Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia

Abstract

Substantial activation of platelets can occur in the course of hemodialysis. Platelet surface markers show evidence of platelet degranulation. Some activation occurs due to exposure of blood to the roller pump segment and microbubbles may play a role. Platelet activation seems to be reduced with reused dialyzers or with those containing synthetic versus cellulosic membranes. Nevertheless, a substantial degree of platelet activation can be demonstrated with polysulfone and other synthetic membranes; the amount of activation may differ substantially among polysulfone membranes, depending on the manufacturer and the polyvinylpyrrolidone content. Platelet-platelet and platelet-leukocyte aggregates have been detected in the dialyzer blood outflow line and the consequences of these to the microcirculation are unknown. Typically, the platelet count decreases slightly during the first hour of dialysis, but mostly returns to initial values by the end of dialysis. A number of chronic hemodialysis patient cases have been reported in which a marked decrease in platelet count (50% or more) during dialysis was observed, resulting in mild degrees of predialysis thrombocytopenia. In only one case was the decrease in platelet count associated with bleeding. Dialyzer hypersensitivity symptoms are infrequently associated with a fall in platelet count. Most recent cases of dialysis-associated thrombocytopenia have been with polysulfone membranes, especially polysulfone membranes sterilized by electron beam. The exact cause of these reactions remains unknown.

Hematological Changes in Pre and Post Hemodialysis in Patients With Chronic Renal Failure

“…In a study of Daugirdas JT et al, 15 platelet count was found to be decreased in post dialysis patients when compared to predialysis.…”

The role of platelets in the prognosis of renal disease

“…A reduction in platelet count during the course of a dialysis session is recognised, alongside platelet activation and degranulation, which is attributed to exposure to the dialysis membrane and the roller pump and results in platelet-lymphocyte aggregates 29,33 . Thrombocytopenia may also be seen as part of the syndrome of heparin-induced thrombocytopenia in dialysis patients, whereby the generation of the platelet-factor 4/ heparin complex triggers antibody formation.…”

Biocompatibility and small protein permeability of hydrophilic-coated membrane dialyzer (NV) in hemodialysis patients: a pilot study

“…PF4 and β-TG are substances contained within platelet α-granules, and changes in platelet PF4 or β-TG levels are useful indicators of platelet degranulation and activation during dialysis [9]. However, there were no significant changes observed in the coagulation factor values with either dialyzer.…”

“…Although acute leukopenia is known to occur in all patients during the first 30 min of HD treatment [10], our study showed no reduction in the WBC during dialysis with either dialyzer. The platelet count usually decreases 5 to 15% at 15 to 30 min from the start of HD and recovers to the normal level by the end of the dialysis session [9,11]. Oshihara [3] reported that the numbers of platelets adhering to the membrane surface were lower with NV than with the conventional PS (CX) membrane.…”