Editor—McConkey (and Medline) wonders about the cause of haemoglobinuria on three occasions during stress in a fit young officer who without any treatment was still doing well 48 years later.1 Malingering is ruled out by the circumstances.
A likely explanation is that the “haemoglobinuria” was actually haematuria caused by a haemangioma in the urinary tract. The bleeding was due to the raised blood pressure associated with stress. Swan and Balme reviewed the literature on 27 patients with bleeding renal haemangiomas who had a median age of 30 years with a range of <10 to >70 years.2 Twenty six were diagnosed after nephrectomy was performed because of suspected malignancy, which in McConkey’s case is fortunately ruled out by the survival of his patient.
Imaging of the upper urinary tract and a cystoscopy should be done in any patient with unexplained haematuria to rule out neoplasia, silent stones, etc. Officers of any responsible airline system are grounded in case of unexplained haematuria for safety reasons. I believe that this should apply for military officers as well.
References
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- 2.Swan RHJ, Balme H. Angioma of the kidney: report of a case and review of 26 previously reported cases. Br J Surg. 1935;23:282–295. [Google Scholar]