Acute allergic reaction associated with reprocessed hemodialyzers - United States, 1989-1990

Article Abstract:

Reused hemodialyzers have long been a factor in causing fevers and infection with a number of microorganisms. An epidemiological investigation was initiated when clusters of acute allergic reactions (AARs) occurred at a dialysis clinic within minutes of beginning treatment. It seemed that the AARs were caused by reused dialyzers, so a study was undertaken to identify risk factors. A questionnaire was mailed to all licensed chronic hemodialysis centers, and 1,290 (76 percent) responded. A subsequent telephone survey was administered to all centers reporting clusters of AARs. Almost 60 percent of the respondents reported reusing dialyzers. In the United States, 68 percent of centers reuse dialyzers, a large increase from 18 percent in 1977. By means of multivariate analysis, it was determined that risk of AARs with reprocessed dialyzers was higher with a certain heparin (anti-clotting drug) product, and with washing the blood compartment with bleach or hydrogen peroxide. A subsequent telephone survey found that after procedures for reprocessing dialyzers were modified, AARs were substantially reduced. Among patients undergoing hemodialysis with first use of a dialyzer, severe allergic reactions (''first-use syndrome'') have been caused by the type of dialyzer membrane or ethylene oxide, a sterilizing agent. Although AARs with reused dialyzers are similar to ''first-use syndrome,'' the cause of AARs has not been identified. Physicians are urged to report AARs caused by hemodialysis to the Centers for Disease Control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Contamination, Hemodialyzers, Hemodialysis equipment

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Allergic skin disorders and mastocytosis

Article Abstract:

Urticaria (hives) and angioedema are relatively common. They may be caused by food or drugs and involve the production of IgE antibody. Another form involves activation of the complement system and can occur weeks after the administration of the drug. Hereditary angioedema is characterized by swelling of the skin, respiratory tract and gastrointestinal system. It has no apparent cause. Some physical agents such as cold, heat, sunlight or exercise can also cause urticaria. Atopic dermatitis is a chronic skin disease involving IgE production. Contact dermatitis is an allergic reaction to topical medications, industrial chemicals, cosmetics and other agents. It involves activation of T cells. Mastocytosis is characterized by the proliferation of mast cells. When this occurs in the skin, the result is urticaria pigmentosa.

Physiological aspects, Atopic dermatitis, Urticaria, Hives (Disease), Contact dermatitis, Angioneurotic edema, Mast cell disease, Mastocytosis

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Multistate Outbreak of Hemolysis in Hemodialysis Patients-Nebraska and Maryland, 1998

Article Abstract:

Thirty patients in Maryland, Nebraska and Massachusetts developed severe hemolysis after undergoing hemodialysis. Mechanical damage to red blood cells is an uncommon complication of hemodialysis, a process which cleans the blood in patients with severe kidney disease. CDC, US Department of Health, and state officials determined that a manufacturing defect in a lot of COBE Centrysystem 3 dialysis tubing sets was responsible for excessive red blood cell damage. The patients reported chest pain, shortness of breath, nausea, and abdominal pain, and two patients died. The manufacturer voluntarily recalled the blood tubing sets.

Nebraska, Maryland, Product defects and recalls, Causes of, Hemolysis and hemolysins, Hemolysis, Gambro Healthcare Inc., COBE-RENAL Care Inc.

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