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Open Access Highly Accessed Case report

Percussion hemoglobinuria - a novel term for hand trauma-induced mechanical hemolysis: a case report

Monica Vasudev2, Barbara A Bresnahan1, Eric P Cohen1, Parameswaran N Hari3, Sundaram Hariharan1 and Brahm S Vasudev1*

Author Affiliations

1 Division of Nephrology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee WI 53226, USA

2 Division of Allergy and Clinical Immunology, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Milwaukee, WI 53226, USA

3 Division of Hematology and Oncology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226, USA

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Journal of Medical Case Reports 2011, 5:508  doi:10.1186/1752-1947-5-508

Published: 7 October 2011

Abstract

Introduction

Extracorpuscular hemolysis caused by mechanical trauma has been well described in relation to lower extremity use, such as in soldiers and runners. Terms such as "march hemoglobinuria", "foot strike hemolysis" and "runners hemoglobinuria" have previously been coined and are easily recalled. Newer cases, however, are being identified in individuals vigorously using their upper extremities, such as drum players who use their hands to strike the instrument. Given the increased recognition of upper extremity-related mechanical hemolysis and hemoglobinuria in drummers, and the use of hand drumming worldwide, we would like introduce a novel term for this condition and call it "percussion hemoglobinuria".

Case presentation

A 24-year-old Caucasian man presented with reddish brown discoloration of his urine after playing the djembe drum. Urine examination after a rigorous practice session revealed blood on the dipstick, and 0 to 2 red blood cells per high power field microscopically. The urine sample was negative for myoglobulin. Other causes of hemolysis and hematuria were excluded and cessation of drum playing resulted in resolution of his symptoms.

Conclusions

The association of mechanical trauma-induced hemoglobinuria and playing hand percussion instruments is increasingly being recognized. We, however, feel that the true prevalence is higher than what has been previously recorded in the literature. By coining the term "percussion hemoglobinuria" we hope to raise the awareness of screening for upper extremity trauma-induced mechanical hemolysis in the evaluation of a patient with hemoglobinuria.