One of the rare but potentially severe complications seen with hemodialysis is intravascular hemolysis. There is an interesting differential diagnosis of what might cause dialysis-associated hemolysis, many of which have to do with contamination of the dialysis water supply, and therefore one may observe this as an outbreak of hemolysis clustered within the same dialysis unit. Hopefully, the incidence of these outbreaks should be relatively low with proper water monitoring.
The Differential Diagnosis of Dialysis-With-Hemolysis (taken from Dr. Kevin Tucker’s lecture from earlier today):
-“The 3 C’s”: water contamination with COPPER, CHLORINE, or CHLORAMINE can all cause hemolysis-with-dialysis.
-Other contaminants, such as nitrite, nitrates, or formaldehyde may also cause hemolysis-with-dialysis.
-Overheated Dialysate can cause it.
-Kinked tubing: also different batches of defective tubing have also been cited as a cause of hemolysis at dialysis.
-Hypotonicity: e.g. if there is an error mixing the concentrate with not enough water.
If there is any suspicion of hemolysis(which might be detected based on a falling Crit line, severe pain, or pink-hued filtrate), the blood lines should be immediately clamped and not returned to the patient, as there is a high risk of hyperkalemia in this setting.