Kidney Week

Abstract: SA-PO975

Acute Pancreatitis Related to Hemolysis During Hemodialysis Due to Defective or Kinked Blood Tubing

Session Information

• Fellows/Residents Case Reports: ESRD: HD, PD, Transplant
  November 04, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Nephrology Education

• 1302 Fellows and Residents Case Reports

Authors

• Yaziji, Muataz, Stony Brook Medicine/University Hospital, Stony Brook, New York, United States

Muataz Yaziji,

• Khan, Sobia N., Stony Brook Medicine/University Hospital, Stony Brook, New York, United States

Sobia N. Khan,

• Arbeit, Leonard A., Stony Brook Medicine/University Hospital, Stony Brook, New York, United States

Leonard A. Arbeit,

• Kim, Kyung Ho, Stony Brook Medicine/University Hospital, Stony Brook, New York, United States

Kyung Ho Kim,

• Wadhwa, Nand K., Stony Brook Medicine/University Hospital, Stony Brook, New York, United States

Nand K. Wadhwa,

Background

Hemolysis during hemodialysis (HD) may be related to dialysate, extracorporeal circuit or patients’ disease. Extracorporeal hemolysis may result from blood pump occlusion, miss-size needle and partial occlusion of catheter in relation to high BFR, and kinked or faulty tubing. We report a case with massive hemolysis during HD related to faulty or kinked blood tubing presenting as acute pancreatitis.

Methods

A 32-year-old man with ESRD due to obstructive uropathy has been on HD since 2014. On his HD day, he started HD at 5:37 AM at BFR 400 ml/min with a 14 gauze needle using right brachiocephalic AV fistula. At 6:08 AM, arterial pressure increased from -80 to -10 mmHg and venous pressure dropped from 170 to 50 mmHg at a BFR of 360 ml/min. He continued HD until 6:43 AM with repeated alarms. He was moved to another HD machine and completed HD for 3.45 hrs with no issues. He presented to ER the next morning with gradual, progressive worsening abdominal and back pain, nausea and vomiting since HD yesterday. On departure, the patient felt well but staff noted that his color had changed to dark red. On way home, he began to feel unwell and progressed until presented to the ER where labs were repeatedly reported hemolyzed. Physical exam: Alert and oriented, BP 122/88 mmHg, HR 98 bpm, RR 18/min, Temp 36.7^oc. He was jaundiced with a soft abdomen and mild tenderness. Rest of the exam was normal. Lab data: WBC 6.78 K/uL, Hgb 7.7 g/dl (10.5 g/dL on 2 week prior), hcts 21.6%, platelets 138 K/UL with no schistocytes, Na 135 mmol/L, K 4.3 mmol/L, BUN 69 mg/dL, Cr 9.5 mg/dL, amylase 525 IU/L, lipase 1260 IU/L, T Bili 2.4 mg/dL, D Bili 0.4 mg/dL, LDH 2300 IU/L, haptoglobin 10.3 mg/dl and negative Coombs test. MRI abdomen: Dilated common bile duct with no luminal defect. HIDA Scan: No acute cholecystitis. He received 1 unit of PRBC during HD the next day. He continued to improve in the hospital. He was discharged home on third day to outpatient HD with no further issues.

Conclusion

Our patient developed severe mechanical hemolysis during HD likely related to blood tubing in view of temporal relation to out-patient HD with repeated alarms. This was supported by a sudden change in his skin color to dark red after HD. His abdominal and back pain were due to acute pancreatitis likely related to toxic effect of free hemoglobin in his blood.