Nephrology

147 Haemolysis

  • Haemolysis Cause

    Acute haemolysis during dialysis is nearly always a problem with the dialysate solution 

    • abnormally low Na+ content of dialysate
    • overheated dialysate
    • hypotonic dialysate
    • dialysate is contaminated with
    • formaldehyde
    • bleach
    • copper
    • nitrates
    • Other causes include faulty blood pump causing stress and trauma, excessive suction at the arterial access site or exposure of red blood cells to toxic substances in the extracorporeal circuit

    Signs and Symptoms

    • back pain
    • tightness in chest
    • shortness of breath
    • severe cramps
    • possible change of appearance of blood in venous blood line eg. port wine appearance
    • cardiac arrest

    Treatment

    1. Stop blood pump (stop dialysis)
    2. Clamp venous and arterial lines
    3. Clamp venous and arterial access
    4. Do not return the blood (haemolysed blood has high K+ content)
    5. Notify medical officer
    6. Take dialysate sample for biochemistry analysis to test for the presence of formaldehyde and bleach
    7. Check Haematocrit level
    8. Check K+ level
    9. Reassure patient
    10. Symptomatic management eg. oxygen