HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: CJN.03540807v1 3/2/382    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Watnick, S. Articles by Cohen, D. M. PubMed PubMed Citation Articles by Watnick, S. Articles by Cohen, D. M.

White Thrombus Formation in Blood Tubing Lines in a Chronic Hemodialysis Unit

Suzanne Watnick^*,, Michael Stooksbury^*, Rolf Winter, Michael Riscoe, and David M. Cohen^*,

^* Division of Hospital and Specialty Medicine, and Research and Development Service, Portland Veterans Administration Medical Center, Portland, Oregon, and Division of Nephrology and Hypertension, Department of Medicine, Oregon Health and Science University, Portland, Oregon

Correspondence: Dr. Suzanne Watnick, P3 NEPH, Medical Director, Dialysis Unit, PVAMC, 3710 SW US Veterans Hospital Road, Portland, OR 97239. Phone: 503-494-8490, Fax: 503-721-7810, E-mail: watnicks{at}ohsu.edu

Background and objectives: Previous reports have described white particulate matter in banked blood components, but no prior public reports describe such matter in blood tubing during the course of routine in-center hemodialysis. This report describes the events, investigations, and preliminary conclusions associated with the spontaneous formation of adherent white thrombus in the venous and arterial blood lines during routine in-center hemodialysis treatments.

Design setting, participants, & measurements: This investigation occurred at the Portland Veterans Administration Medical Center (PVAMC) Hemodialysis Unit from October 2006 through April 2007. Sixty-eight variables regarding demographics, medical history and dialysis treatments were collected on our 34 chronic hemodialysis outpatients.

Results: Over a 5-wk interval, 62% (21 of 34) of the chronic hemodialysis patients unexpectedly developed a white precipitate adhering to the lumenal surface of their dialysis blood tubing, with 73 of 580 chronic dialysis treatments exhibiting the phenomenon. Microscopic and biochemical analyses were consistent with white thrombus, formed by an aggregation of platelets and fibrin. An alert was issued and other in-center hemodialysis units noted similar findings. This was remedied by the removal of specific tubing.

Conclusions: Both patient-specific and tubing-specific factors may have been operative. Although patient safety was not adversely affected, assessment of clinical and manufacturing variables potentially affecting platelet activation is warranted.