| Abstrakt: |
The article reports a case of massive hematuria in a 13-year old boy with sickle cell trait. Hematuria occurs in approximately six per cent of persons with sickle cell hemoglobin, the incidence being much more frequent with sickle cell trait than with sickle cell anemia. Most of these episodes of urinary tract bleeding are microscopic, mild, and transient. Physical examination revealed the patient to be a healthy appearing adolescent who was afebrile and normotensive. There were no petechiae, ecchymotic lesions, or skin rashes. Vision was normal and the fundi were clear. The nasopharynx was not injected. The lungs were clear, heart sounds were normal, and the peripheral pulses were full and equal. There was no hepatosplenomegaly, renal enlargement, or flank pain. The remainder of the physical examination was normal. The site of urinary tract bleeding in the majority of patients with HgbS is believed to be the renal medulla. The renal medulla has increased hyperosmolarity and is relatively hypoxic and acidotic, conditions which favor the sickling phenomena. When erythrocytes with sickle hemoglobin undergo alteration and become elongated and sickle-shaped, decreased blood flow and stasis in small vessels result. |
