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Percussion hemoglobinuria - a novel term for hand trauma-induced mechanical hemolysis: a case report. J Med Case Rep 2011 Oct 07;5:508 PMID: 21982397 PMCID: PMC3213680

Pubmed ID



INTRODUCTION: 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".

CASE PRESENTATION: 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.

CONCLUSIONS: 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.

Author List

Vasudev M, Bresnahan BA, Cohen EP, Hari PN, Hariharan S, Vasudev BS


Barbara A. Bresnahan MD Professor in the Medicine department at Medical College of Wisconsin
Parameswaran Hari MD Chief, Professor in the Medicine department at Medical College of Wisconsin
Brahm Vasudev MD Associate Professor in the Medicine department at Medical College of Wisconsin

jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6