Plasma exchange in a 13-year-old male with acute intravascular hemolysis and acute kidney injury after placement of a ventricular assist device.
Intravascular hemolysis and resulting plasma-free hemoglobin elevation has been associated with acute kidney injury via several mechanisms. Proximal tubular injury due to iron compound deposition and nitric oxide sequestration with subsequent impairment of the microcirculation and hypoperfusion are specific adverse effects of intravascular hemolysis that may contribute to acute kidney injury. Therefore, removal of plasma-free hemoglobin and restoration of normal nitric oxide vasodilatory mechanisms may play a beneficial role in treating acute kidney injury secondary to acute intravascular hemolysis. We report herein the case of a 13-year-old patient with severe intravascular hemolysis and acute kidney injury and describe the role of plasma exchange with plasma replacement in his successful recovery.
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. jraval@itxm.org
Jay S
JS
Raval
Peter D
PD
Wearden
Richard A
RA
Orr
Joseph E
JE
Kiss
D058186:Acute Kidney Injury / Q000150:complications* / Q000378:metabolism; D000293:Adolescent; D003404:Creatinine / Q000097:blood; D006242:Haptoglobins / Q000737:chemistry; D006353:Heart-Assist Devices; D006461:Hemolysis; D006760:Hospitalization; D006801:Humans; D008297:Male; D008833:Microcirculation; D009569:Nitric Oxide / Q000737:chemistry / Q000378:metabolism; D010951:Plasma Exchange / Q000379:methods*
D006242:Haptoglobins; D009569:Nitric Oxide; D003404:Creatinine