S.KEV 588-590] CLINICAL PICTURE 117
4-CLINICAL PICTURE
A short account of some of the clinical forms of haemoglobinuria will
now be given. Blackwater fever, which is associated \\ith malaria, is B.
considered in a separate article (see Vol. II, p. 561). •/V
(1)—Haemoglobinuria due to Chemical Agents
(a) Quinine Haemoglobinuria
589.] Terplan and Javert recorded fatal haemoglobinuria due to quinine, I'
which was taken by a woman to terminate a three months" pregnanc\. a
The patient died of uraemia, \vith a blood urea content cf 344 mgrn.
per 100 c.c. Haernoglobinuric infarcts in the kidnevs \\ere found at
necropsy. At least eight other cases have been published of fatal haemo-
globinuria due to quinine taken in the early stages of pregnancy.
(b) Arsine Haemoglobinuria
Panton, Maitiand-Jones, and RIddoch described two cases of arsine
haemoglobinuria in men who supervised the mixing of zinc and sulphuric
acid in open vessels. Both of the ingredients of the mixture contained
arsenic. Dudley observed some men \\ho were admitted to hospital
from two submarines \vith a diagnosis of carbon dioxide or carbon
monoxide poisoning. They were found to be suffering from poisoning
from arseniuretted hydrogen gas exolved from batteries in the sub-
marines. The metallic portion of the plates contained 0-2 per cent of
arsenic, which was the source of the poisoning. The cases \vere char-
acterized by an onset with headache, nausea, and vomiting; a se\ere
anaemia then developed, with a tendency to leucopenia and a slight
degree of icterus; and in one case the urine was dark brown to blood-
red owing to the presence of haemoglobin.
(2)—Mismatched Blood Transfusion
590.] When an incompatible blood is used in transfusion, the reaction s\mptoms
provoked depends to a certain extent upon the size of the transfusion.
As small an amount as 100 c.c. may prove fatal. The immediate reaction
consists in a feeling of distress, pains in the loins, headache, shivering,
and rise of temperature, followed by a rigor, vomiting, and possibly
urticaria (see also BLOOD TRANSFUSION, Vol. II, p. 541). If this reaction
does not prove fatal, death may subsequently occur from renal failure
with haemoglobinuria. Baker and Dodds showed that the blood urea
might reach a level of 803 mgrn. per 100 c.c. before death. The donor's
red cells are rapidly agglutinated and haemolysed with resulting haemo-
globinuria. The haemoglobin is precipitated in the renal tubules as a
variety of acid haematin if the reaction of the urine reaches a pH of
6 or lower and the concentration of sodium chloride in the urine is up
to 1 per cent. Death, from uraemia, is only likely to occur if there is
blockage of the renal tubules.