ESPN 50th Annual Meeting

ESPN 2017


 
ZEBRAS CAN KILL YOU- THE ONE ZEBRA YOU SHOULD NEVER FORGET ABOUT DURING HAEMODIALYSIS.
ROWENA LALJI 1 DALJIT HOTHI 1 Kate Sinnott 1

1- GREAT ORMOND STREET
 
Introduction:

Haemodialysis (HD) is a challenging treatment  especially within the paediatric population. Though life saving, it is not without risk to the patient. Acute haemolysis associated with haemodialysis (HD) is rare, but potentially life threatening complication which requires prompt recognition by the clinician. We describe the first paediatric patient with this sequelae, a 13 year old girl with a background of HIV nephropathy, well established on HD post failure of her renal transplant. 

Material and methods:

Approximately 90minutes into a routine haemodialysis session via an AV fistula on a GambroTM AK200 highflux dialyser, the patient developed facial flushing, whole body rash, diffuse abdominal pain and significant hypertension (>190mmHg). Haemodialysis was ceased and the patient treated for a presumed severe allergic reaction. She remained symptomatic for the next 24hours. Unfortunately her post dialysis bloods were unable to be analysed due to ‘gross haemolysis’. 

The following morning, she recommenced haemodialysis on a FreseniusTM 5008 using a highflux dialyser. Post connection, a blood leak alarm was triggered. A second FreseniusTM machine was prepared with a midflux dialyser. Again, a blood leak alarm was triggered. A third circuit was prepared on the GambroTMAK200 

 

 

Results:

At this point we became strongly suspicious of a severe haemolytic reaction. Bloods revealed an acute drop in haemoglobin and haematocrit, grossly raised LDH and bilirubin and positive DAT. The patient tolerated the dialysis session but was not ‘washed back’. Dialysate fluid was sent for chemical, bacterial toxin and copper analysis. Tubing and dialysers were returned to the respective companies for analysis. All results returned negative. By elimination, we deduce the most likely cause of haemolysis to be mechanical from the AV fistula  in combination with intermittent HIV or EBV viraemia. The patient fully recovered within 72 hours. 

Conclusions:

Acute haemolysis is a rare but life threatening complication associated with haemodialysis. Prompt recognition and appropriate management is vital.