Case 704 -- Two patients with red urine

Contributed by Lisa Radkay, MD and Lirong Qu, MD, PhD


The patient was a 70 year old female with a past medical history of degenerative scoliosis, hypertension, and anxiety. The patient's social history was negative for alcohol and tobacco. Her medications included Zoloft, Percocet, Metoprolol, Cymbalta, Amlodipine, and Lyrica. The patient had spinal fusion surgery for her degenerative scoliosis. During the surgery, the patient lost three liters of blood. The patient was group O positive with a negative antibody screen and received crossmatched blood products including 7 units of RBCS, 3 units FFP, one 6 units of whole blood platelet concentrates, as well as 7 liters of crystalloid, and 675 ml from the cell saver. Days following the surgery, the patient was recovering well and plans for discharge were being made.

Ten days after the surgery the patient had red urine, abdominal pain, altered mental status and dysuria. Urinalysis showed brown urine, large amount of blood, RBCs 6 to 10, and moderate bilirubin, negative for leukocyte esterase, nitrite, and bacteria. Urine culture was negative.

Table 1: Case 1 Laboratory Workup. Values in parentheses pertain to the laboratory reference ranges

Table 2: Case 1 Blood Bank Workup

Other laboratory testing such as reticulocyte count and hemoglobinuria were not measured. The patient received 2 units of crossmatched RBCs, Jkb antigen negative and her hemoglobin remained stable. She was discharged one week after the start of the hematuria.


The patient was a 57 year old female with a past medical history of newly diagnosed colon cancer on biopsy. Her social history is negative for alcohol and tobacco. The patient was not on any medications. She underwent a right colon resection and received one unit of crossmatched RBCs, after the transfusion the patient's hemoglobin was 7.8 gm/dL. Over two days, the patient's hemoglobin dropped to 7.1 gm/dL and two additional units of RBCs were ordered.

During the transfusion of 200 ml of RBCs of the first unit, the patient went from afebrile to a temperature of 103 F, , tachycardia (heart rate from 85 to 110 beats per minute), blood pressured decreased from 110/90 to 90/65 mmHg, and decreased oxygen saturation from 95 % to 69 % requiring supplemental oxygen. The patient experienced chills, dyspnea and cherry colored urine. The transfusion was stopped immediately.

Table 3: Case 2 Laboratory Workup. Values in parentheses pertain to the laboratory reference ranges

Table 4: Case 2 Blood Bank Workup

The patient was given two Jka antigen negative crossmatched units of RBCs and recovered well. The patient was discharged five days later.


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