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Beljan A, Blagec V, Bronic A, Pavić M. Hematological investigations in a case of intravascular hemolysis due to Clostridium perfringens infection. Biochem Med (Zagreb) 2024; 34:021001. [PMID: 38665872 PMCID: PMC11042560 DOI: 10.11613/bm.2024.021001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/16/2024] [Indexed: 04/28/2024] Open
Abstract
A patient presented with fever, severe pain and edematous tight due to hip trauma and was scheduled for urgent fasciotomy. Following physical examination, laboratory analyses were requested, and results revealed anemia and severe infection. As the patient's condition was serious, a new set of samples was sent to the laboratory four hours later. Following centrifugation, severely hemolyzed dark-colored serum and plasma samples were obtained and in vitro hemolysis was suspected. The collection of samples was repeated, but a new set of samples was also hemolyzed with a significant decrease in the hemoglobin value. At that point, in vivo hemolysis was suspected, and samples were processed according to standard laboratory procedures for hemolytic samples. Following confirmation of the gas gangrene diagnosis by clinicians, the cause of hemolysis was attributed to the cytotoxic activity of α-toxin produced by the anaerobic gram-positive bacterium Clostridium perfringens. An insight into the laboratory procedure that could help to narrow down the causes of hemolysis and single out C. perfringens as a cause of intravascular hemolysis was given.
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Affiliation(s)
- Anamarija Beljan
- Clinical Institute of Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Viktorija Blagec
- Clinical Institute of Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Ana Bronic
- Clinical Institute of Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
| | - Marina Pavić
- Clinical Institute of Chemistry, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
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Reffo I, Domini M, Cevolani M, Del Fabro G, Rufolo D, Venturini S, Pinciroli L, Tonin D, Avolio M, Crapis M, Basaglia G, Balbi M, Nadalin G. Clostridium perfringens-induced massive hemolysis treatment with blood purification to target toxins: a case report. CEN Case Rep 2024:10.1007/s13730-024-00857-3. [PMID: 38436873 DOI: 10.1007/s13730-024-00857-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Clostridium perfringens can rarely cause severe systemic infections, usually from an abdominal source, associated with massive hemolysis, which is usually fatal. Hemolytic anemia and acute renal injury resulting from toxin action are critical for the development of multiple organ dysfunction syndrome (MODs), making this condition a real emergency, requiring multispecialty skills and aggressive multimodal therapies. We herein describe a case of septic shock from acute cholecystitis with massive hemolysis caused by C. perfringens in a 55 year-old man that was successfully treated with early blood purification and continuous renal replacement therapy (CRRT) along with antibiotic therapy and surgery. The effect of the enormous amount of toxins produced by Clostridium which elicit a strong cytokine response and the damage caused by the hemolysis products are the main pathogenetic mechanisms of this rare but lethal clinical entity. The main goal of treatment is to remove toxins from plasma, block toxin action, and further production by achieving bacterial killing with antimicrobial agents and controlling the infectious focus, remove waste products and prevent or limit multiorgan damage. Blood purification techniques play an important role due to a strong pathophysiological rationale, as they can remove toxins and cytokines as well as cell-free products from plasma and also replace renal function. Although this condition is rare and robust data are lacking, blood purification techniques for C. perfringens-induced massive hemolysis are promising and should be further explored.
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Affiliation(s)
- I Reffo
- Anaesthesia and Intensive Care Department, Azienda Sanitaria Friuli Occidentale "Santa Maria Dei Battuti" Hospital, Via Savorgnano 2, San Vito al Tagliamento, 33078, Pordenone, Italy.
| | - M Domini
- Anaesthesia and Intensive Care Department, Azienda Sanitaria Friuli Occidentale "Santa Maria Dei Battuti" Hospital, Via Savorgnano 2, San Vito al Tagliamento, 33078, Pordenone, Italy
| | - M Cevolani
- Internal Medicine Department, Azienda Sanitaria Friuli Occidentale "Santa Maria dei Battuti" Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - G Del Fabro
- Infectious Diseases Department, Azienda Sanitaria Friuli Occidentale "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - D Rufolo
- Anaesthesia and Intensive Care Department, Azienda Sanitaria Friuli Occidentale "Santa Maria Dei Battuti" Hospital, Via Savorgnano 2, San Vito al Tagliamento, 33078, Pordenone, Italy
| | - S Venturini
- Infectious Diseases Department, Azienda Sanitaria Friuli Occidentale "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - L Pinciroli
- General Surgery Department, Azienda Sanitaria Friuli Occidentale "Santa Maria dei Battuti" Hospital, San Vito Al Tagliamento, Pordenone, Italy
| | - D Tonin
- General Surgery Department, Azienda Sanitaria Friuli Occidentale "Santa Maria dei Battuti" Hospital, San Vito Al Tagliamento, Pordenone, Italy
| | - M Avolio
- Microbiology Department, Azienda Sanitaria Friuli Occidentale "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - M Crapis
- Infectious Diseases Department, Azienda Sanitaria Friuli Occidentale "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - G Basaglia
- Microbiology Department, Azienda Sanitaria Friuli Occidentale "Santa Maria degli Angeli" Hospital, Pordenone, Italy
| | - M Balbi
- Internal Medicine Department, Azienda Sanitaria Friuli Occidentale "Santa Maria dei Battuti" Hospital, San Vito al Tagliamento, Pordenone, Italy
| | - G Nadalin
- Anaesthesia and Intensive Care Department, Azienda Sanitaria Friuli Occidentale "Santa Maria Dei Battuti" Hospital, Via Savorgnano 2, San Vito al Tagliamento, 33078, Pordenone, Italy
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Guillaume L, Chapelle V, Peeraer S, Streel C, Deneys V. Biological investigations of transfusion reactions: contribution of symptom-based decisional algorithms. Transfus Clin Biol 2022; 30:195-204. [PMID: 36273773 DOI: 10.1016/j.tracli.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/16/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES While transfusion is a common and safe therapeutic procedure in health care facilities, transfusion reactions can occur, whether acute or delayed, mild or life-threatening. In face of these reactions, the biological analysis laboratory plays a central role in their diagnosis. The objective of this article is to develop decisional algorithms for laboratory tests to be performed according to the clinical symptoms developed by the patient during or after transfusion. METHODS Based on the information collected by reviewing the literature and the procedures used in our hospital, we then developed biological investigation algorithms according to the symptoms presented by the patient, rather than the presumed reaction. RESULTS AND CONCLUSION We have developed symptom-based algorithms for acute transfusion reactions management that streamline laboratory testing and simplify the differential diagnosis.
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Ehrenschwender M, Muehlenberg K, Ambrosch A. [52 year old female with sepsis and severe hemolysis]. Dtsch Med Wochenschr 2021; 146:1445-1446. [PMID: 34741289 DOI: 10.1055/a-1639-9104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Martin Ehrenschwender
- Institut für Labormedizin, Mikrobiologie und Krankenhaushygiene, Krankenhaus Barmherzige Brüder, Regensburg
| | - Klaus Muehlenberg
- Klinik für Gastroenterologie und interventionelle Endoskopie, Krankenhaus Barmherzige Brüder, Regensburg
| | - Andreas Ambrosch
- Institut für Labormedizin, Mikrobiologie und Krankenhaushygiene, Krankenhaus Barmherzige Brüder, Regensburg
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Bibi M, Viana S, Leitão C, Moço R, Eremina YO. Fulminant Haemolysis Following Endoscopic Retrograde Cholangiopancreatography. Eur J Case Rep Intern Med 2021; 8:002811. [PMID: 34671578 DOI: 10.12890/2021_002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/13/2021] [Indexed: 11/05/2022] Open
Abstract
We report the case of a 77-year-old-man with a history of type 2 diabetes mellitus who underwent endoscopic retrograde cholangiopancreatography (ERCP) because of a gallstone in the common bile duct. Thirty-six hours after the procedure, the patient developed persistent fever and epigastric pain associated with de novo jaundice. Massive haemolysis (with exuberant spherocytosis) occurred and patient died in 3 hours. Clostridium perfringens was isolated in the blood cultures. Massive haemolysis associated with C. perfringens has a high mortality rate. Management involves a high index of suspicion after gastrointestinal procedures like ERCP, surgical consultation, antibiotic therapy, transfusion of red cell concentrates and, potentially, hyperbaric oxygen therapy. LEARNING POINTS Endoscopic retrograde cholangiopancreatography (ERCP) can be complicated by Clostridium perfringens bacteraemia with devastating consequences.C. perfringens infection should be suspected in an icteric, febrile patient with abdominal pain, especially if intravascular haemolysis is present.Management of intravascular haemolysis and inflammation in a patient following ERCP should be multidisciplinary, involving surgery when needed and potentially hyperbaric oxygen therapy; penicillin or penicillin-derived antibiotics associated with clindamycin or metronidazole are the mainstays of antibiotic therapy.
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Affiliation(s)
- Mário Bibi
- Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
| | - Susana Viana
- Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
| | - Cátia Leitão
- Gastroenterology Department, Hospital Pedro Hispano, Porto, Portugal
| | - Rui Moço
- Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
| | - Yuliana O Eremina
- Clinical Pathology Department, Hospital Pedro Hispano, Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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