Dialysis-related thrombocytopenia: a case report

Abstract Thrombocytopenia is frequently observed in hemodialysis patients, and its correct investigation and control remain a challenge. It is estimated that during the hemodialysis session there is a drop of up to 15% in the platelet count, with recovery after the end of treatment. This reduction in platelets is due to platelet adhesion and complement activation, regardless of the membrane material. Several studies with platelet surface markers demonstrate increased platelet activation and aggregation secondary to exposure to cardiopulmonary bypass. This case report describes a patient on hemodialysis who developed severe thrombocytopenia during hospitalization. Investigation and exclusion of the most common causes were carried out: heparin-related thrombocytopenia, adverse drug reaction, hypersplenism, and hematological diseases. Afterwards, the possibility of hemodialysis-related thrombocytopenia was raised, since the fall was accentuated during the sessions with partial recovery after the dialyzer change. Attention to the sterilization method and dialyzer reuse must be considered for correction. In the current case, reusing the dialyzer minimized the drop in platelet counts associated with hemodialysis.

摘要 血液透析患者常出现血小板减少症（thrombocytopenia），其精准筛查与规范管控仍是临床难题。据估算，单次血液透析治疗过程中，患者血小板计数可下降最高达15%，且于治疗结束后可恢复至基线水平。该血小板减少现象由血小板黏附与补体激活介导，且不受透析膜材质影响。多项针对血小板表面标志物的研究证实，暴露于心肺转流（cardiopulmonary bypass）环境后，血小板激活与聚集程度会显著升高。本病例报告描述了一名住院期间接受血液透析时出现重度血小板减少症的患者。研究团队对其进行了全面排查，排除了最常见的致病诱因：肝素相关性血小板减少症（heparin-related thrombocytopenia）、药物不良反应、脾功能亢进（hypersplenism）及血液系统疾病。随后，临床考虑为血液透析相关性血小板减少症，因患者透析期间血小板计数下降幅度显著，且更换透析器后症状可部分缓解。临床需关注透析器的灭菌方式与复用策略，以纠正该并发症。在本病例中，复用透析器可有效减轻血液透析相关的血小板计数下降程度。