Hemolysis

Etiology1

  • Mechanical
    • High blood pump flow
    • Single-needle dialysis
    • Small gauge cannula
    • Kinked blood lines
    • High negative arterial pressure
    • Offset blood pump
    • Failure of rinsing
    • Hydrogen peroxide
  • Contamination with
    • Hypochlorite
    • Formaldehyde
  • Priming error
    • Hypotonic saline
  • Dialysate error
    • Hyper or hypotonic dialysate
    • Overheated dialysate
  • Dialysate contamination
    • Chloramines
    • Nitrates
    • Copper

Treatment

  • Stop blood pump, clamp venous bloodline and discard the blood
  • Provide oxygen to the patient
  • Type and cross of blood transfusion if needed
  • Resume HD as soon as patient is stabilized, since hyperkalemia accompanies hemolysis

Prevention

  • Test machine prior to use to ensure that the air detector alarm system is working effectively
  • Avoid chemical contaminants that can damage RBC’s
  • Oxidants such as chloramines, copper, zinc
  • Reducing agents such as formaldehyde, hypo or hypertonic dialysate
  • Overheated dialysate
  • Avoid small needles
  • Highly negative arterial pressure alarms
  • Ensure correct positioning of tubing in the roller pumps
  • Avoid accidental compression of lines

Reference:

1.  Davenport A: Intradialytic complications during hemodialysis. Hemodial Int 10:162-167, 2006