Red Blood Cell Damage from Extracorporeal Circulation in Hemodialysis

Abstract

Blood damage is an unavoidable side effect of extracorporeal circulation. The effects of blood damage on patients' hematocrit and erythropoietin requirement as well as other potential side effects have not been studied for uneventful treatments. Comparing long nocturnal dialysis with regular 4-hour, three times per week dialysis allows for the conclusion that the influence of blood damage caused by extracorporeal circulation is small compared with biochemical effects. Acute hemolysis is one of the few remaining mechanical problems of dialysis. Acute hemolysis is caused by obstructions within the extracorporeal circuit caused by manufacturing errors, kinking of blood tubing or user errors, or by a combination of excessive flow and improper cannula or catheter dimensions. The risk of acute hemolysis can be further reduced by industrial quality control, better design of dialysis equipment, and hemodialysis machine control. Adverse effects caused by chronic mechanical hemolysis need to be studied.

Individual Response Variations to Erythropoietin Stimulating Agents in Patients on Maintenance Hemodialysis.

“…However, our finding in the studied patients was that increased dialysis dose (Kt/V) is associated with higher ERI. This may be explained as a delayed hemolysis or severe changes of the erythrocyte morphology occurred after prolonged extracorporeal circulation [49]. In agreement with our study, Lopez-Gomez et al [40] reported positive association of spKt/V and ERI but failed to find a statistical significance.…”

Does the extracorporeal circulation worsen anemia in hemodialysis patients? Investigation with advanced microscopes of red blood cells drawn at the beginning and end of dialysis

“…• Extrinsic class: Increased mechanical stress due to kinks in the extracorporeal circulation line that can motivate macroscopic lysis of RBCs 8,9 is not relevant in our case. Notes: Dependence of r or with (A) pre-hD Ur; (B) pre-hD cr, (C) pre-hD ca; and (D) pre-hD P, comparison was between all different pairs: the two subgroups of hD patients, of low and high uremic marker concentration, and the group of healthy donors.…”

“…However, the contribution of the roller pump or even minor mechanical stress due to the shear forces and biochemical activation due to the imperfect biocompatibility of the extracorporeal materials that unavoidably occur during dialysis cannot be neglected since these can damage RBCs. [8][9][10][11] Furthermore, a number of studies have reported that both the lipid and protein compositional profile of the RBC membrane is drastically modified during dialysis. [12][13][14][15] It is plausible to assume that these compositional modifications of the RBC membrane that are motivated by the extrinsic mechanisms [12][13][14][15] could somehow influence the membrane structure and ultimately influence the RBC lifespan.…”

“…The possible mechanisms motivating and/or promoting the decreased lifespan of RBCs can be categorized as extrinsic (extracorporeal circuit) or intrinsic (uremic milieu). The extrinsic mechanisms relate to the extracorporeal circulation of the HD patient's blood during dialysis, since this can induce mechanical stress, 8,9 biochemical activation, 10,11 and membrane compositional modifications [12][13][14][15] to the RBCs. Intrinsic mechanisms refer to the interference of the biochemically crowded landscape of the RBC membranes (receptors, transport channels, etc) with the complex environment of uremic toxins.…”

Hemolysis in Medical Devices

“…Surface roughness and the chemistry of the surface have major roles in hemolysis, and they may even govern capillary flow, especially at shear stress below the critical limit of ~150Pa [13]. Several hemolysis experiments conducted by researchers and investigators that all had similar tension for lysis, including but not limited to: Blachshear and Anderson (33 dyne/cm), Rand (28.6 dyne/cm) and Zydney (25.6dyne/cm) [1].…”