Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 2314  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Article Submission Resources Sections Etcetera Contact
 
  NAVIGATE Here 
  Search
 
 :: Next article
 :: Previous article 
 :: Table of Contents
  
 RESOURCE Links
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (61 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  References
 ::  Article Figures

 Article Access Statistics
    Viewed5407    
    Printed95    
    Emailed1    
    PDF Downloaded177    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


 


 
LETTER
Year : 2008  |  Volume : 54  |  Issue : 2  |  Page : 168-169

Hemoglobin electrophoresis: An important investigation in the evaluation of patients with massive hematuria


Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

Correspondence Address:
I I Ulasi
Renal Unit, Department of Medicine, University of Nigeria Teaching Hospital, Enugu
Nigeria
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0022-3859.40793

Rights and Permissions




How to cite this article:
Ulasi I I, Ijoma C K. Hemoglobin electrophoresis: An important investigation in the evaluation of patients with massive hematuria. J Postgrad Med 2008;54:168-9

How to cite this URL:
Ulasi I I, Ijoma C K. Hemoglobin electrophoresis: An important investigation in the evaluation of patients with massive hematuria. J Postgrad Med [serial online] 2008 [cited 2020 Oct 21];54:168-9. Available from: https://www.jpgmonline.com/text.asp?2008/54/2/168/40793


Sir,

We report a case of a 34-year-old Nigerian woman who presented at the renal clinic of a University Hospital in Nigeria in July 2003 with a history of sudden onset of painless, profuse and persistent hematuria. She had fever and rigors at the onset of illness which were relieved by antipyretics. There were no other urinary symptoms; neither did she have sore throat, skin rash, abdominal pains nor bone pains. She denied use of any herbal mixtures or abuse of analgesics. She was engaged in subsistent farming and lived in the village.

Physical examination revealed no abnormality except moderate anemia. The significant findings from laboratory investigations were: mild proteinuria, severe hematuria. Schistosoma ova were not seen in urine microscopy. Abdominal ultrasonography revealed no abnormality but the intravenous urography (IVU) was remarkable with features suggestive of pyelitis. There was blunting of the calyces with filling defects (blood clots) in both pelvises. Also noted were kinking of the right ureter [Figure - 1] and ureterocele in the left ureter [Figure - 2]. There was no renal cyst or evidence of neoplasm. Urine culture yielded no growth after 48h (she had previously been treated with antibiotics prior to presentation) and the fasting blood sugar was normal (5.6mmol/l). Hemoglobin electrophoresis revealed sickle cell trait (HbAS) with percentages of Hb A and Hb S 60% and 40%, respectively, and hemoglobin was 8.5g/dl. There were no bleeding or clotting abnormalities. The platelet count was above 250,000/cumm. She was given a 10-day course of ofloxacin tablets, hematinics and advised to take lots of fluids. Symptoms resolved within five days of commencing therapy and repeat urine examination after two weeks showed no abnormality.

Though sickle cell trait is asymptomatic, it can be responsible for renal abnormalities such as gross hematuria. [1] Factors that predispose a sickle cell trait patient to hematuria include- urinary tract infection (UTI), trauma, instrumentation and analgesic consumption. Other causes of hematuria in sickle cell disease include renal medullary carcinoma [2] and use of toxic/herbal agents.

The bleeding can be massive with clots as was the case with our patient. Duvic et al. , [1] also documented clots in some patients with sickle cell trait that they studied. The prevalence of hematuria in sickle cell disease varies from nil to 30% in some series. [3],[4] Remarkably, there was involvement of both kidneys in our patient. This occurs in only about 10% of cases. [5]

This patient's hematuria may have been precipitated by UTI despite negative urine culture. The negative culture result could be attributed to the antibiotics she had received prior to presentation. In addition, the resolution of hematuria within five days of commencing antibiotic therapy and the evidence of pyelitis in the IVU suggest the presence of upper UTI as the precipitating factor.

The incidence of sickle cell trait in the African black population is between 20% and 40%. In Nigeria, it is currently estimated that about 25% of adults have sickle cell trait. The epidemiological implication is obvious. This case underscores the need for sickling test and hemoglobin electrophoresis in the evaluation of every patient with unexplained hematuria, especially black patients.

 
 :: References Top

1.Duvic C, Bordier L, Hertig A, Ridel C, Didelot F, Herody M, etal . Macroscopic haematuria associated with sickle cell anaemia trait: Report of ten cases. Rev Med Intern 2002;23:690-5.  Back to cited text no. 1    
2.Baig MA, Lin YS, Rasheed J, Mittman. Renal medullareyt carcinoma. J Natl Med Assoc 2006;98:1171-4.  Back to cited text no. 2    
3.Kar BC. Clinical profile of sickle cell trait. J Assoc Physicians India 2002;50:1368-71.  Back to cited text no. 3  [PUBMED]  
4.Sesso R, Almeida MA, Fiqueirodo MS, Bordin JO. Renal dysfunction in patients with sickle cell anaemia or sickle cell trait. Braz J Med Biol Res 1998;31:1257-62.  Back to cited text no. 4    
5.Statius van Eps. Sickle cell disease and Kidney. In : The Oxford textbook of Clinical Nephrology. Cameron S, Davison AM, Grunfeld JP, Kerr D, Ritz E, editors. Oxford University Press: 1992. p. 700-20.  Back to cited text no. 5    


    Figures

  [Figure - 1], [Figure - 2]

This article has been cited by
1 Severe Anemia in an Adolescent Male With Sickle Cell Trait
Adrian Chapa-Rodriguez,Dipti Dighe,Lisa Giordano
Journal of Pediatric Hematology/Oncology. 2015; 37(1): e60
[Pubmed] | [DOI]
2 Detección de un caso de rasgo falciforme por medio del examen del sedimento de orina
Rafael Cartagena,Consuelo Tormo,José Francisco Sánchez,Alberto Romero
Medicina Clínica. 2012; 139(6): 273
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow