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Published ahead of print on January 9, 2008
Clinical Journal of the American Society of Nephrology
© 2008 American Society of Nephrology
doi: 10.2215/CJN.03540807
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Received August 23, 2007
Accepted on November 15, 2007

ORIGINAL ARTICLES

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

Suzanne Watnick *{ddagger}1, Michael Stooksbury *, Rolf Winter {dagger}, Michael Riscoe {dagger}, and David M. Cohen *{ddagger}

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


1 To whom correspondence should be addressed. E-mail: watnicks{at}ohsu.edu.


  Abstract

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.




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Copyright © 2008 by the American Society of Nephrology.