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Two infants who received whole blood filtered through commercially available woven stainless steel micropore filters experienced a sudden onset of hemoglobinuria. The plasma hemoglobin level in one child was 200 mg/dL. To investigate whether filters might lead to RBC destruction, we experimentally quantitated filter-induced hemolysis using standard conditions. Our studies in vitro show that hemolysis decreases with increased speed to transfusion. Hemolysis is particularly extensive with blood stored more than 14 days, but measurable hemolysis occurs with blood stored for as little as one day.

Hemoglobinuria occurred in two children following severe beating. The development of transient oliguria in one child and acute renal failure in the other emphasizes the importance of early recognition of these unusual complications in the syndrome of child abuse. Appropriate therapy should be given to prevent or lessen the severity of acute renal failure in this clinical situation.

A patient was transfused with a unit of red blood cells that had been frozen accidentally prior to transfusion. Although he had received approximately 60 gm of free hemoglobin intravenously, the patient's only clinical reaction was massive hemoglobinuria. The benign clinical response, in the presence of massive hemoglobinuria, is attributed to the absence of immunologic imcompatibility and, thus, failure to activate vasoactive mediators and disseminated intravascular coagulation. The case illustrates revised concepts of the pathophysiology of acute renal failure associated with hemolytic blood transfusion reactions.