Mechanical stress-related haemolysis in a paediatric haemodialysis patient

Area of Science:

• Pediatric Nephrology
• Hematology
• Medical Device Complications

Background:

• Hemodialysis (HD) is a vital kidney replacement therapy (KRT) for pediatric end-stage kidney disease (ESKD).
• Intraluminal mechanical hemolytic anemia is a rare but serious complication.
• Previous reports often linked hemolysis to arteriovenous fistulas.

Observation:

• A 2-year-old child developed insidious hemolytic anemia linked to acute angulation of the HD line.
• Hyperbilirubinemia was modest due to HD clearance.
• Key indicators included rising lactate dehydrogenase and falling hemoglobin post-HD.

Findings:

• The primary cause was mechanical stress on the HD line leading to intraluminal hemolysis.
• Onset was subtle, identified through serial biochemical and hematological monitoring.
• Lactate dehydrogenase elevation post-HD with decreasing hemoglobin was the most consistent marker.

Implications:

• Mechanical stress-induced hemolysis should be considered in pediatric HD patients with unexplained anemia.
• This diagnosis is crucial for children resistant to standard iron and erythropoiesis-stimulating agent therapy.
• Early recognition can prevent delayed diagnosis and optimize KRT management in children.