Abstract: FR-PO559
Hypereosinophilia in Haemodialysis Patients
Session Information
- Dialysis and Vascular Trainee Case Reports
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Griffiths, Kathryn Jane, Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- Makanjuola, David, Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- Austin, Michael J., Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- De lord, Corinne Frances mary, Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- Cheney lowe, Hannah, Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- Stern, Simon C., Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
- Winn, Simon K., Epsom and St Helier University Hospital NHS Trust, London, United Kingdom
Introduction
The incidence of hypereosinophilia (>2 x 109/L) in our haemodialysis population in London over the last 13 years is 9.7 per 100 patients per year. We present 9 cases of significant hypereosinophilia which occured alongside significant haemodynamic instability during haemodialysis (HD) sessions.
Case Description
All the patients survived these episodes; 7 of 9 had prompt reduction in eosinophil counts following high dose corticosteroids. All patients were on haemodiafiltration, with ultra-pure water. There was a high recurrence rate following wean of steroid treatment. Adaptations to the HD circuits including changing the line lock, dialyser type and dialyser surface area were made, but the inconsistent response suggests more than bioincompatibility. We did specific allergy testing for ethylene oxide (ETO), latex and chlorhexidine in 3 patients, 1 of which raised to latex. All 9 patients were ANCA negative, Hepatitis B, C and HIV negative. 1 patient had positive strongyloides serology.
Discussion
The reason for the hypereosinophilia is unclear, but it has made HD challenging in these patients. It is possible that there may be other precipitants not related to the HD circuit. Joint management between nephrologists, haematologists and HD unit staff is important for the management of hypereosinophilic patients experiencing severe haemodynamic instability during HD.
Investigations for patients 1-9
| Patient | Peak eosinophil count (X10<9>/L) Normal range: <0.4 X10<9>/L | Mast cell tryptase (μmol/L) Normal range: 2- 14 μmol/L | Total IgE (kUA/L) Normal range: <75 kUA/L | BMAT, FIP1L1-PDGRFA performed (Y/N) | Cause of end stage renal failure | Dialysis access | ACEi or ARB therapy (Y/N) | CT scan performed (Y/N) |
| 1 | 11.6 | N | Presumed diabetes | AVF | Y | N | ||
| 2 | 20.9 | 7.9 | Y - no clonal abnormality | Presumed diabetes | RIJTL | N | Y | |
| 3 | 15.5 | 16.2 | 864 | N | Presumed diabetes | AVG | Y | N |
| 4 | 36.1 | 14.7 | Y - no clonal abnormality | MPGN | RIJTL | N | Y | |
| 5 | 7.9 | 11.9 | <2 | Y - no clonal abnormality | Unknown | RIJTL | Y | N |
| 6 | 33.1 | 10 | 1220 | Y - no clonal abnormality | Unknown | RIJTL | N | Y |
| 7 | 5.6 | 8.2 | 238 | N | Unknown | RIJTL | Y | N |
| 8 | 20.1 | N | Amyloidosis | AVF | Y | Y | ||
| 9 | 20.3 | 20.3 | 1628 | Y - no clonal abnormality | FSGS | RIJTL | Y | N |
BMAT: bone marrow aspirate trephine, ACEi: Angiotensin converting enzyme inhibitor, ARB: Angiotensin receptor blocker, MPGN: membranoproliferative glomerulonephritis, FSGS: focal segmental glomerulosclerosis, RIJTL: right internal jugular tunnelled line, AVF: arteriovenous fistula, AVG: arteriovenous graft,
Patient 6