Hemolysis in Dialized Patients caused by Chloramines
作者:
Carl M. Kjellstrand,
John W. Eaton,
Yoshihito Yawata,
Harold Swofford,
Charles F. Kolpin,
Theodore J. Buselmeier,
Barry von Hartitzsch,
Harry S. Jacob,
期刊:
Nephron
(Karger Available online 1974)
卷期:
Volume 13,
issue 6
页码: 427-433
ISSN:1660-8151
年代: 1974
DOI:10.1159/000180421
出版商: S. Karger AG
关键词: Dialysis;Uremia;Hemolysis;Chloramines;Tap water dialysate;Reverse osmosis;Ascorbic acid;Hexosemonophosphate shunt
数据来源: Karger
摘要:
Normal red cell survival is possible in dialyzed patients. Certain substances like copper and nitratenitrite induce hemolysis if present in the dialysate. We have identified another and probably a more frequent cause for hemolysis in dialyzed patients; chloramines. These compounds (a) are becoming more frequent in tap water as large water plants increasingly use chloramines rather than chlorine as bactericidal agents in tap water; (b) pass reverse osmosis membranes easily; (c) directly induce oxidant damage to red cells with methemoglobin formation; (d) damage the hexosemonophosphate shunt (HMPS) with which red cells defend themselves against oxidant damage; (e) consequently induce hemolysis and short red cell survival time; (f) sensitize the patients to oxidant drugs like primaquine, sulfonamides, etc.; (g) can be removed by charcoal filtration, boiling, or vacuum treatment, and (h) are most expediently neutralized by the addition of ascorbic acid in physiological amounts to the dialysate.
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