Abstract: FR-PO009

Acute Intravascular Hemolysis and Kidney Injury from an Amplatzer Device: Complication of an Innovative Cardiac Procedure and the Challenge of Dialysis

Session Information

Category: Nephrology Education

  • 1302 Fellows and Residents Case Reports

Authors

  • Marquez, Kevin D., University of California Davis Medical Center, Sacramento, California, United States
  • Chin, Andrew I., University of California Davis Medical Center, Sacramento, California, United States
Background

The Amplatzer septal occluder is a transcatheter device used as a treatment option for ostium secundum atrial septal defects. It has also been used to treat residual mitral regurgitation (MR) in patients with a high open surgical risk. We describe a rare complication of rapid mechanical hemolysis leading to acute kidney injury, and describe the challenge of hemodialysis (HD) in this setting.

Methods

A 68 yo man with persistent MR despite 2 prior procedures had an elective 3rd MitraClip with placement of the Amplatzer septal occluder device in the lateral mitral commissure. The procedure went well. The following morning, his serum creatinine doubled from 1.33 to 2.62 mg/dL, his urine turned dark in color (Figure A), and he became oliguric. Labs at that time: potassium 5.9 mEq/L, lactate dehydrogenase 2200 U/L, haptoglobin 4 mg/dL, and peripheral smear with schistocytes. Notably, plasma was red in color (Figure B). Rapid mechanical hemolysis due to the Amplatzer device was suspected. The device was immediately removed. HD was initiated. However, within a minute, the dialysate blood leak detector alarm was triggered. No blood was visualized in the dialysate, which tested positive using hemoglobin test strips. Blood was not returned and a new circuit and machine were set up. Using low blood flow of 100 cc/min and high dialysate flow of 800 cc/min, HD was resumed with minimal alarms. Subsequent HD treatments did not activate the blood leak alarms.

Conclusion

While intravascular hemolysis with the Amplarzer device has been reported, this is the second reported case of hemolysis when this device is used to treat residual mitral regurgitation. This case demonstrates the sensitivity of the dialysate blood leak detector to being triggered by the diffusion of free hemoglobin into dialysate due to intravascular hemolysis.