Hemoperitoneum, or blood in the peritoneal cavity, is a frequent complication of peritoneal dialysis (PD) – particularly among premenopausal women – with an overall incidence of 6-57%(1–3). It may be due to the dialysis procedure itself or due to factors unrelated to renal disease. The presentation of hemoperitoneum can vary from a light-red contamination in the dialysate effluent, to the appearance of gross blood in the effluent bag(4). Regular performance of dialysis exchanges allows early detection.

Etiology of Hemoperitoneum(4,5)

  • Gynecological
    • Menstruation – ovulation
    • Ovarian cyst – endometriosis
  • Neoplastic
    • Renal cell carcinoma
    • Adenocarcinoma of colon
    • Carcinomatosis of the liver or hepatoma
  • Hematological
    • Thrombocytopenic purpura- anticoagulation
  • Polycystic diseases
  • Gastrointestinal
    • Splenic rupture or infarct, cholecystitis, pancreatitis, colonic perforation
  • Sclerosing peritonitis
  • Peritoneal calcification
  • Retroperitoneal or iliopsoas hematoma

Evaluation and Management

Typically, the PD effluent should be cultured initially. The white blood cell count and amylase level are then obtained at the first occurrence of hemoperitoneum. To determine the severity of bleeding, an effluent hematocrit level should also be obtained and changes in blood hemoglobin levels are monitored. Heavy recurrent bleeding associated with pain and fever should prompt urgent evaluation. An effluent hematocrit greater than 2% suggests severe bleeding. Further evaluation may include coagulation studies and abdominal imaging, such as a CT scan, an ultrasound, magnetic resonance imaging or an angiography. In the presence of visible blood, rapid exchanges and the use of intraperitoneal anticoagulants have been recommended to prevent clotting(5). Oral contraceptives may prevent ovulation and control bleeding(2). Aspirin and other systemic anticoagulants should be stopped, if possible. If bleeding persists, surgical exploration may be required(5).


  1. Greenberg A, Bernardini J, Piraino BM, Johnston JR, Perlmutter JA. Hemoperitoneum complicating chronic peritoneal dialysis: single-center experience and literature review. Am J Kidney Dis. 1992;19(3):252-256. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1553970.
  2. Harnett JD, Gill D, Corbett L, Parfrey PS, Gault H. Recurrent hemoperitoneum in women receiving continuous ambulatory peritoneal dialysis. Ann Intern Med. 1987;107(3):341-343. Available from: https://www.ncbi.nlm.nih.gov/pubmed/3619223.
  3. Tse K-C, Yip P-S, Lam M-F, Li F-K, Choy B-Y, Chan T-M, Lai K-N. Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Perit Dial Int. 2002;22(4):488-491. Available from: https://www.ncbi.nlm.nih.gov/pubmed/12322820.
  4. Dimitriadis CA, Bargman JM. Gynecologic issues in peritoneal dialysis. Adv Perit Dial. 2011;27:101-105. Available from: https://www.ncbi.nlm.nih.gov/pubmed/22073839.
  5. Lew SQ. Hemoperitoneum: bloody peritoneal dialysate in ESRD patients receiving peritoneal dialysis. Perit Dial Int. 2007;27(3):226-233. Available from: https://www.ncbi.nlm.nih.gov/pubmed/17468466.

The information and reference materials contained in this document are intended solely for the general education of the reader. It is intended to provide pertinent data to assist you in forming your own conclusions and making decisions. This document should not be considered an endorsement of the information provided nor is it intended for treatment purposes and is not a substitute for professional evaluation and diagnosis. Additionally, this information is not intended to advocate any indication, dosage or other claim that is not covered, if applicable, in the FDA-approved label.

P/N 102510-01 Rev. A 06/2016