More Than Meets the Eye

A CLINICAL PROBLEM-SOLVING article by John Nguyen from Johns Hopkins University School of Medicine, Baltimore, Maryland.
A 61-year-old woman was hospitalized with a two-day history of palpitations and dyspnea. She was found to be in atrial fibrillation with a rapid ventricular response, and intravenous diltiazem and a heparin infusion were begun. Her condition improved, but on the third hospital day, she reported feeling weak and nauseated and began passing dark red urine. She did not have a urinary catheter, dyspnea, back pain or dysuria.
The hematocrit 30% was compared with 35% at admission. Urinary dipstick testing revealed high levels of hemoglobin and 3 plus protein. Results of urine testing for myoglobin were negative.
Often, clinicians encounter new problems during the course of a patient's hospitalization that are unrelated to the initial reasons for admission. In this case, the patient's symptoms developed while she was being treated with anticoagulants for atrial fibrillation. 

最近は、英語に合わせて「発作性夜間ヘモグロビン尿症」と呼ばれるのですね。Marchiafava-Micheli症候群という冠名もあるようですが。