Determination of plasma hemoglobin levels may be a useful clinical tool for detection of bloody serous effusions when direct aspiration cannot be carried out successfully. After such extravasation, there is usually rapid absorption of unchanged blood cells through the diaphragmatic peritoneum, with return to the general circulation through mediastinal and parasternal lymphatics. Any delay in this absorption process would probably increase the degree of hemolysis. In this patient, massive hemolysis occurred. Factors probably responsible included excessive load on the lymphatic system, extreme abdominal distention, and pulmonary edema causing engorgement of the right lymphatic duct, with delayed appearance of hemoglobinemia and hemoglobinuria.
Cohn JN, Sagall EL. HEMOGLOBINURIA AFTER MASSIVE INTRAPERITONEAL HEMORRHAGE. JAMA. 1959;170(16):1912–1915. doi:10.1001/jama.1959.03010160028008
Coronavirus Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: