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Hemolysis and Hemoglobinuria Following Angiography

1969; Radiological Society of North America; Volume: 92; Issue: 2 Linguagem: Inglês

10.1148/92.2.329

1527-1315

Lawrence S. Cohen, Juha P. Kokko, Willis H. Williams,

Cardiac Arrhythmias and Treatments

Cardiac catheterization with angiography is often essential in the diagnosis of congenital and acquired heart disease. The complications associated with the technic have been reviewed previously (1–7). They have, in general, been related to arrhythmia, infection, perforation of the heart and great vessels, cardiac tamponade, bleeding, thrombosis, catheter or wire migration, embolism, and allergic and pyrogenic reactions. Although angiography has been routinely performed for over fifteen years, to our knowledge only one study (8) mentions hemolysis and hemoglobinuria following angiocardiography of the heart. These occurred in 3 infants, six, eight, and nine days old. The present report documents 3 additional cases in children. Case Reports Case I: M. M., a l2-year-old Caucasian female weighing 37.7 kg, was admitted for evaluation of a cardiac murmur. The cardiovascular examination revealed a grade 4∕6 apical holosystolic murmur with midsystolic accentuation. The chest roentgenogram and the electrocardiogram were normal. Prior to catheterization, the hemoglobin was 13.4 g∕100 cc, hematocrit 43.5 per cent, platelet count 235,000∕mm3, white count 6,500 cells∕mm3; and urinalysis normal. The child underwent right heart and transseptal left heart catheterization on the third hospital day, at which time a diagnosis of idiopathic hypertrophic subaortic stenosis was made. After the initial hemodynamic measurements were obtained 40 ml of sodium and meglumine diatrizoate was injected for left ventriculography. A transient episode of nausea, vomiting, and headache immediately followed. The first postcatheterization urine sample one hour later was brown, had a positive reaction for hemoglobin, a specific gravity of 1.062 and no red cells on microscopic examination. The serum hemoglobin was 2.9 mg∕100 cc (normal value <0.58 mg∕100 cc) (9). Intravenous fluids were administered to maintain a brisk diuresis, and the urine became negative for hemoglobin thirty-six hours after the catheterization. Eighteen hours after the catheterization the serum haptoglobin was 20 mg∕100 cc (normal 50–100 mg∕100 cc), and total bilirubin was 2.0 mg∕100 cc (normal value <1.0 mg∕100 cc) with a direct bilirubin of 0.12 mg∕100 cc. Fifty-two hours after the catheterization the serum haptoglobin was 46 mg∕100 cc. The total bilirubin had dropped to 0.9 mg∕100 cc with subsequent return to 0.6 mg∕100 cc at the time of discharge on the sixth hospital day. The urinalysis was completely normal at the time of discharge, and the patient felt entirely well. Case II: S.V., an 8-year-old Caucasian male, was admitted for evaluation of transposition of the great arteries.