• Dr. Vincenzo L'Imperio

Hemolysis associated hemoglobin cast nephropathy: Arkana lab strikes again


Hemolysis associated hemoglobin cast nephropathy is a possible complication of systemic hemolysis causing AKI and leading to death in around 11% of cases.

Take home messages:

- Causes of HAHCN are desparate, raging from autoimmune hemolytic anemia to drugs (especially rifampin), transfusions, DIC and hemoglobinopathies

- No evidence of TMA was found on HAHCN renal biopsies

- Casts demonstrated different and non-specific morphologic features (globular, granular, powdery) and tintorial properties with different stains

- The employment of specific IHC directed against hemoglobin is crucial to make the diagnosis

- Prussia blue was negative in the casts in all cases, showing reactivity in proximal tubular cells in only half of the cases (Prussian blue only stains ferric iron (Fe3+) that is loosely bound to protein complexes such as hemosiderin, whereas protein complexes that bind iron strongly, such as hemoglobin, do not stain with Prussian blue)

For other hints about the employment of Prussian blue (Perls' stain) in renal pathology check out our note on anticoagulant related nephropathy: https://www.ncbi.nlm.nih.gov/pubmed/29679257


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Sito della Scuola di Anatomia Patologica

dell'Università degli Studi di Milano-Bicocca

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