활성탄여과 및 Ascorbic Acid 의 투석액 투여로 개선된 혈액투석 환자들에서 발생한 Chloramine에 의한 용혈성 빈혈

• Published in: Kidney research and clinical practice Vol. 13; no. 2; pp. 271 - 276
• Main Authors: 김환곤, 이성미, 김태진, 엄재화, 정재성, 공진민
• Format: Journal Article
• Language: Korean
• Published: 대한신장학회 01.01.1994
• ISSN: 2211-9132

Background: 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 ane- mia in our hemodialysis center, which was managed by the installation of additional charcoal filter and the administration of ascorbic acid into dialysate. Method and Results: 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 additional charcoal filter was installed and ascorbic acid was administered into dialysate, hemoglobin 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 Dee. 1991, which normalized in Jan. 1992. 7 of 41 patients were transfused in Nov. 1991, but 26 patients required transfu- sion in Dec. 1991(p<0.01). 16 and 7 patients had transfusion in Jan. and Feb. 1992, respectively. Chloramines levels in water before and after charcoal filteration in Dec. 1991 was 63.56 and 37.21gm/L, respectively. Those levels before and after charcoal filteration and after ascorbic acid administration in Jan. 1992 were 22.09, 0.04 and less than 0.01mg/L, respectively. Conclusion: 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.