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Abstract: PO0947

Severe Thrombocytopenia due to Electron-Beam Sterilized Polysulfone Dialyzer Membrane Reaction

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chandler, Zachary, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, United States
  • Hasan, Irtiza, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, United States
  • Jaikaransingh, Vishal, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, United States
Introduction

We describe a case of severe thrombocytopenia due to reaction with an electron-beam sterilized polysulfone (PS) membrane. This phenomenon has been previously described but is rarely reported. E-beam sterilized PS membranes are classically more biocompatible than cellulose-based membranes but adverse reactions may occur as demonstrated in our case.

Case Description

A 74 y.o. woman with CKD Stage 4 and secondary hyperparathyroidism presented for evaluation of generalized weakness, anorexia, and weight loss. Her past medical history included gout, short bowel syndrome following prior bowel resection and osteoporosis. Home medications were allopurinol, calcitriol, gabapentin, fluoxetine, and mirtazapine. She was started on hemodialysis (HD) for suspected progression to ESRD. She developed progressive thrombocytopenia (Figure 1) that was worse following HD with improvement on non-HD days. Evaluation of usual culprits of thrombocytopenia was unrevealing. Reaction to the polysulfone filter was suspected and she was switched to a cellulose-based filter with resolution of her thrombocytopenia. She was dialyzed with a PS membrane on HD20 as proof of concept with recurrent thrombocytopenia following HD. She was dialyzed with cellulose-based filter thereafter with no further thrombocytopenia.

Discussion

We describe a case of PS-membrane induced thrombocytopenia. It is hypothesized that e-beam radiation may affect membrane integrity or structure, or produce intermediary products which may cause platelet activation, aggregation, and adsorption, and therefore thrombocytopenia. This entity should be considered in the differential diagnosis of patients undergoing HD who develop thrombocytopenia. Early recognition may reduce incidence of bleeding and need for blood products in these patients.

PLT counts during admission. HD days with PS membrane are denoted with a diamond label and HD days with cellulose-based membrane are denoted with a circle label. Single unit PLT transfusions are denoted with arrows.