Approach to a Rare Entity: Hemolysis due to Dialysis Machine

OBJECTIVE: Hemolysis is one of the rare and occasionally fatal complications of hemodialysis. The cause of hemolysis should be found for the prevention of further hemolysis and deaths. The checklist for the cause of hemolysis requires every detail of dialysis process to be reviewed, though clinical experience and the literature are still insufficient to guide medical professionals in solving the problem. The aim of this article was to increase awareness regarding the failure of the current evidence to solve the problem of hemolysis in hemodialysis. MATERIAL and METHODS: Clinical, procedural and technical data regarding 11 episodes of hemolysis in 9 patients on 5 machines from two hemodialysis centers were investigated. The cause for hemolysis was investigated step by step based on the available evidence and instructions of the respective hemodialysis machines. RESULTS: Both the frequent and rare causes of hemolysis in hemodialysis such as blood tubing sets, dialysis membranes, needles, water system and machine contamination, chloramines, high temperature dialysis, and hypo-osmolar dialysis were excluded. Technical investigations of the hemodialysis machines by the authorized services were also of no help. Lastly, replacement of the 5 suspected hemodialysis machines resulted in permanent cessation of the hemolysis episodes. CONCLUSION: The current evidence for the causes of hemolysis in hemodialysis may be insufficient, and replacement of the suspected hemodialysis machines may be the last resort.