Severe Haemolytic Anaemia Resulting from a Malpositioned Haemodialysis Catheter

Severe haemolytic anaemia is a rare complication of haemodialysis that is often difficult to recognize, especially when there are other potential differential diagnoses. Here, we present the case of 19-year-old man on haemodialysis who developed severe haemolytic anaemia while recovering from acute renal failure secondary to rhabdomyolysis. Other causes of haemolytic anaemia such as thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome were ruled out. As his blood counts were dropping on days following haemodialysis, haemolysis secondary to the mechanical sheering effect of the catheter was considered and his haemodialysis catheter was exchanged, which led to the resolution of anaemia.

Haemodialysis-related haemolysis can be due to the mechanical sheering effect of the catheter/tubing, and overheating or contamination of the dialysate fluid.Most cases of catheter or faulty tubing-related haemolysis need a high level of suspicion for diagnosis and normally resolve with correction of the underlying mechanical issue.Due to the rarity of the phenomenon, it is very important to rule out other life-threatening causes of haemolytic anaemia, such as disseminated intravascular coagulation and thrombotic thrombocytopenic purpura.