Background:
@EN Chloramines cause hemolysis in hemodialysis patients both by directly oxidizing red cells and by inhibiting HMP shunt with which red cells defend themselves against oxidant damage. We report here an eposode of chloramine-induced hemolytic
anemia in
our hemodialysis center, which was managed by the installation of additional charcoal filter and the administration of ascorbic acid into dialysate.
@ES Method and Results:
@EN The hemoglobin level before chloramines exposure in Nov. 1991 was 7.2±1.5 gm%, which reduced to 6.3±1.5 gm% (P<0.01) in Dec. 1991 when the dialysate was contaminated by chloramines. In Jan. 1992, when aditional charcoal filter was installed
and
ascoribc acid was restored to 6.9±1.3 gm% (p<0.01). Heinz body was positive in 25% of patients in Dec. 1991, all negative in Jan. 1992. Inceased methemoglobin and decreased haptoglobin was also observed in Dec. 1991, which normalized in Jan.
1992.
7 to
41 patients were transfused in Nov. 1991, but 26 patients required transufusion in Dec. 1991(p<0.01). 16 and 7 patients had transfusion in Jan. and Feb. 1992, respetively.
Chloramines levels in water before and after charcoal filteration in Dec. 1991 was 63.56 and 37.21 gm/L, respectively. Those levels before and after charcoal filteration and after ascorbc acid administration in Jan. 1992 wee 22.09, 0.04 and less
than
0.01 mg/L, respectively.
@ES Conclusion:
@EN Because chloramines are one of the major causes of the aggravation of anemia in hemodialysis patients, physicians should be vigilant for the contamination of dialysate by chloramines. Charcoal filtration and ascorbic acid administration are
efficient methods for the removal of chloramines.
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