Abstract: FR-PO140
A Roadmap to Recovery: Managing AKI in a Case of Hemophilia B
Session Information
- AKI: Outcomes, RRT
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Kulkarni, Avani, All India Institute of Medical Science - Bhopal, Bhopal, Madhya Pradesh, India
- Pathak, Shrirang Deepak, All India Institute of Medical Science - Bhopal, Bhopal, Madhya Pradesh, India
- Saigal, Saurabh, All India Institute of Medical Science - Bhopal, Bhopal, Madhya Pradesh, India
Introduction
Hemophilia, a rare inherited bleeding disorder, poses unique challenges in the management of patients requiring renal replacement therapy. Acute Kidney Injury is a serious complication that can occur in hemophilic patients following prolonged hospitalization secondary to trauma. There is limited data on the appropriate dialysis modality selection, and prescription of dialysis treatments in these patients.
Case Description
We present a case report highlighting the innovative approach adopted for the management of acute kidney injury (AKI) in a 31-year-old male hemophiliac patient with a history of abdominal trauma following a road traffic accident. The diagnostic workup revealed intra-abdominal bleeding and sepsis, leading to the development of AKI. Given the patient's complex clinical profile, a tailored approach was necessary to balance the need for renal replacement therapy while minimizing the bleeding risks associated with hemophilia. Sustained low-efficiency daily dialysis (SLEDD) was utilized for renal support, with modifications made to minimize bleeding risks.
The modifications included the use of normal saline and cryoprecipitate to maintain adequate clotting factor levels, to minimize bleeding during catheter insertion and removal and to prevent coagulation of the circuit, and close monitoring of coagulation parameters throughout the dialysis sessions.
6 such dialysis sessions were done following which the acute kidney injury was resolved.
Discussion
In this case, the key challenge to overcome was concerning the use of heparin to prevent coagulation in the extracorporeal circuit, but at the same time it carried the risk of prolonging the already prolonged Actiavted Partial Thromboplastin Time (APTT). The solution was to use saline and cryoprecipitate in the process to maintain the dialysis circuit and the hemodynamic stability of the patient.
The modality of choice was SLEDD, because of its capacity to offer continuous renal support while retaining a low risk of bleeding.
SLEDD with modifications proved to be a safe and effective method for managing AKI in our patient. Further research is needed to establish optimal management strategies for AKI in patients with Hemophilia B.