ACUTE HEMOLYSIS WITH SUBSEQUENT LIFE-THRE ATENING PANCREATITIS ASSOCIATED WITH HEMODIALYSIS - A COMPLICATION NOT PREVENTABLE BY CURRENT DIALYSIS EQUIPMENT

A retrospective study was undertaken of 14 patients (eleven men, three women; mean age 52 [33-68] years in whom haemolysis had occurred duri ng chronic haemodialysis (n = 12) or haemofiltra- tion (n = 2). The ha emolysis was of mechanical cause in eight patients, by an osmotic mech anism in one, and of unknown cause in five. Cardinal symptoms were nau sea in 14 patients, abdominal pain in nine, vomiting in eight and rais ed blood pressure in ten. The plasma was discoloured in all patients a nd there was also an increase in free haemoglobin (110-2400 mg/dl) and (or) lactate dehydrogenase (311-7403 U/l). In all of eleven patients in whom it was measured the activity of serum amylase and (or) lipase was more than doubled (to 73-2400 U/l and 473-16,740 U/l, re- spective ly). All patients were treated symptomatically, three had a blood exch ange, two others plasma separation. Eight patients recovered within a few days, but necrotizing pancreatitis developed in six, three of : wh om died while two had permanent sequelae. - This series shows that dia lysis-induced acute haemolysis can cause life-threatening pancreatitis . Narrowings within the extracorporeal circuit, not always recognized in current dialysis equipment, are the most frequent cause of the mech anical haemolysis.