Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets

Duffy, Rosemary E.; Tomashek, Kay M.; Spangenberg, Michael; Spry, Leslie; Dwyer, Diane M.; Safranek, Thomas J.; Ying, Christopher Y.; Portesi, David; Divan, Hozefa A.; Kobrenski, John; Arduino, Matthew J.; Tokars, Jerome I.; Jarvis, William R.

doi:10.1046/j.1523-1755.2000.00011.x

Cited by 35 publications

(36 citation statements)

References 2 publications

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“…Toxins can also include contamination of the dialysate with bacteria, endotoxins, and disinfectants although hemolysis due to these toxins is very rare. In one simulated HD study where post HD blood samples were run through faulty tubing, gross hemolysis occurred within thirty minutes [7]. …”

Section: Case Presentationmentioning

confidence: 99%

Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

et al. 2014

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BackgroundThe burden of end-stage renal disease (ESRD) in the United States has increased dramatically over the past 30 years with almost 613,000 patients receiving renal replacement therapy in 2011. That same year, more than 112,000 new patients initiated dialysis with 92% of them receiving hemodialysis (HD). These patients experience significant morbidity and mortality with very frequent emergency room visits. Acute hemolysis associated with HD is a rare complication; however, if it’s not recognized early and managed adequately, it can be associated with life-threatening complications such as hyperkalemia and even myocardial infarction.Case presentation66-year-old African-American female with a history of ESRD secondary to hypertension developed a blood infiltration on the arterial side of her arteriovenous fistula followed by sudden onset of diffuse abdominal pain with nausea and vomiting during her regular HD treatment. She was referred to the emergency department where she was found to have shortness of breath with improved gastrointestinal symptoms. Her initial work-up revealed a severe anemia with a hematocrit of 10%. Further work-up revealed massive hemolysis, likely mechanical in nature and believed to be induced by malpositioning of her HD needle in the fistula. Her hospital course was complicated by rhabdomyolysis and acute myocardial infarction thought to be secondary to supply–demand ischemia in the setting of her profound anemia. Within a week, she eventually had a full recovery.ConclusionIt is extremely important for physicians and particularly emergency department physicians to be aware of this potentially life-threatening complication of HD and have a high index of suspicion in the setting of acute anemia with hemolysis in this population.

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Section: Case Presentationmentioning

confidence: 99%

Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

et al. 2014

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“…Mechanical damage can occur if blood is forced through a constriction in the circuit caused by, for example, a kink in the tubing, a deformity in the moulding of a connector or a fragment of plastic in the lines. 4,5 This will lead to excessive pressures in the circuit which is usually picked up by the pressure monitoring systems. However, in older machines (including the Fresenius 4008), there is no monitoring for excessive pressure in the section of the circuit between the outlet of the blood pump and the inlet of the dialyser.…”

Section: What Caused the Haemolysis?mentioning

confidence: 99%

Unexpected triggering of the dialysate blood leak detector by haemolysis

Lindley

Finney

Jones

et al. 2014

Acta Clinica Belgica

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2Blood Bank, Leeds Teaching Hospitals NHS Trust, Leeds, UK This case showed that it is possible for haemoglobin released by haemolysis in the extracorporeal circuit to pass through a high permeability (albumin retaining) dialyser membrane. In the incident described, the blood leak detector of the dialysis machine was activated before the patient became symptomatic. Haemolysis should be considered as a possible cause of blood leak alarms during dialysis with high flux membranes

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“…55 Investigation of a dialysis outbreak requires a methodical A recent nationwide outbreak in the United States of severe adverse reactions in HD patients was attributed to vials of heparin contaminated with oversulfated chondroitin sulfate. 47…”

Section: Investigation Of a Dialysis Outbreakmentioning

confidence: 99%

Acute Complications During Hemodialysis

Seabra¹,

Jaber²

2010

Comprehensive Clinical Nephrology

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Multistate outbreak of hemolysis in hemodialysis patients traced to faulty blood tubing sets

Abstract: Our investigation traced the multiple hemolysis outbreaks to partially occluded hemodialysis blood tubing produced by a single manufacturer. On May 25, 1998, the manufacturer issued a voluntary nationwide recall of the implicated lots of hemodialysis blood tubing cartridge sets.

Cited by 35 publications

References 2 publications

Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

Hemolysis as a rare but potentially life-threatening complication of hemodialysis: a case report

Unexpected triggering of the dialysate blood leak detector by haemolysis

Acute Complications During Hemodialysis

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