Hemolysis in hemodialysis

the lecture is about hemolysis during hemodialysis, which is an acute complication arising during hemodialysis session, this lectures will cover the all aspects of hemolysis including prevention , management, investigation, , sign and symptoms arises due to hemolysis. the mechanical shear stress related hemolysis, dialysate related factors, as well as patient related factors induces hemolysis.

1. Hemolysis in Hemodialysis By: Aniqa Atta BS: Renal dialysis technology Mphil: Molecular biology and genetics

2. Hemolysis Is defined as the rupturing of red blood cells, a ssociated with significant mortality and morbidity

3. CAUSES MECHANICAL/SHEAR STRESS Flow rate, pressures and cannula size Mechanical obstructions Single needle technique and cannula positioning Dialysis membranes DIALYSATE FACTORS Temperature Osmolality Uremia and oxidative stress

4. Causes Patient specific factors (medical conditions and medications ) Hemolysis include, but are not limited to : • Autoimmune conditions such as systemic lupus erythematosus, scleroderma, polyarteritis nodosa, hemolytic uremic syndrome, and thrombotic thrombocytopenic purpura • Malignant hypertension • Malignancies that predispose to microangiopathic hemolytic anaemia • Hypersplenism • Hemolytic disorders i.e. Sickle cell anemia , G6PD deficiency, spherocytosis • Mechanical valves • Electrolyte disturbances, particularly low phosphate concentrations Some medications that may induce hemolysis include: aspirin, penicillin, cephalosporin (especially cefotetan), sulfonamides, sulfones, nitrofurantoin, phenacetin, primaquine, quinidine, hydralazine and certain vitamin K derivatives

5. S ign and Symptoms Back pain Tightness in chest Shortness of breath Deepening of skin pigmentation Port wine appearance of blood in the venous blood line Severe hyperkalemia if massive massively hemolysis occur leading to muscle weakness, electrocardiographic abnormalities and ultimately cardiac arrest

6. Management Blood pump should be stopped immediately and blood line should be clamped Hemolyzed blood has a very high potassium should not be reinfused Check potassium and Hb Seek cause urgently Multiple patient may be affected if it is due to water or central dialysate problem