Hemolysis: a hidden danger

Hemolysis is something that occurs to a small degree with every dialysis treatment. As we monitor our patients and the equipment we use, we hope that we have looked at everything and that our patients will be safe. We were extremely fortunate that we did not have a mortality related to this event. All of the hospitalized patients recovered and HP went on to receive her kidney transplant and is doing well. CG came back to dialyze in our unit after his physician was satisfied that our problem had been solved. In retrospect, we did not realize that we had an instrument in use that picked up the hemolysis long before we did. Our blood volume monitors showed us the increase in blood volume as the cells were lysed and vascular volume increased as the intracellular fluids were released. The concurrent rise in BP with these patients was also indicative of increased vascular volume. The blood volume monitor also showed the drop in hematocrit as red cells were lysed. We are now more experienced in interpreting these parameters and we are grateful to have this monitor on all of our patients and to have a new parameter to watch for to help forestall any further problems. Our patients' symptoms were baffling at the time because there were no overt signs of hemolysis. There was no "cherry pop" or brown colored blood in the lines or dialyzers which are what we have been taught to look for. Patients #1 and #3 essentially had no symptoms till the next day. Patient #2 exhibited nausea and some mild abdominal pain, which was also not new for him with his diabetic gastroparesis. Our nursing staff was very "gun shy" following this episode and some staff members seriously considered a change in profession. Fortunately they did not and opted to stay. It was brought home to all that dialysis, though it may seem to be a routine procedure, is inherently risky. Diligence and careful monitoring of all of our patients during their runs needs to be our utmost priority. Hemolysis to this degree is fortunately rare and we are grateful to have had an education with a positive outcome for all concerned.