Gault M H, Duffett S, Purchase L, Murphy J
General Hospital, St. John's, Nfld., Canada.
Nephron. 1992;62(3):267-71. doi: 10.1159/000187057.
Between May 29 and September 13, 1991, 4 patients developed acute intravascular hemolysis during hemodialysis with Monitral-S delivery systems and Hospal BSM A77 blood lines. All had malaise, nausea and headache; 3 had severe abdominal pain and 2 became very ill. Plasma hemoglobins were 3-21 g/l and LDH 542-3,300 IU in the 4 patients. Hepatoglobin became unmeasurable in 3 and was 0.09 g/l in the 4th patient. Soon afterwards, we found the arterial blood line tightly kinked at the dialyzer inlet port in the 4th patient and released it; he developed abdominal pain, hemolysis was present. We then found these lines had an extra long pump segment, and the rest was short and fitted poorly. When put in the first tubing organizer, severe kinking could occur just after the pump segment, causing back pressure but no alarm. We produced early visible hemolysis in a 1-liter circulating closed loop blood system with the blood line kinked either at the dialyzer inlet or just below the first arterial line tubing organizer with 40 g/l free plasma hemoglobin by 30 min. We excluded reported causes of intravascular hemolysis during hemodialysis. No hemolysis occurred before or during the 9 months after we discarded BSM A77 lines. The evidence indicates that kinked blood lines caused the hemolysis.
1991年5月29日至9月13日期间，4例患者在使用Monitral - S输送系统和Hospal BSM A77血路进行血液透析时发生急性血管内溶血。所有患者均有乏力、恶心和头痛症状；3例有严重腹痛，2例病情严重。4例患者的血浆血红蛋白为3 - 21 g/l，乳酸脱氢酶为542 - 3300 IU。3例患者的触珠蛋白无法测出，第4例患者的触珠蛋白为0.09 g/l。此后不久，我们发现第4例患者的动脉血路在透析器入口处严重扭曲并将其解开；他出现腹痛，存在溶血现象。然后我们发现这些血路的泵段过长，其余部分短且装配不佳。当放入第一个管路整理器时，在泵段之后很快就会出现严重扭曲，从而产生背压但没有警报。在一个1升的循环闭环血液系统中，将血路在透析器入口处或刚好在第一个动脉管路整理器下方扭曲，30分钟内游离血浆血红蛋白达到40 g/l时，会出现早期明显的溶血现象。我们排除了已报道的血液透析期间血管内溶血的原因。在我们丢弃BSM A77血路之前及之后的9个月内均未发生溶血。证据表明，扭曲的血路导致了溶血。
