Acute intravascular hemolysis during hemodialysis initially detected as analytical interference

Rodríguez-Chávez L.Á.; Nazario Huaranga F.M.; Sáenz-Lázaro J.M.; Pérez-Jimenez R. · Medicina Clinica Practica (2026) · DOI: 10.1016/j.mcpsp.2026.100547

Resumen

Intravascular hemolysis associated with hemodialysis is an uncommon but potentially serious complication, generally related to mechanical or chemical factors of the extracorporeal circuit. We present the case of a 72-year-old man with chronic kidney disease on hemodialysis who, during a session, developed acute abdominal pain, gastric intolerance, and clinical deterioration. Laboratory findings revealed severe anemia, markedly elevated lactate dehydrogenase, indirect hyperbilirubinemia, and the presence of schistocytes, with a negative Coombs test. Hemolysis was initially suggested as analytical interference in consecutive samples, allowing early identification. The temporal relationship with hemodialysis and the exclusion of immunological causes supported the diagnosis of procedure-associated intravascular hemolysis. The patient required hospitalization, intradialytic transfusion, and supportive management, with favorable clinical evolution. This case highlights the importance of early recognition of this complication to prevent severe outcomes.

Instituciones: Universidad Privada Antenor Orrego