The onset of bacteremia with certain Clostridium species may be confused with a hemolytic transfusion reaction. These species produce a hemolysin and other toxin that can hemolyze red blood cells. Unfortunately Clostridium sepsis can be rapidly fatal.


Species involved: Clostridium perfringens, Cl. septicum, others


Clinical features:

(1) high fever

(2) hypotension and shock

(3) hemolysis with hemoglobinemia

(4) tachycardia



(1) evidence of ischemic bowel

(2) presence of an intra-abdominal or pelvic tumor

(3) gas-producing infection, clinically or on imaging studies

(4) positive blood cultures for a Clostridium species (underlying the need to perform blood cultures on patients with unexplained fever)


Differential diagnosis:

(1) immune-mediated hemolytic transfusion reaction (the workup should show compatible units with a negative DAT)

(2) drug-induced hemolytic anemia, especially beta-lactam antibiotic related

(3) bacterial contamination of a blood product (which underlies the need to Gram stain and culture a blood product implicated in a possible transfusion reaction)


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