DOI: 10.12890/2021_002811

Fulminant Haemolysis Following Endoscopic Retrograde Cholangiopancreatography

Authors

  • Mário Bibi Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
  • Susana Viana Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
  • Cátia Leitão Gastroenterology Department, Hospital Pedro Hispano, Porto, Portugal
  • Rui Moço Internal Medicine Department, Hospital Pedro Hispano, Porto, Portugal
  • Yuliana O. Eremina Clinical Pathology Department, Hospital Pedro Hispano, Porto, Portugal; EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal

mariob@campus.ul.pt

Keywords

Clostridium perfringens, haemolysis, spherocytosis, endoscopic retrograde cholangiopancreatography, sepsis

Abstract

We report the case of a 77-year-old-man with a history of type 2 diabetes mellitus who underwent endoscopic retrograde cholangiopancreatography (ERCP) because of a gallstone in the common bile duct. Thirty-six hours after the procedure, the patient developed persistent fever and epigastric pain associated with de novo jaundice. Massive haemolysis (with exuberant spherocytosis) occurred and patient died in 3 hours. Clostridium perfringens was isolated in the blood cultures. Massive haemolysis associated with C. perfringens has a high mortality rate. Management involves a high index of suspicion after gastrointestinal procedures like ERCP, surgical consultation, antibiotic therapy, transfusion of red cell concentrates and, potentially, hyperbaric oxygen therapy.

View the entire article

Downloads

References

  1. Bari K, Aslanian HR, Pollak J, Reiner E, Salem RR, Taddei TH, et al. Emphysematous cholecystitis resulting in secondary biliary cirrhosis: a rare complication of endoscopic retrograde cholangiopancreatography. ACG Case Rep J 2013;1(1):51–54.
  2. Smit B, van der Helm MW, Bosma M, Hudig F, Russcher H. Massive hemolysis due toClostridium perfringens: a laboratory's perspective. Clin Chem Lab Med 2020;58(11):e295–e297.
  3. García Carretero R, Romero Brugera M, Vazquez-Gomez O, Rebollo-Aparicio N. Massive haemolysis, gas-forming liver abscess and sepsis due to Clostridium perfringens bacteraemia. BMJ Case Rep2016;2016:bcr2016218014.
  4. Hashiba M, Tomino A, Takenaka N, Hattori T, Kano H, Tsuda M, et al. Clostridium perfringens infection in a febrile patient with severe hemolytic anemia. Am J Case Rep 2016;17:219–223.
  5. Simon TG, Bradley J, Jones A, Carino G. Massive intravascular hemolysis from Clostridium perfringens septicemia: a review. J Intensive Care Med 2014;29(6):327–333.

Published

2021-10-08

How to Cite

1.
Bibi M, Viana S, Leitão C, Moço R, Eremina YO. Fulminant Haemolysis Following Endoscopic Retrograde Cholangiopancreatography. EJCRIM [Internet]. 2021 Oct. 8 [cited 2026 Nov. 3];8(9). Available from: https://ejcrim.com/index.php/ejcrim/article/view/2811

Most read articles by the same author(s)