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Kidney Week

Abstract: SA-PO854

"Tag - You're It!" Use of Tagged Red Blood Cell (RBC) Scan to Localize Gross Hematuria

Session Information

Category: Glomerular Diseases

  • 1401 Glomerular Diseases: From Inflammation to Fibrosis

Authors

  • Ayub, Fatima, University of Arkansas System, Little Rock, Arkansas, United States
  • Bin Homam, Wadhah Mohammed, University of Arkansas System, Little Rock, Arkansas, United States
  • Hasan, Md Rajibul, Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas, United States
  • Holthoff, Joseph H., University of Arkansas System, Little Rock, Arkansas, United States
  • Karakala, Nithin, University of Arkansas System, Little Rock, Arkansas, United States
Introduction

Tagged red blood cell (RBC) scan performed with technetium-99m-labeled autologous erythrocytes has proven to be a clinically useful tool for localizing bleeding in the gastrointestinal (GI) tract. However, it has never been used to identify a bleed in the kidneys or genitourinary tract (GU). We hereby present the first known case in which a tagged RBC scan was utilized to detect an occult GU source of bleeding.

Case Description

A 58-year-old African American female with an extensive history of gross hematuria and chronic severe anemia requiring monthly blood transfusions presented to the emergency department with complains of extreme fatigue. She has been having hematuria with the passage of blood clots for at least 25 years. She has had extensive hematological work up including bone marrow biopsy, angiograms and cystoscopies with no clear source of bleeding identified. She even underwent radical left nephrectomy with pathology revealing papillary necrosis and thin basement membrane disease.

She was hypotensive and appeared extremely pale on presentation. Initial labs revealed a hemoglobin of 1.1 g/dl with surprisingly normal renal chemistry. After initial stabilization with multiple blood transfusions, the patient underwent CT angio abdomen and pelvis which did not show any evidence of active bleeding followed by an unremarkable cystoscopy. Patient was recommended to have the right nephrectomy as well which would have guaranteed lifelong dialysis dependency.

In an attempt to identify the source of bleeding before any surgical intervention, she subsequently underwent a tagged RBC scan with technetium that did not show any evidence of renal bleeding, but instead showed increased radio tracer uptake in the urinary bladder wall representing the likely source of bleeding. This was followed by the placement of a percutaneous nephrostomy tube which drained clear urine versus the persistently bloody urine draining in the urinary bag further ruling out a renal source of bleeding and in turn salvaging her kidney.

Discussion

Tagged RBC scans are recommended to confirm gastrointestinal (GI) bleeding. We suggest this modality could be an alternative tool to localize bleeding in the kidneys and the GU tract, especially in difficult cases like ours, where there was no identifiable source of chronic hematuria. It proved to be an organ saver in her case.