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      Hemolysis in Dialized Patients caused by Chloramines

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          Normal red cell survival is possible in dialyzed patients. Certain substances like copper and nitratenitrite induce hemolysis if present in the dialysate. We have identified another and probably a more frequent cause for hemolysis in dialyzed patients; chloramines. These compounds (a) are becoming more frequent in tap water as large water plants increasingly use chloramines rather than chlorine as bactericidal agents in tap water; (b) pass reverse osmosis membranes easily; (c) directly induce oxidant damage to red cells with methemoglobin formation; (d) damage the hexosemonophosphate shunt (HMPS) with which red cells defend themselves against oxidant damage; (e) consequently induce hemolysis and short red cell survival time; (f) sensitize the patients to oxidant drugs like primaquine, sulfonamides, etc.; (g) can be removed by charcoal filtration, boiling, or vacuum treatment, and (h) are most expediently neutralized by the addition of ascorbic acid in physiological amounts to the dialysate.

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          Author and article information

          S. Karger AG
          28 November 2008
          : 13
          : 6
          : 427-433
          Departments of Medicine, Chemistry, and Surgery, University of Minnesota, Minneapolis, Minn.
          180421 Nephron 1974;13:427–433
          © 1974 S. Karger AG, Basel

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          Pages: 7
          Original Paper


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