Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

BMC Research Notes

Bernard G Jaar²  Robert Dobbin Chow³  Sritika Thapa³  Jenni Yoon¹ 

[1] Department of Medicine, MedStar Good Samaritan Hospital, 5601 Loch Raven Boulevard, Suite 3 North, Baltimore, MD, USA;Nephrology Center of Maryland, Baltimore, MD, USA;Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

关键词: Myocardial infarction;    Hyperkalemia;    Complications;    Anemia;    Hemodialysis;    Hemolysis;   

Others  :  1131821
DOI  :  10.1186/1756-0500-7-475

 received in 2014-03-15, accepted in 2014-07-18,  发布年份 2014

【 摘 要 】

Background

The burden of end-stage renal disease (ESRD) in the United States has increased dramatically over the past 30 years with almost 613,000 patients receiving renal replacement therapy in 2011. That same year, more than 112,000 new patients initiated dialysis with 92% of them receiving hemodialysis (HD). These patients experience significant morbidity and mortality with very frequent emergency room visits. Acute hemolysis associated with HD is a rare complication; however, if it’s not recognized early and managed adequately, it can be associated with life-threatening complications such as hyperkalemia and even myocardial infarction.

Case presentation

66-year-old African-American female with a history of ESRD secondary to hypertension developed a blood infiltration on the arterial side of her arteriovenous fistula followed by sudden onset of diffuse abdominal pain with nausea and vomiting during her regular HD treatment. She was referred to the emergency department where she was found to have shortness of breath with improved gastrointestinal symptoms. Her initial work-up revealed a severe anemia with a hematocrit of 10%. Further work-up revealed massive hemolysis, likely mechanical in nature and believed to be induced by malpositioning of her HD needle in the fistula. Her hospital course was complicated by rhabdomyolysis and acute myocardial infarction thought to be secondary to supply–demand ischemia in the setting of her profound anemia. Within a week, she eventually had a full recovery.

Conclusion

It is extremely important for physicians and particularly emergency department physicians to be aware of this potentially life-threatening complication of HD and have a high index of suspicion in the setting of acute anemia with hemolysis in this population.

【 授权许可】

   
2014 Yoon et al.; licensee BioMed Central Ltd.

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