Tharmaraj Dhakshayini, Kerr Peter G
Department of Nephrology, Monash Medical Centre, Clayton, Victoria, Australia.
Nephrology (Carlton). 2017 Nov;22(11):838-847. doi: 10.1111/nep.13119.
Haemolysis in haemodialysis, although rare in current times, is associated with significant mortality and morbidity. As such prompt recognition, treatment, analysis of root cause and correction of underlying causative factors is crucial. Dialysate, extracorporeal circuit and patient related factors all contribute to haemolysis risk. Haemolysis can manifest with non-specific signs and symptoms including but not restricted to hypertension, nausea, pain (abdominal, chest, back) and dyspnoea. It may present acutely during the dialysis session or may take a protracted course. Potential life threating consequences include; hyperkalaemia induced cardiac arrhythmias, profound anaemia and associated acute coronary events and respiratory distress, and severe necrotizing pancreatitis. Chronic haemolysis results in impaired endothelial function thus contributing to the long-term cardiovascular risk profile in haemodialysis patients. Stringent national and international standards, technological advancements in membrane and dialysis equipment design, dialyser purification methods and water treatment systems have greatly reduced the incidence of haemolysis. Despite these improvements recognition of haemolysis risk and ongoing clinical vigilance is important.
血液透析中的溶血现象，尽管在当前较为罕见，但与显著的死亡率和发病率相关。因此，迅速识别、治疗、分析根本原因并纠正潜在的致病因素至关重要。透析液、体外循环和患者相关因素均会导致溶血风险。溶血可表现为非特异性体征和症状，包括但不限于高血压、恶心、疼痛（腹部、胸部、背部）和呼吸困难。它可能在透析过程中急性发作，也可能呈迁延病程。潜在的危及生命的后果包括：高钾血症诱发的心律失常、严重贫血及相关急性冠脉事件和呼吸窘迫，以及严重坏死性胰腺炎。慢性溶血会导致内皮功能受损，从而增加血液透析患者的长期心血管疾病风险。严格的国家和国际标准、膜和透析设备设计的技术进步、透析器净化方法及水处理系统已大大降低了溶血的发生率。尽管有这些改进，但认识到溶血风险并持续保持临床警惕仍很重要。
