ACUTE INTRAVASCULAR HEMOLYSIS IN CLOSTRID IUM-PERFRINGENS SEPTICEMIA - DIFFERENTIAL-DIAGNOSIS OF HEMOLYTIC TRANSFUSION MISMATCH

A 19-year-old man with acute lymphoblastic leukaemia developed fever, general deterioration and somnolence 3 days after a cycle of cytostati c treatment. He had anaemia (haemoglobin 6.6 g/dl), leukopenia (100/mu l) and thrombocytopenia (7,000/mul). As an acute septicaemia was suspe cted he received broad spectrum antibiotic therapy, together with two units of red cell and platelet concentrates. However, his condition wo rsened rapidly over the next 5 hours (meningism, seizures, fever to 41 .1-degrees-C, dyspnoea). Another blood count revealed severe haemolysi s. Computed tomography of the skull demonstrated multilocular intrapar enchymal gas formation. Although the antibiotic treatment was extended the patient died several hours later. Retrospective examination for s uspected transfusion mismatch provided no evidence for erythrocyte inc ompatibility. But there was liberation of T-antigen as sign of a bacte rial cause of erythrocyte damage. An anaerobic blood culture grew Clos tridium perfringens. This case demonstrates that acute intravascular h aemolysis in septicaemia should be considered in the differential diag nosis of transfusion mismatch.