ACUTE, MASSIVE HEMOGLOBINURIA OF OBSCURE CAUSE, WITH JAUNDICE AND ANEMIA

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Abstract
Hemoglobinuria is encountered in several well defined clinical conditions in which intravascular hemolysis occurs. In the present study an unusual case of acute, severe hemoglobinuria, accompanied by jaundice and slowly developing anemia, with final recovery, is reported. The clinical and laboratory findings in this case do not conform completely with those in any recognized type of hemolytic attack leading to hemoglobinuria. The diagnostic procedures utilized are discussed. The effects of posture and of exercise on the production of hemolysis were investigated. The continuation of the hemolytic attack for three weeks in this case gave an unusual opportunity for studying the quantitative aspects of the hemolysis. Hematologic studies were made; the plasma and the urine hemoglobin and the plasma bilirubin were studied quantitatively, and the urinary and fecal excretions of urobilinogen were measured. The total amount and rate of hemolysis during the attack have been calculated from certain of these data.