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Kidney Week

Abstract: PO1194

A Case of Polysulfone Membrane-Induced Thrombocytopenia

Session Information

Category: Trainee Case Report

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Claudio-Gonzalez, Ivan L., Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
  • Nicholls, Sarah, Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
  • Someren, James T., Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
  • Wall, Susan M., Emory University Emory College of Arts and Sciences, Atlanta, Georgia, United States
Introduction

The development of biocompatible hemodialysis membranes has been a major advance in the treatment of renal failure. Newer, synthetic membranes such as polysulfone are considered to be more biocompatible than the older cuprophane or cellulose membranes. However, polysulfone dialyzers can interact with and thereby reduce platelet counts. A few isolated case reports have observed thrombocytopenia in patients following hemodialysis with polysulfone membranes.

Case Description

We report a case of an 82 year old man with a history of hypertension, an abdominal aortic aneurysm Stage 5 chronic kidney disease and AV malformations admitted to with recurrent GI bleeding and acute kidney injury. Admission laboratory values were significant for Hgb 4.9, Plt 209, HCT 16.0, BUN 166, Cr 19.23, K 5.7, Bicarbonate 7 and Phosphorous 7.5. The bleeding site was found to be the transverse colon, which was ligated with resolution of the bleeding. Intermittent hemodialysis was initiated thrice weekly using an F180NR polysulfone hemodialysis membrane. On admission, the patient’s platelet count was 233,000. However, each morning after a hemodialysis treatment, his platelet count was ~40% lower than that of the previous day, but then increased until the next dialysis session. Over the course of the admission, his platelet count therefore progressively fell, reaching a nadir of 37,000 on hospital day 38. The patient was anticoagulated with citrate and did not receive heparin. His heparin-induced thrombocytopenia panel (HIT) was negative. On hospital day 38, the dialysis membrane was changed to Cellentia-H cellulose triacetate single-use, hollow-fiber, high-flux hemodialyzer. Over the following week he underwent 3 additional dialysis treatments, over which time his platelet count rose to 120,000 and the post-dialysis drop in platelet count was no longer observed.

Discussion

Dialyzer membrane-associated thrombocytopenia was suspected by the platelet count decline observed the morning after a dialysis treatment, and by eliminating other possible causes. We observed significant improvement in platelet count when the membrane was changed to modified cellulose membrane (cellulose triacetate). In patients that develop thrombocytopenia following the initiation of dialysis with a polysulfone membrane, consideration should be given to a trial of an alternative membrane, such as cellulose triacetate.