Thrombocytopenia Induced by Polysulfone Dialysis Membranes.
Thrombocytopenia Induced by Polysulfone Dialysis Membranes.
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DOI：
10.12659/ajcr.932045
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发表时间：
2021-07-03
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影响因子：
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通讯作者：
Wall SM
中科院分区：
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作者：
Claudio-Gonzalez I;Ravindranathan D;Kempton CL;Bailey JL;Wall SM
病人：男性，82岁最终诊断：终末期肾脏疾病·血小板减少症·并存疾病症状：疲劳·黑便·虚弱用药：-临床程序：-专科：肾脏学治疗的异常或意外效果生物相容性血液透析膜极大地促进了肾衰竭的治疗。合成聚砜透析膜被认为具有很好的生物相容性，因为其激活补体的倾向较低。然而，这些膜可以通过血小板活化减少血小板计数，尽管这种活化的机制尚不清楚。我们报告了一例82岁男性患者，有慢性肾脏疾病病史，伴有反复胃肠道出血和肾功能恶化，开始接受聚砜透析膜肾脏替代治疗。入院时，患者血小板计数正常，为233×103/μL。大多数透析治疗后观察到血小板计数显著下降，达到最低值37×103/μL。偶尔接受透析治疗，他的血小板计数没有变化。这种透析诱导的血小板减少症在用Cellentia-H三醋酸纤维素一次性中空纤维高通量血液透析器膜替代后消退。聚砜膜能够激活血小板，这可能导致重度血小板减少症。然而，透析诱导的血小板减少症的程度因治疗而异。因此，当测量单次治疗的透析前和透析后血小板计数时，可能不明显。由于这种血小板活化的病因尚不清楚，应考虑用三醋酸纤维素膜替代。这些膜具有不相关的化学组成和非常低的激活血小板的倾向。
Patient: Male, 82-year-old Final Diagnosis: End stage renal disease • thrombocytopenia • co-existing disea Symptoms: Fatigue • melena • weakness Medication: — Clinical Procedure: — Specialty: Nephrology Unusual or unexpected effect of treatment 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. 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. 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.