Hemolysis during percutaneous mechanical thrombectomy can mimic a hemolytic transfusion reaction

Mair, David; Eastlund, Ted; Rosen, G.; Covin, Randal B.; Harmon, James V.; Menser, Margaret A.; Carr, Robert W.; Shrwany, S.

doi:10.1111/j.1537-2995.2005.00208.x

Cited by 20 publications

(21 citation statements)

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“…9 This process also results in the mechanical lysis of red blood cells. 7,10,11 Hemolysis following use of AngioJet® has been reported, which in one case (where the device was used to treat portal vein thrombosis) caused transient elevation of the serum creatinine level. 11 The Amplatz thrombectomy device uses a similar mechanical approach to that of AngioJet®, by creating a hydrodynamic vortex to dissolve the clot.…”

Section: Hemolysis Caused By Thrombectomymentioning

confidence: 99%

Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

et al. 2008

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Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy. Continuing Medical Education online Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To receive credit, please go to http://www.medscape.com/cme/ncp and complete the post-test. Learning objectivesUpon completion of this activity, participants should be able to: 1 Describe the clinical features of pulmonary embolism in a pregnant woman. 2 Describe the clinical features of intravascular hemolysis. 3 Describe the mechanism of action of the AngioJet ® . 4 Review the management of acute kidney injury associated with hemolysis. Competing interestsThe authors, the Journal Editor C Harman and the CME questions author D Lie declared no competing interests. THE CASEA 43-year-old African-American female (gravida 5 para 0), with an intrauterine pregnancy of 8 weeks' gestation, presented to the emergency room with crampy abdominal pain, shortness of breath, and shoulder pain. The patient's medical history was notable for hypertension, uterine fibroids, one spontaneous abortion in the first trimester, and three elective therapeutic abortions. She was not taking any prescription medications and had no known drug allergies. The patient's history also indicated that she had smoked one pack of cigarettes per week for 25 years, but she denied alcohol or illicit drug use. On physical examination, the patient's temperature was 36.0 °C, and she had a pulse rate of 118 beats per minute and a blood pressure of 142/87 mmHg. Oxygen saturation was 100% on a nonrebreather mask. The patient was alert S u M M a rYBackground A 43-year-old African-American female (gravida 5 para 0) with an 8-week intrauterine pregnancy presented to the emergency room with crampy abdominal pain, shortness of breath, and shoulder pain. She had normal renal function on admission. CT angiography of the chest revealed bilateral pulmonary emboli; therefore, the AngioJet® (Possis Medical, Inc., Minneapolis, MN) device was used to perform mechanical thrombolysis. The patient subsequently developed hyperkalemia, red urine and anuria.

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Section: Hemolysis Caused By Thrombectomymentioning

confidence: 99%

Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

et al. 2008

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“…In addition, a chart review was performed for confounding variables within the observational period including thrombectomy, thrombolytic therapy, prosthetic valves, tricuspid valve regurgitation and pulmonary hypertension, blood transfusion, and infection [5][6][7][8][9][10][11][12][13][14]. In select patients, a review of related laboratory values during the study period was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Four patients were excluded during analysis due to extremely low day 0 haptoglobin levels (haptoglobin=1-11 gm/dl). In three patients, a predisposing condition or treatment known to decrease haptoglobin was identified: end-stage liver disease, thrombectomy and/or thrombolytic therapy [1,7,8]. For the remaining 18 patients, the mean haptoglobin on day 0 was 274 ± 142 mg/dl (median 283, range 59-551).…”

Section: Patientsmentioning

confidence: 99%

“…Haptoglobin is also decreased in the setting of mechanical and shear-induced hemolysis including severe aortic stenosis, heart valves, thrombectomy, extracorporeal membrane oxygenation, and cardiac bypass surgery [6][7][8][9][10][11]. In some instances, non-immune, mechanical hemolysis has been initially confused for a hemolytic transfusion reaction [7].…”

Section: Introductionmentioning

confidence: 99%

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Inferior Vena Cava Filters as a Potential Non-immune Cause of Low Serum Haptoglobin

Cooling¹,

Giacherio²,

Elkins³

2017

J Blood Disord Transfus

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Objective: Serum haptoglobin level is commonly used as a marker of hemolysis. We hypothesized that inferior vena cava (IVC) filters may be a potential non-immune etiology for subclinical hemolysis and low haptoglobin in some patients, after encountering a patient with an IVC filter, mild macrocytic anemia and unexplained severe haptoglobinemia. IVC filters can be associated with pressure gradients and turbulent blood flow in the presence of trapped clots and thrombus formation. Methods:Prospective study in patients undergoing IVC filter placement at our institution over a 3-month period in 2008. All patients had a haptoglobin level prior to filter placement, and then daily for a period of 3-14 days. The absolute and relative change in haptoglobin compared to pre-procedure levels was determined. Results were evaluated by t-test (paired, 2-tail). Statistics and graphics were performed with commercial software.Results: A total of 22 patients underwent IVC filter placement. Four patients were excluded due to low preprocedure haptoglobin levels. At least one post-procedure haptoglobin values was available until day 3 in 18/18 eligible patients. Nine patients were followed for a period of 1-2 weeks. Although the majority of patients had an increase in haptoglobin after IVC filter placement, 3/9 (30%) had >50% decrease in haptoglobin by day 7, including one patient with severe haptoglobinemia by day 14. Patients with decreased haptoglobin levels also had decreases in platelet count over the same period. Conclusion:These results suggest that IVC filters may be another non-immune, device-related cause of decreased haptoglobin in some patients.

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“…Antibodies and/or complement proteins induce a hemolytic reaction during the acute (acute hemolytic transfusion reaction) [1] and delayed (delayed hemolytic transfusion reaction) phases [2]. Nonimmune mediated causes of transfusion-associated hemolysis include thermal injury [3], osmotic injury [4], mechanical injury [5], infection [6], drugs [7] and others. In mechanical injuries, defective blood administration causes induced transfusionassociated hemolysis [8].…”

Section: Introductionmentioning

confidence: 99%

Possible red blood cell damage due to iatrogenic transfusion filter-related mistakes during blood transfusion

Fujita¹,

Sakuma²,

Nishimura³

2013

Med Instrum

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Background: Red cell concentrates are usually transfused through a transfusion filter. Iatrogenic accidents can occur in which the red blood cell concentrate is transfused through the infusion filter by mistake. Therefore, we examined the extent of red blood cell damage in red cell concentrates transfused through transfusion and infusion filters ex vivo. Methods: We evaluated red blood cell damage using lactate dehydrogenase, free hemoglobin, and erythrocyte membrane phosphatidylserine expression in red cell concentrates transfused through transfusion and infusion filters (transfusion rate: 100mL/h). In addition, we performed hemolytic experiments using a 50% glucose solution in red cell concentrates transfused through both filters. Results: Red cell concentrates transfused through infusion filters revealed higher lactate dehydrogenase, free hemoglobin, and phosphatidylserine expression levels than those transfused through transfusion filters. The 50% glucose solution induced hemolysis of the red cell concentrates from the infusion filters more strongly than those from the transfusion filters. Conclusion: An iatrogenic mistake from the transfusion filter to the infusion filter might induce red blood cell damage.

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Hemolysis during percutaneous mechanical thrombectomy can mimic a hemolytic transfusion reaction

Cited by 20 publications

References 21 publications

Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

Acute kidney injury caused by intravascular hemolysis after mechanical thrombectomy

Inferior Vena Cava Filters as a Potential Non-immune Cause of Low Serum Haptoglobin

Possible red blood cell damage due to iatrogenic transfusion filter-related mistakes during blood transfusion

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