![]() Laboratory data was abnormal, with a hemoglobin of 9.9 g/dL and hematocrit of 29.3% (mean corpuscular volume of 107.2 fL, mean corpuscular hemoglobin of 36.5 pg and red cell distribution of width of 23.6 percent) platelet cell count of 69,000 per mm 3. Upon further review, there was no evidence of blood in her stools or post-menopausal bleeding. Vital signs and physical examination were unremarkable. She was not a smoker and had no family history of cancers. Her past medical history included hypothyroidism treated with thyroid supplements, gastric erosions, Alzheimer’s dementia treated with Donepezil, myelodysplastic syndrome (with chronic anemia and thrombocytopenia dating back 5 years) treated with erythropoietin supplementation, and chronic inflammatory demyelinating polyneuropathy treated with monthly IV Immunoglobulin injections. She had no dysuria or frequency, no abdominal, flank or supra-pubic pain, and no history of kidney stones. ![]() Further history revealed intermittent episodes of dark-colored urine for several years. The article also gives an overview of the approach to diagnosing and treating discolored urine.Ī woman in her 80s was admitted to an inpatient medical service at a tertiary care medical center in the Boston area with cranberry-colored urine. Her hemoglobinuria was misdiagnosed as hematuria, leading to extensive urologic work-up. This article begins with a case summary of a woman presenting with cranberry-colored urine and a final delayed diagnosis of paryxysmal nocturnal hemoglobinuria. ![]() Specific characteristics in a dipstick test or urinalysis can guide differentiation of these three causes of discolored urine. Three commonly confused entities of discolored urine include hematuria, hemoglobinuria, and myoglobinuria. This can be easily confused with other common causes of discolored urine and result in extensive urologic work-up. Patients with this clinical syndrome present with paroxysms of hemolysis, causing hemoglobinuria manifesting as discolored urine. The deficiency of these proteins leads to an increased risk of hemolysis of erythrocytes and structural damage of platelets, resulting in a clinical syndrome characterized by complement-mediated intravascular hemolytic anemia, bone marrow failure, and venous thrombosis. Paroxysmal nocturnal hemoglobinuria is a clonal disorder caused by acquired somatic mutations in the PIG-A gene on the X- chromosome of hemopoietic stem cells and leads to deficiency of surface membrane anchor proteins. ![]() Early differentiation of the type or cause of discolored urine is necessary for accurate diagnosis and prompt management. Discolored urine is a common reason for office visits to a primary care physician and urology referral. ![]()
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