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Acute gram-negative urosepsis mimicking an acute hemolytic transfusion reaction
1Department of Pathology and Laboratory Medicine, Veterans Affairs Medical Center, Syracuse, New York, USA.
Background:
The acute hemolytic transfusion reaction (AHTR) is one of the most feared complications of blood transfusion. Over the years, several clinical conditions, as well as errors in blood component preparation and administration, that mimic AHTR have been identified. This report describes a novel variation on the theme of pseudo-AHTR.
Case Report:
A 47-year-old diabetic man with drug-induced pancytopenia suddenly manifested severe shaking chills, flank pain, and back pain during a red cell transfusion. The passage of bright red urine immediately after the transfusion virtually confirmed for the clinicians administering the transfusion that an AHTR had occurred. In the laboratory, the hematuria was shown to be due principally to red cells and not to free hemoglobin. Further posttransfusion work-up showed a urinary tract infection and overwhelming bacterial sepsis with Escherichia coli.
Conclusion:
As a pseudo-AHTR, gram-negative bacterial sepsis of urinary tract origin may surpass other forms of sepsis. Urosepsis should be considered in the work-up of a suspected AHTR in a pancytopenic patient with a urinary tract infection.
Insights
Severe sepsis from a urinary tract infection can mimic acute hemolytic transfusion reactions (AHTR). This case highlights the importance of considering urosepsis in pancytopenic patients presenting with transfusion-related symptoms.
Area of Science:
- Hematology
- Infectious Disease
- Transfusion Medicine
Background:
- Acute hemolytic transfusion reaction (AHTR) is a serious complication of blood transfusions.
- Various conditions can mimic AHTR, necessitating careful differential diagnosis.
- This report details a unique presentation of a pseudo-AHTR.
Observation:
- A 47-year-old diabetic patient with drug-induced pancytopenia developed chills, flank, and back pain during red cell transfusion.
- Bright red urine post-transfusion initially suggested AHTR.
- Laboratory analysis revealed hematuria primarily from red blood cells, not free hemoglobin.
Findings:
- The patient was diagnosed with a urinary tract infection and overwhelming gram-negative bacterial sepsis (Escherichia coli).
- The clinical presentation mimicked AHTR but was ultimately attributed to urosepsis.
- Hematuria was a key symptom, originating from the infection rather than hemolysis.
Implications:
- Gram-negative bacterial sepsis, particularly urosepsis, can present as a pseudo-AHTR.
- Urosepsis should be a critical consideration in the diagnostic work-up of suspected AHTR in pancytopenic patients with urinary tract infections.
- This finding expands the spectrum of conditions that can mimic AHTR, emphasizing comprehensive patient evaluation.
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