[Reaction to blood transfusion recognized by sudden onset of red urine during operation]

A 54-year-old woman was scheduled for the total hip replacement. She was anesthetized with continuous epidural blockade combined with general anesthesia using oxygen, sevoflurane, and propofol. When she received her autologous blood transfusion, we noticed the obstruction of the venous line, and pushed 30 ml of blood with 10 ml syringe. However, it was difficult to return her blood through the venous line. At that time, a sudden onset of red urine without any special symptom occurred. We investigated the cause of the red urine, whether this urine is attributable to hemoglobinuria, myoglobinuria, or porphyria. According to the patient's symptoms during and after the operation, and blood as well as urine examination, a microfilter in the venous line might have led to red blood cell destruction. The filter-induced hemolysis can be life-threatening especially in a child. We conclude that the early recognition and management of reactions associated with blood transfusion is essential during the operation.