title: When pure is not so pure: chloramine-related hemolytic anemia in home hemodialysis patients.
abstract: Worldwide, chloramines are used as the preferred disinfectant for city water supplies. Although they have distinct advantages compared with chlorine and are deemed harmless to the general population, hemodialysis (HD) patients are at risk from chloramine-induced hemolytic anemia. In recent years, this has been highlighted in regional dialysis units but not as frequently in the home HD group. We report on 2 home HD patients who succumbed to severe oxidative hemolysis due to high mains water chloramine concentrations. Both patients were extensively investigated for other cause of anemia before a definitive diagnosis was reached. Delays in diagnosing this uncommon condition can be costly in terms of significant morbidity and excessive usage of recombinant erythropoietin and blood transfusion. Prevention primarily involves enforcing strict water quality control and establishing regular communication with water supply boards and home HD patients. Double (inline) carbon filters should be installed in patient's homes as an effective means for removing high incoming chloramine concentrations.
authors.affiliation: Department of Nephrology, Ysbyty Gwynedd, Penrhosgarnedd, Bangor, Wales, UK. naushadaj@yahoo.com
authors.forename: Naushad A
authors.initials: NA
authors.lastname: Junglee
authors.forename: Saeed U
authors.initials: SU
authors.lastname: Rahman
authors.forename: Mike
authors.initials: M
authors.lastname: Wild
authors.forename: Anke
authors.initials: A
authors.lastname: Wilms
authors.forename: Sarah
authors.initials: S
authors.lastname: Hirst
authors.forename: Mahdi
authors.initials: M
authors.lastname: Jibani
authors.forename: Jim R C
authors.initials: JR
authors.lastname: Seale
mesh_terms: D000328:Adult; D000743:Anemia, Hemolytic / Q000139:chemically induced*; D002700:Chloramines / Q000009:adverse effects* / Q000032:analysis; D004202:Disinfectants / Q000009:adverse effects* / Q000032:analysis; D006437:Hemodialysis, Home / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006113:United Kingdom; D014874:Water Pollutants, Chemical / Q000009:adverse effects* / Q000032:analysis; D014881:Water Supply / Q000032:analysis
chemical_list: D002700:Chloramines; D004202:Disinfectants; D014874:Water Pollutants, Chemical; C030816:chloramine