Abstract
Blood and dialyzer membrane interaction can cause significant thrombocytopenia through the activation of complement system. The extent of this interaction determines the biocompatibility of the membrane. Although the newer synthetic membranes have been shown to have better biocompatibility profile than the cellulose-based membranes, little is known about the difference in biocompatibility between synthetic membrane and modified cellulose membrane. Herein, we report a case of a patient on hemodialysis who developed dialyzer-membrane-related thrombocytopenia with use of synthetic membrane (F200NR polysulfone). The diagnosis of dialyzer membrane-associated thrombocytopenia was suspected by the trend of platelet count before and after dialysis, and the absence of other possible causes of thrombocytopenia. We observed significant improvement in platelet count when the membrane was changed to modified cellulose membrane (cellulose triacetate). In patients at high risk for thrombocytopenia, the modified cellulose membrane could be a better alternative to the standard synthetic membranes during hemodialysis.
Highlights
Thrombocytopenia is common in patients receiving hemodialysis, and it is usually secondary to use of heparin, uremia, sepsis, blood loss, and bone marrow suppression [1]
At the third dialysis session, dialyzer membrane was changed to Baxter cellulose triacetate exceltra 210 and the platelet count remained stable after dialysis
Cellulose membranes are composed of polysaccharide units with hydroxyl groups which are responsible for the biochemical interactions and associated complications through the activation of the complement system
Summary
Thrombocytopenia is common in patients receiving hemodialysis, and it is usually secondary to use of heparin, uremia, sepsis, blood loss, and bone marrow suppression [1]. Studies have shown that the dialysis membrane itself can cause significant thrombocytopenia through the activation of the complement system [2]. The degree to which the dialyzer membrane activates the complement system determines its biocompatibility. Hemodialysis initially relied predominantly on the use of cellulose-based membranes with poor biocompatibility profile and associated thrombocytopenia and leucopenia [3]. Membranes manufactured from synthetic polymers are commonly used because of their superior biocompatibility as compared to cellulose-based membranes. Whether the biocompatibility of synthetic membrane is superior to that of synthetically modified cellulose membrane remains unclear. We report a case of a 54-year-old female that developed dialyzer membrane-associated thrombocytopenia while on hemodialysis with synthetic membrane. The platelet count significantly increased when the membrane was changed to modified cellulose
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