Abstract
IntroductionExtracorpuscular 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 presentationA 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.ConclusionsThe 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.
Highlights
Extracorpuscular hemolysis caused by mechanical trauma has been well described in relation to lower extremity use, such as in soldiers and runners
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
We propose to name this phenomenon “percussion hemoglobinuria” given the fact that this occurrence is common in passionate hand percussion drum players, as observed by our patient, as well as in prior documented cases in the literature
Summary
The diagnosis of percussion hemoglobinuria should be considered in drum players who have repeated trauma to their palms followed by dark urination. Our patient informed us about other people in his drum circle who have dark urine after strenuous drum playing. We hypothesize that this entity is more prevalent than reported in the literature. Author details 1Division of Nephrology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee WI 53226, USA. Authors’ contributions BV evaluated our patient and followed up on appropriate tests. MV helped diagnose the case and co-wrote the manuscript. EPC helped diagnose the case and reviewed the manuscript. SH helped diagnose the case and reviewed the manuscript. BAB helped diagnose the case and reviewed the manuscript. Competing interests The authors declare that they have no competing interests
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