E. Strobel et al., ACUTE INTRAVASCULAR HEMOLYSIS IN CLOSTRID IUM-PERFRINGENS SEPTICEMIA - DIFFERENTIAL-DIAGNOSIS OF HEMOLYTIC TRANSFUSION MISMATCH, Deutsche Medizinische Wochenschrift, 119(11), 1994, pp. 375-379
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.