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Doctors investigate why man bled green

June 7, 2007
Courtesy The Lancet
and World Science staff

An un­usu­al case of a man who bled dark green blood dur­ing an opera­t­ion is an­a­lysed in in the June 9 edi­tion of the med­i­cal jour­nal The Lan­cet.

Anaes­the­si­ologists Stephan Schwarz and Alana Flexman of St Paul’s Hos­pi­tal at The Un­ivers­ity of Brit­ish Co­lum­bia, Van­cou­ver, Can­a­da and col­leagues did the opera­t­ion and wrote the case re­port. It de­scribed the situa­t­ion as fol­lows:

A 42-year-old white Ca­na­di­an man had de­vel­oped a con­di­tion known as com­part­ment syn­drome, in­volv­ing tis­sue or nerve dam­age due to re­strict­ed blood flow, in the low­er legs af­ter fall­ing asleep sit­ting. He was a smok­er with a his­to­ry of chron­ic shoul­der pain and mi­graine, and was on a num­ber of med­ica­t­ions.

Doc­tors de­cid­ed he needed ur­gent fas­ciotomies, a limb saving-procedure that in­volves cut­ting in­to tis­sue to re­lieve pres­sure. Emer­gen­cy tests re­vealed a some­what rap­id heart beat, but nor­mal blood pres­sure. There was one abnor­mal blood test re­sult, ex­tremely high lev­els of an en­zyme called cre­a­tine ki­nase.

Dur­ing the sur­gery, doc­tors at­tempted to in­sert an ar­te­ri­al cath­e­ter, a thin flex­i­ble tube used to al­low in­tro­duc­tion or with­draw­al of flu­ids or to keep a pas­sage­way open. Sev­er­al in­sertion at­tempts yielded dark greenish-black blood, which was im­me­di­ately sent away for anal­y­sis. The cath­e­ter was even­tu­ally fully in­serted, and the man re­cov­ered.

Physi­cians said the green blood might be due to his very high in­take of the mi­graine drug suma­trip­tan, which con­tains sul­fur. This could have caused a con­di­tion called sulfhaemoglobi­naemia, in which a sul­fur at­om is in­cor­po­rat­ed in­to the mol­e­cule hemo­globin. Hemo­globin is a pro­tein car­ried by red blood cells that func­tions to pick up ox­y­gen in the lungs and de­liv­er it through­out the body.

Sulfhaemoglobi­naemia gen­er­ally goes away by it­self with red blood cell turn­o­ver, but blood trans­fu­sion can be nec­es­sary in se­vere cases, the re­search­ers wrote.

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An unusual case of a man who produced dark green blood during an operation is analysed in in this week’s edition of the medical journal The Lancet. Anaesthesiologists Stephan Schwarz and Alana Flexman of St Paul’s Hospital at The University of British Columbia, Vancouver, Canada and colleagues did the operation and authored the case report. It described the situation as follows: A 42-year-old white Canadian man had developed a condition known as compartment syndrome, involving tissue or nerve damage due to restricted blood flow, in the lower legs after falling asleep sitting. He was a smoker with a history of chronic shoulder pain and migraine, and was on a number of medications. Doctors decided he needed urgent fasciotomies, a limb saving-procedure that involves cutting into tissue to relieve pressure. Emergency tests revealed a somewhat rapid heart beat, but normal blood pressure. There was one abnormal blood test result, extremely high levels of an enzyme called creatine kinase. During the surgery, doctors attempted to insert an arterial catheter, a thin flexible tube used to allow introduction or withdrawal of fluids or to keep a passageway open. Several insertion attempts yielded dark greenish-black blood, which was immediately sent away for analysis. The catheter was eventually fully inserted, and the man recovered. Physicians said the green blood might be due to his very high intake of the migraine drug sumatriptan, which contains sulfur. This could have caused a condition called sulfhaemoglobinaemia, in which a sulfur atom is incorporated into the molecule hemoglobin. Hemoglobin is a protein carried by red cells that functions to pick up oxygen in the lungs and deliver it throughout the body. Sulfhaemoglobinaemia generally goes away by itself with red blood cell turnover, but blood transfusion can be necessary in severe cases, the researchers wrote.