Hasler C R, Owen G R, Brunner W, Reinhart W H
Internal Medicine, Kantonsspital, Chur, Switzerland.
Nephrol Dial Transplant. 1998 Dec;13(12):3132-7. doi: 10.1093/ndt/13.12.3132.
Haemodialysis, widely used to treat patients with renal failure, is not always well tolerated. Different mechanisms have been postulated for this. We analyzed the influence of haemodialysis on erythrocyte morphology and blood rheology.
Twenty-two haemodialysed patients were studied immediately before haemodialysis, after 30 min, and at the end of haemodialysis with biocompatible membranes. Haematological routine was measured, the erythrocyte morphology was assessed on glutaraldehyde-fixed cells and blood viscosity was determined.
Erythrocytes underwent various degrees of echinocytic shape transformation after 30 min of haemodialysis, which was completely reversible at the end. In a repetition of the investigations during a subsequent haemodialysis other patients were affected. A plasmatic factor caused echinocytosis since the incubation of control erythrocytes in patients plasma induced a similar, even more marked shape transformation and, vice versa, patient echinocytes regained a discocytic shape when incubated in buffer. The degree of echinocytosis was related to an increased blood viscosity at high shear rates (r=0.800, P<0.01). Echinocytosis was not accompanied by obvious clinical reactions.
Reversible echinocytosis and an increase in blood viscosity is often seen during haemodialysis, which may affect the circulation in patients at risk.
血液透析广泛用于治疗肾衰竭患者，但其耐受性并不总是良好。对此已提出了不同的机制。我们分析了血液透析对红细胞形态和血液流变学的影响。
对22例接受血液透析的患者在血液透析前、30分钟后以及使用生物相容性膜进行血液透析结束时进行研究。检测血常规，评估戊二醛固定细胞的红细胞形态，并测定血液粘度。
血液透析30分钟后红细胞发生不同程度的棘形转变，最终完全可逆。在随后的血液透析过程中重复进行调查时，其他患者也受到影响。一种血浆因子导致棘形红细胞增多，因为将对照红细胞在患者血浆中孵育会诱导类似的、甚至更明显的形态转变，反之，将患者的棘形红细胞在缓冲液中孵育时会恢复为盘状形态。棘形红细胞增多的程度与高剪切率下血液粘度的增加有关（r = 0.800，P < 0.01）。棘形红细胞增多并未伴有明显的临床反应。
血液透析期间常出现可逆性棘形红细胞增多和血液粘度增加，这可能会影响高危患者的循环。
