour after exercise, whereas plasma lactate concentration did not change after submaximal exercise. Hp and HpC did not change even after maximal exercise. These results suggest that the elevation in plasma lactate concentration may not affect intravascular hemolysis during exercise.