iments with the hemodialysis blood tubing revealed that hemo-Multistate outbreak of hemolysis in ... more iments with the hemodialysis blood tubing revealed that hemo-Multistate outbreak of hemolysis in hemodialysis patients lysis was caused by increased pressure on erythrocytes as they traced to faulty blood tubing sets. passed through the partially occluded hemodialysis blood Background. Hemolysis associated with hemodialysis is tubing. rare. The most frequent causes of hemodialysis-associated he-Conclusions. Our investigation traced the multiple hemolymolysis are chemical contamination, heat, or mechanical injury sis outbreaks to partially occluded hemodialysis blood tubing of erythrocytes from occluded or kinked hemodialysis blood produced by a single manufacturer. On May 25, 1998, the lines. When patients in three states developed hemolysis while manufacturer issued a voluntary nationwide recall of the impliundergoing hemodialysis between May 13 and 23, 1998, an invescated lots of hemodialysis blood tubing cartridge sets. tigation was initiated. Methods. A case-patient was defined as any patient at healthcare facilities A (Nebraska), B (Maryland), or C (Massachusetts) during May 13 through 23, 1998 (epidemic period), Annually, over 225,000 persons with end-stage renal who had hemolysis diagnosed Ն48 hours after undergoing hedisease undergo long-term hemodialysis in the United modialysis. To identify case-patients and to determine background rates, the medical records of patients from facilities States and Canada [1, 2]. Hemolysis, or premature break-A, B, and C who were undergoing hemodialysis during the down of erythrocytes, associated with hemodialysis is epidemic and pre-epidemic (that is, May 5 through 19, 1998) rarely reported [3, 4]. Causes of hemolysis include oxidizperiods were reviewed. Experiments simulating hemodialysis ing agents (for example, copper, zinc, chloramine, or niwith the same lot numbers of hemodialysis blood tubing cartrate contamination of the dialysate), reducing agents (for tridge sets used on case-and control-patients were conducted. Results. The rates of hemolysis among patients at facilities example, formaldehyde used to disinfect reprocessed di-A, B, and C were significantly higher during the epidemic than alyzers or water treatment systems), osmolar insults (for the pre-epidemic period (13 out of 118 vs. 0 out of 118, P Ͻ example, hypotonic dialysate), the use of dialysate ex-0.001; 12 out of 298 vs. 0 out of 298, P ϭ 0.001; and 5 out ceeding 42ЊC; mechanical injury from occluded blood of 62 vs. 0/65, P ϭ 0.03, respectively). All case-patients had hemolysis. Twenty (66%) had hypertension. Eighteen (60%) pumps, arterial line collapse, or kinked or obstructed hehad abdominal pain, and 10 (36%) were admitted to an intenmodialysis tubing [3-5]; or excessive uremia at the initiasive care unit. There were two deaths. The only commonality tion of dialysis [5]. When outbreaks of hemolysis in heamong the three outbreaks was the use of the same lot of modialysis patients were reported from seven dialysis disposable hemodialysis blood tubing from one manufacturer. centers in three states, we initiated an investigation. Examination of the implicated hemodialysis blood tubing cartridge sets revealed narrowing of an aperture through which blood was pumped before entering the dialyzers. In vitro exper-METHODS Definition and ascertainment of cases
iments with the hemodialysis blood tubing revealed that hemo-Multistate outbreak of hemolysis in ... more iments with the hemodialysis blood tubing revealed that hemo-Multistate outbreak of hemolysis in hemodialysis patients lysis was caused by increased pressure on erythrocytes as they traced to faulty blood tubing sets. passed through the partially occluded hemodialysis blood Background. Hemolysis associated with hemodialysis is tubing. rare. The most frequent causes of hemodialysis-associated he-Conclusions. Our investigation traced the multiple hemolymolysis are chemical contamination, heat, or mechanical injury sis outbreaks to partially occluded hemodialysis blood tubing of erythrocytes from occluded or kinked hemodialysis blood produced by a single manufacturer. On May 25, 1998, the lines. When patients in three states developed hemolysis while manufacturer issued a voluntary nationwide recall of the impliundergoing hemodialysis between May 13 and 23, 1998, an invescated lots of hemodialysis blood tubing cartridge sets. tigation was initiated. Methods. A case-patient was defined as any patient at healthcare facilities A (Nebraska), B (Maryland), or C (Massachusetts) during May 13 through 23, 1998 (epidemic period), Annually, over 225,000 persons with end-stage renal who had hemolysis diagnosed Ն48 hours after undergoing hedisease undergo long-term hemodialysis in the United modialysis. To identify case-patients and to determine background rates, the medical records of patients from facilities States and Canada [1, 2]. Hemolysis, or premature break-A, B, and C who were undergoing hemodialysis during the down of erythrocytes, associated with hemodialysis is epidemic and pre-epidemic (that is, May 5 through 19, 1998) rarely reported [3, 4]. Causes of hemolysis include oxidizperiods were reviewed. Experiments simulating hemodialysis ing agents (for example, copper, zinc, chloramine, or niwith the same lot numbers of hemodialysis blood tubing cartrate contamination of the dialysate), reducing agents (for tridge sets used on case-and control-patients were conducted. Results. The rates of hemolysis among patients at facilities example, formaldehyde used to disinfect reprocessed di-A, B, and C were significantly higher during the epidemic than alyzers or water treatment systems), osmolar insults (for the pre-epidemic period (13 out of 118 vs. 0 out of 118, P Ͻ example, hypotonic dialysate), the use of dialysate ex-0.001; 12 out of 298 vs. 0 out of 298, P ϭ 0.001; and 5 out ceeding 42ЊC; mechanical injury from occluded blood of 62 vs. 0/65, P ϭ 0.03, respectively). All case-patients had hemolysis. Twenty (66%) had hypertension. Eighteen (60%) pumps, arterial line collapse, or kinked or obstructed hehad abdominal pain, and 10 (36%) were admitted to an intenmodialysis tubing [3-5]; or excessive uremia at the initiasive care unit. There were two deaths. The only commonality tion of dialysis [5]. When outbreaks of hemolysis in heamong the three outbreaks was the use of the same lot of modialysis patients were reported from seven dialysis disposable hemodialysis blood tubing from one manufacturer. centers in three states, we initiated an investigation. Examination of the implicated hemodialysis blood tubing cartridge sets revealed narrowing of an aperture through which blood was pumped before entering the dialyzers. In vitro exper-METHODS Definition and ascertainment of cases
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