Abstract
A 15-year-old high school boy visited our hospital because of the passing of “Cola”-like dark urine which occurred immediately after “Kendo” training and lasted for several hours only.
“Kendo” exercise test was performed: he was instructed to repeat to step barefoot strenuously on floor board (“fumikomi” training) for 60 minutes.
The examination of the urine and blood taken immediately after exercise revealed the hallmarks of intravascular hemolysis including a raised plasma hemoglobin value, lowered serum haptoglobin, elevated serum lactic dehydrogenase level and hemoglobinuria with no red blood cell in sediment. Only a trace of myoglobin was detected in the urine. These abnormalities gradually decreased in intensity and all of them except serum haptoglobin were normalized 24 hours after the exercise test.
Based on the clinical findings and the results of exercise test, a diagnosis of march hemoglobinuria following “kendo” exercise was made. The trace of the myoglobin in the urine was considered to be due to physiological phenomenon for muscle activity.
It was reported in addition that his apparently healthy elder brother was tested in the same way and the urine was straw colored and clear, with no hemoglobin, while the blood showed significant increases of plasma hemoglobin and serum lactic dehydrogenase and a significant decrease of serum haptoglobin.
