Reversal of thrombocytopenia in a pregnant woman after changing hemodiafiltration membranes.

摘要

We would like to confirm the finding described recently by Dr Post by reporting another case in which switching to a polysul-fone dialysis membrane from another manufacturer was sufficient to reverse thrombocytopenia in a pregnant dialyzed patient. In May 2010, we started a 28-year-old gravida 5 para 2 pregnant woman on a daily program (6 days a week) of 4 hours postdilution online hemodiafiltration (HDF) using a polyethersulfone membrane (SureLyzer; a biocompatible polysulfone membrane supplied by Nipro Europe [www.nipro-europe.com]). Our objective was a predialysis serum urea level <14 mmol/L. Chronic kidney disease had been diagnosed nearly 2 years prior, without renal histology available before the preterminal stage. She was 13 weeks pregnant when we started HDF. Two weeks after the start of treatment, the platelet count started to decrease (Fig 1). Pre-eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count occurring in association with preeclampsia) syndrome were excluded because of the absence of hypertension, edema, proteinuria, and abnormal liver enzyme levels and because of the onset early in pregnancy. Antiphospholipid and antiplatelet antibodies were undetectable. Changing to a different biocompatible polysulfone membrane, FX100 (Fresenius [www.fresenius. com]), was followed by an increasing platelet count without a change in other HDF parameters. The patient completed her pregnancy successfully and gave birth at 36 weeks of gestation without complications. Platelet count remained within the reference range, -160 X 10~3/muL, until delivery. Although there is limited experience with the use of HDF in pregnant women, more efficient urea clearance and more frequent weekly sessions may be beneficial.