Recurrent white thrombi formation in hemodialysis tubing: a case report

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• 作者：Kiran P Sathe (1)
  Wee-Song Yeo (1)
  Isaac Desheng Liu (1)
  Sudha Ekambaram (1)
  Mohammed Azar (1)
  Hui-Kim Yap (1) (2)
  Kar-Hui Ng (1) (2)
  
  1. Shaw-NKF-NUH Children鈥檚 Kidney Centre ; Khoo Teck Puat-National University Children鈥檚 Medical Institute ; National University Health System ; Level 12 NUHS Tower Block ; 1E Kent Ridge Road ; Singapore ; 119228 ; Singapore
  2. Department of Paediatrics ; Yong Loo Lin School of Medicine ; National University of Singapore ; Singapore ; Singapore
  
• 关键词：Platelet activation ; Renal dialysis ; Thrombosis ; Blood platelets ; Hemodialysis ; Home
• 刊名：BMC Nephrology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：16
• 期：1
• 全文大小：371 KB
• 参考文献：1. Baccheschi, S, Sereni, L, De Nitti, C, Barbucci, R, Tetta, C (2001) Blood tubing and cytokine production: effect of sterilization. Ren Fail 23: pp. 411 CrossRef
  2. Joannidis, M, Oudemans-van Straaten, HM (2007) Clinical review: Patency of the circuit in continuous renal replacement therapy. Crit Care 11: pp. 218 CrossRef
  3. Daugirdas, JT, Bernardo, AA (2012) Hemodialysis effect on platelet count and function and hemodialysis-associated thrombocytopenia. Kidney Int 82: pp. 147-157 CrossRef
  4. Hakim, R, Schafer, A (1985) Hemodialysis-associated platelet activation and thrombocytopenia. Am J Med 78: pp. 575 CrossRef
  5. De Prada, L, Lee, J, Gillespie, A, Benjamin, J (2013) Thrombocytopenia associated with one type of polysulfone hemodialysis membrane: A report of 5 cases. Am J Kidney Dis 61: pp. 131-133 CrossRef
  6. Kiaii, M, Djurdjev, O, Farah, M, Levin, A, Jung, B, MacRae, J (2011) Use of electron-beam sterilized hemodialysis membranes and risk of thrombocytopenia. JAMA 306: pp. 1679 CrossRef
  7. Allison, S (2011) Dialysis: Dialyzer sterilization method linked to thrombocytopenia. Nat Rev Nephrol 7: pp. 676 CrossRef
  8. Sirolli, V, Ballone, E, Di Stante, S, Amoroso, L, Bonomini, M (2002) Cell activation and cellular-cellular interactions during hemodialysis: effect of dialyzer membrane. Int J Artif Organs 25: pp. 529
  9. Watnick, S, Stooksbury, M, Winter, R, Riscoe, M, Cohen, DM (2008) White thrombus formation in blood tubing lines in a chronic hemodialysis unit. Clin J Am Soc Nephrol 3: pp. 382 CrossRef
  10. Sagripanti, A, Cupisti, A, Baicchi, U, Ferdeghini, M, Morelli, E, Barsotti, G (1993) Plasma parameters of the prothrombotic state in chronic uremia. Nephron 63: pp. 273-278 CrossRef
  11. Gordge, MP, Leaker, BR, Rylance, PB, Neild, GH (1991) Haemostatic activation and proteinuria as factors in the progression of chronic renal failure. Nephrol Dial Transplant 6: pp. 21-26 CrossRef
  12. Martinovic, Z, Basic-Jukic, N, Pavlovic, DB, Kes, P (2013) Importance of platelet aggregation in patients with end-stage renal disease. Acta Clin Croat 52: pp. 472-477
  13. Salvati, F, Liani, M (2001) Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal dialysis. Int J Artif Organs 24: pp. 131-135
  14. Serradell, M, Diaz-Ricart, M, Cases, A, Zurbano, MJ, Aznar-Salatti, J, Lopez-Pedret, J, Ordinas, A, Escolar, G (2001) Uremic medium disturbs the hemostatic balance of cultured human endothelial cells. Thromb Haemost 86: pp. 1099-1105
  15. Chitalia, VC, Shivanna, S, Martorell, J, Balcells, M, Bosch, I, Kolandaivelu, K, Edelman, ER (2013) Uremic serum and solutes increase post-vascular interventional thrombotic risk through altered stability of smooth muscle cell tissue factor. Circulation 127: pp. 365-376 CrossRef
  16. Farid, FA, Faheem, MS, Heshmat, NM, Shaheen, KY, Saad, SS (2004) Study of the homocysteine status in children with chronic renal failure. Am J Nephrol 24: pp. 289-295 CrossRef
  17. Fadel, FI, Elshamaa, MF, Essam, RG, Elghoroury, EA, El-Saeed, GS, El-Toukhy, SE, Ibrahim, MH (2014) Some amino acids levels: glutamine, glutamate, and homocysteine, in plasma of children with chronic kidney disease. Int J Biomed Sci 10: pp. 36-42
  18. Wu, CC, Zheng, CM, Lin, YF, Lo, L, Liao, MT, Lu, KC (2012) Role of homocysteine in end-stage renal disease. Clin Biochem 45: pp. 1286-1294 linbiochem.2012.05.031" target="_blank" title="It opens in new window">CrossRef
  19. Bostom, AG, Lathrop, L (1997) Hyperhomocysteinemia in end-stage renal disease: prevalence, etiology, and potential relationship to arteriosclerotic outcomes. Kidney Int 52: pp. 10-20 CrossRef
  20. Van Campenhout, A, Moran, CS, Parr, A, Clancy, P, Rush, C, Jakubowski, H, Golledge, J (2009) Role of homocysteine in aortic calcification and osteogenic cell differentiation. Atherosclerosis 202: pp. 557-566 CrossRef
  21. Tsai, JC, Perrella, MA, Yoshizumi, M, Hsieh, CM, Haber, E, Schlegel, R, Lee, ME (1994) Promotion of vascular smooth muscle cell growth by homocysteine: a link to atherosclerosis. Proc Natl Acad Sci U S A 91: pp. 6369-6373 CrossRef
  22. Cetin, O, Bekpinar, S, Unlucerci, Y, Turkmen, A, Bayram, C, Ulutin, T (2006) Hyperhomocysteinemia in chronic renal failure patients: relation to tissue factor and platelet aggregation. Clin Nephrol 65: pp. 97-102 CrossRef
  23. Syed, S, Reilly, R (2009) Heparin-induced thrombocytopenia: a renal perspective. Nat Rev Nephrol 5: pp. 501 CrossRef
  24. Lim, W, Cook, DJ, Crowther, MA (2004) Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. J Am Soc Nephrol 15: pp. 3192-3206 CrossRef
  25. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2369/16/3/prepub
  
• 刊物主题：Nephrology; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1471-2369

文摘

Background While the appearance of red clots in the dialyzer is a common phenomenon in every hemodialysis unit, the occurrence of white thrombi in the tubing is relatively rare. Case presentation We describe an adolescent male with recurrent white thrombi formation in the hemodialysis tubing. This patient had chronic renal failure from focal segmental glomerulosclerosis, but was no longer nephrotic at the time of the thrombi formation. He had a history of recurrent thrombosis of his vascular access. However, no pro-thrombotic risk factors could be identified. White particulate matter, measuring 1 to 3mm in size, and adherent to the arterial and venous blood tubing lines was found during the rinse back of a hemodialysis session. This was associated with a 60% decrease in his platelet count. Light microscopic examination of the deposits revealed the presence of platelet aggregates. He subsequently developed thrombosis of his arteriovenous graft six hours later. The white thrombi recurred at the next dialysis session, as well as six months later. These episodes occurred regardless of the type of dialysis machine or tubing, and appeared to resolve with an increase in heparin dose. Conclusion Recurrent white thrombi formation can occur in the hemodialysis tubing of a patient with no identifiable pro-thrombotic factors. The white thrombi may be a harbinger of arteriovenous graft thrombosis and may be prevented by an increase in heparin dose.