Vasudev Monica, Bresnahan Barbara A, Cohen Eric P, Hari Parameswaran N, Hariharan Sundaram, Vasudev Brahm S
Division of Nephrology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee WI 53226, USA.
J Med Case Rep. 2011 Oct 7;5:508. doi: 10.1186/1752-1947-5-508.
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".
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.
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.
由机械性创伤引起的体外溶血与下肢活动相关，如士兵和跑步者，这已得到充分描述。诸如“行军性血红蛋白尿”“足击性溶血”和“跑步者血红蛋白尿”等术语此前已被创造出来且易于记忆。然而，在大力使用上肢的个体中发现了新的病例，比如用手敲击乐器的鼓手。鉴于鼓手身上与上肢相关的机械性溶血和血红蛋白尿的认知度不断提高，且手鼓演奏在全球范围内广泛存在，我们想为这种情况引入一个新术语，称之为“敲击性血红蛋白尿”。
一名24岁的白种男性在演奏非洲手鼓后出现尿色呈红棕色。一次高强度练习课后的尿液检查显示试纸上有血液，显微镜下每高倍视野有0至2个红细胞。尿样中肌红蛋白呈阴性。排除了其他溶血和血尿原因，停止击鼓后其症状得到缓解。
机械性创伤诱发的血红蛋白尿与演奏手敲击乐器之间的关联正日益受到认可。然而，我们认为实际患病率高于此前文献记载的水平。通过创造“敲击性血红蛋白尿”这个术语，我们希望在评估血红蛋白尿患者时，提高对筛查上肢创伤诱发的机械性溶血的认识。
