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Kidney Week

Abstract: PO1201

Doctor, There Is a Blood Leak!

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Malepati, Deepthi Chandra, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, United States
  • Bobba, Sindhura, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, United States
  • Aggarwal (Gupta), Monika, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, United States
Introduction

Blood leak detector detects blood in the dialysate that is confirmed with a blood leak test strip . We report a case of false blood leak alarm due to hydroxocobalamin that was initially treated as a true positive blood leak due to the incorrect use of blood leak test strip, and required switching from hemodialysis (HD) to continuous veno-venous hemodialysis (CVVHD).

Case Description

67 year old male with alcohol abuse presented with shortness of breath.Exam significant for tachycardia,confusion and respiratory distress. Laboratory data remarkable for serum potassium 3.1 meq/L, bicarbonate 6 meq/L ,anion gap 45, serum osmolality 351 mosm/L, and osmolar gap 61.Serum creatinine was 2.5 mg/dl .Fomepizole and Hydroxocobalamin were given.HD with Fresenius 2008T was terminated after 2 minutes due to a blood leak alarm .Blood leak test strip (Serim Guardian) was read positive for blood.HD was reinitiated with a new setup, again triggering blood leak alarm .Effluent was pink (Figure 1.) and repeat blood leak test strip was negative at 60 seconds. Patient was successfully switched to CVVHD (Nxstage) without further blood leak alarms.

Discussion

False positive blood leak alarm was triggered due to change in the color of the effluent by hydroxocobalamin. Fresenius 2008T dialysis machine blood leak detector uses red and green light . Green light was absorbed due to the discoloration of the effluent, triggering blood leak alarm. Blood leak alarm was not triggered on NxStage, as it uses infrared wavelength, allowing continuation of dialysis.Initial blood leak test strip was read positive due to reading beyond recommended 60 seconds (subsequent test strip was negative) . Correct use of blood leak test strip would have avoided second setup of HD and would have correctly identified false blood leak alarm due to hydroxocobalamin requiring switching to CVVHD.

Figure 1.