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 Table of Contents  
IMAGE IN HEMATOLOGY
Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 176-177

Investigating a single episode of cranberry-coloured urine in an indian male after blood transfusion


1 Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
2 Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India

Date of Submission26-Sep-2020
Date of Decision15-Nov-2020
Date of Acceptance08-Dec-2020
Date of Web Publication21-Oct-2021

Correspondence Address:
Dr. Manish Raturi
Department of Immunohematology and Blood Transfusion, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Swami Ram Nagar, Jolly Grant, Dehradun - 248 016, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_182_20

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How to cite this article:
Raturi M, Kala M, Kusum A. Investigating a single episode of cranberry-coloured urine in an indian male after blood transfusion. J Appl Hematol 2021;12:176-7

How to cite this URL:
Raturi M, Kala M, Kusum A. Investigating a single episode of cranberry-coloured urine in an indian male after blood transfusion. J Appl Hematol [serial online] 2021 [cited 2021 Dec 2];12:176-7. Available from: https://www.jahjournal.org/text.asp?2021/12/3/176/328716



An acute hemolytic transfusion reaction is the rapid lysis of the transfused red blood cells (RBCs) due to an immunologic mismatch between the donor and their recipient/s, within 24 h of blood transfusion. Besides, based on causative mechanisms, it may further be classified as an immunologic acute intravascular hemolytic transfusion reaction (AIHTR) or acute non-immunologic hemolytic transfusion reaction (ANIHTR) in nature.[1] Herein, we describe a clinical case of ANIHTR with the primary aim to do a root cause analysis (RCA), to know the possible reason for the same. The immuno-hematologic workup included RBC typing (ABO and Rh), direct anti-globulin test (DAT), indirect anti-globulin test, and antibody screening and identification using poly-specific (anti-IgG, -C3d) column agglutination test (Ortho Clinical Diagnostics, New Jersey, USA). A 16-year-old Indian male received a unit of packed RBC after undergoing an urgent orchiectomy of his left testis in our hospital. Barring one episode of cranberry-coloured urine [Figure 1], all the other clinical and laboratory findings, namely, an uneventful blood transfusion, no ABO and Rh discrepancy, no unexpected alloantibodies, and a negative DAT, ruled out AIHTR. His serum bilirubin was 4.75 mg/dL, lactate dehydrogenase was 813 U/L, and urine was positive for hemoglobin (confirmed on saturating 5-mL urine with 2.8-g ammonium sulfate with the appearance of clear supernatant post centrifugation).[2] On initiating RCA, the nursing staff had inadvertently kept the donor unit near the room heater on a window sill. They did so to avoid “giving cold blood transfusion” to the recipient. This, perhaps, gave us the clue as to why his urine was “cranberry coloured.” With a presumptive diagnosis of DAT-negative ANIHTR, he was given prednisolone 60 mg/m2/day. There was a dramatic improvement with the rise in his hematocrit to 29.5%. During discharge, he was clinically stable.
Figure 1: After the blood transfusion, the sample showed cranberry-coloured urine of the recipient as compared to the (a) pale yellow-coloured urine in the control sample

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Deborah T. Firestone and Christine Pitoco, Adverse effects of blood transfusion, In: Rudmann SV, Editor. 2nd ed. Philadelphia: Elsevier; 2005. p. 400-7.  Back to cited text no. 1
    
2.
Blondheim SH, Margoliash E, Shafrir E. A simple test for myohemoglobinuria (myoglobinuria). J Am Med Assoc 1958;167:453-4.  Back to cited text no. 2
    


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