Hemolytic transfusion reaction occurring in a patient with acute renal failure.

A CUTE RENAL FAILURE is a well-known, though by no means inevitable, consequence of acute intravascular hemolytic transfusion reaction. The mechanism responsible for the renal damage is not fully understood, but undoubtedly depends on complex interrelationships of the plasma “free hemoglobin” concentration, the filtered load of hemoglobin, the per cent reabsorption of filtered water, urinary pH, hypotension and the possibility that nephrotoxic substances are released into the circulation in relation to the intravascular antigen-antibody reaction.’ The distribution of extracorpuscular hemoglobin in the circulating plasma and the relationship of free and proteinbound hemoglobin to the renal excretion of hemoglobin have been welldescribed by Lathem in studies on normal human volunteers.2’3 So far as we know, similar studies of the disappearance rates for free and protein bound hemoglobin in the plasma have not been reported for human subjects with markedly reduced renal function. The present brief report concerns a patient severly traumatized in an automobile accident, who in the fifth week of artificial kidney dialysis for presumed acute tubular necrosis experienced an acute intravascular hemolytic