the lecture is about hemolysis during hemodialysis, which is an acute complication arising during hemodialysis session, this lectures will cover the all aspects of hemolysis including prevention , management, investigation, , sign and symptoms arises due to hemolysis. the mechanical shear stress related hemolysis, dialysate related factors, as well as patient related factors induces hemolysis.
2. Hemolysis
Is defined as the rupturing of red blood cells,
associated with significant mortality and morbidity
3. CAUSES
MECHANICAL/SHEAR STRESS
Flow rate, pressures and cannula size
Mechanical obstructions
Single needle technique and cannula positioning
Dialysis membranes
DIALYSATE FACTORS
Temperature
Osmolality
Uremia and oxidative stress
4. Causes
Patient specific factors (medical conditions and medications)
Hemolysis include, but are not limited to:
• Autoimmune conditions such as systemic lupus erythematosus, scleroderma, polyarteritis nodosa, hemolytic
uremic syndrome, and thrombotic thrombocytopenic purpura
• Malignant hypertension
• Malignancies that predispose to microangiopathic hemolytic anaemia
• Hypersplenism
• Hemolytic disorders i.e. Sickle cell anemia, G6PD deficiency, spherocytosis
• Mechanical valves
• Electrolyte disturbances, particularly low phosphate concentrations
Some medications that may induce hemolysis include: aspirin, penicillin, cephalosporin (especially cefotetan),
sulfonamides, sulfones, nitrofurantoin, phenacetin, primaquine, quinidine, hydralazine and certain vitamin K
derivatives
5. Sign and Symptoms
Back pain
Tightness in chest
Shortness of breath
Deepening of skin pigmentation
Port wine appearance of blood in the venous blood line
Severe hyperkalemia if massive massively hemolysis occur leading to muscle
weakness, electrocardiographic abnormalities and ultimately cardiac arrest
6.
7. Management
Blood pump should be stopped immediately and blood line should be clamped
Hemolyzed blood has a very high potassium should not be reinfused
Check potassium and Hb
Seek cause urgently
Multiple patient may be affected if it is due to water or central dialysate problem
