Department of Medicine, Division of Nephrology, Emory University School of Medicine, Atlanta, GA, USA.
Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA.
Am J Case Rep. 2021 Jul 3;22:e932045. doi: 10.12659/AJCR.932045.
BACKGROUND Biocompatible hemodialysis membranes have greatly advanced the treatment of renal failure. Synthetic polysulfone dialysis membranes are considered to be very biocompatible because of their low propensity to activate complement. However, these membranes can reduce platelet count through platelet activation, although the mechanism of this activation is unknown. CASE REPORT We report the case of an 82-year-old man with a history of chronic kidney disease with recurrent gastrointestinal bleeding and worsening renal function who was initiated on renal replacement therapy with polysulfone dialysis membranes. On admission, the patient's platelet count was normal at 233×10³/μL. A significant fall in platelet count was observed following most dialysis treatments, reaching a nadir of 37×10³/μL. With occasional dialysis treatments, his platelet count did not change. This dialysis-induced thrombocytopenia resolved following substitution with Cellentia-H cellulose triacetate single-use, hollow-fiber, high-flux hemodialyzer membrane. CONCLUSIONS Polysulfone membranes are capable of activating platelets, which can result in severe thrombocytopenia. However, the magnitude of dialysis-induced thrombocytopenia varies from treatment to treatment. As such, it may not be evident when the pre- and postdialysis platelet counts are measured for a single treatment. Because the etiology of this platelet activation is unknown, substitution with cellulose triacetate membranes should be considered. These membranes have an unrelated chemical composition and a very low propensity to activate platelets.
生物相容性血液透析膜极大地推进了肾衰竭的治疗。合成聚砜透析膜因其激活补体的倾向较低，被认为具有很好的生物相容性。然而，这些膜可能通过血小板激活导致血小板计数减少，尽管其激活机制尚不清楚。
我们报告了一例 82 岁男性慢性肾脏病患者的病例，该患者有复发性胃肠道出血和肾功能恶化病史，开始接受聚砜透析膜进行肾脏替代治疗。入院时，患者的血小板计数正常，为 233×10³/μL。大多数透析治疗后观察到血小板计数显著下降，达到 37×10³/μL 的最低点。偶尔进行透析治疗时，其血小板计数没有变化。使用 Cellentia-H 纤维素三醋酸酯一次性使用空心纤维高通量血液透析器膜替代后，这种透析引起的血小板减少症得到解决。
聚砜膜能够激活血小板，从而导致严重的血小板减少症。然而，每次透析治疗引起的血小板减少症的严重程度不同。因此，在测量单次治疗的透析前后血小板计数时，可能并不明显。由于这种血小板激活的病因不明，应考虑使用纤维素三醋酸酯膜进行替代。这些膜具有不同的化学组成，且激活血小板的倾向非常低。
