hemolysis

[diabo, RN]

Had an interesting experience the other night. I am wondering if anyone else has encountered this. I got a patient from the OR after she had her rather large fistula declotted. I hooked her up and imediately after the blood hit the kidney I got a blood leak alarm. I pulled some dialysate to test it with a strip, but I didn't have to: the dialysate was pink. So I discarded the blood and started over with a new kidney on a new machine. Same thing. I did it a third time with a kidney from a different lot and it happened again.

The nephrologist said that it had to be high TMP coming from the poor flow in her access, even though the access had a great thrill, and all pressures as well as the TMP were within normal ranges.

Anyways, for shortness sake, the problem was due to hemolysis that was caused from the Angiomax that was used in the procedure. A cell count of the dialysate revealed zero red blood cells. Another doctor explained that the heme, the part of the RBC that makes it red, was released into the plasma and is small enough to cross into the dialysate from the blood giving the dialysate the pink color that triggered the blood leak alarm.

I successfully ran her 16 hours later. He said even with no kidney, the spleen quickly clears up the blood. Normally the urine would look pink or bloody as the kidney clears the blood up. It was a eye opener for me and several others. including the surgeon and the nephrologist.