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CORD-19:0431b8b024ad140517707f8828cd7dfcc560da4b JSONTXT 9 Projects

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Id Subject Object Predicate Lexical cue
T1 0-29 Sentence denotes Hemolysis During Hemodialysis
T2 31-39 Sentence denotes Abstract
T3 42-168 Sentence denotes Low-grade chronic hemolysis is common in uremia, as red blood cell life span is clearly decreased with reduced renal function.
T4 169-289 Sentence denotes Using isotope red cell tagging, it has been shown that red cell life span averages about 1/2 to 1/3 of normal in uremia.
T5 290-433 Sentence denotes In addition, uremic erythrocytes have been found to be less deformable and osmotically more fragile when compared to their normal counterparts.
T6 434-567 Sentence denotes Transfusion of uremic erythrocytes into an individual with normal renal function will restore the life span of those cells to normal.
T7 568-672 Sentence denotes On the other hand, normal erythrocytes transfused into a uremic individual will have shortened survival.
T8 673-801 Sentence denotes In the past, chronic hemolysis in maintenance dialysis patients may have manifested as increased blood transfusion requirements.
T9 802-980 Sentence denotes However, these days such hemolysis probably more often presents itself as erythropoietin resistance (larger erythropoietin doses being required for a given therapeutic response).
T10 981-1239 Sentence denotes A variety of abnormalities (such as impairment of red cell enzymatic activities and reduced synthesis of Na + -K + pump units by uremic reticulocytes) have been suggested to be the causes for the heightened predisposition of uremic erythrocytes to hemolysis.
T11 1240-1327 Sentence denotes Uncommonly, patients on dialysis can have severe (at times life-threatening) hemolysis.
T12 1328-1571 Sentence denotes These patients fi t into either of two categories, depending on whether hemolysis involves all or the majority of the patients being dialyzed under similar circumstances in a given dialysis center or whether the hemolysis is patient specifi c.
T13 1572-1792 Sentence denotes Hemolysis in the former is often the result of water-borne toxins, centralized dialysis equipment failure, or blood tubing defects-whereas in the latter it results from medication or possibly inadequate dialytic therapy.
T14 1793-1974 Sentence denotes Use of constricted blood tubing systems and of hypo-osmolal or abnormally warm dialysate results in intravascular hemolysis, whereas drug-induced hemolysis is usually extravascular.
T15 1975-2074 Sentence denotes The signs and symptoms of hemolysis are largely nonspecifi c, but certain fi ndings are suggestive.
T16 2075-2168 Sentence denotes Blood undergoing intravascular hemolysis can show color changes from cherry red to port wine.
T17 2169-2302 Sentence denotes A sudden deepening of skin pigmentation during or shortly after dialysis can also be a consequence of severe intravascular hemolysis.
T18 2303-2532 Sentence denotes It is highly likely that these blood and skin color changes are all related to the release of hemoglobin and methemoglobin from erythrocytes, as well as the generation of methemalbumin and a complex containing hemopexin and heme.
T19 2533-2612 Sentence denotes In slowly developing hemolysis, the patient may not notice any symptoms at all.
T20 2613-2760 Sentence denotes In severe acute or subacute hemolysis, the most common presenting symptoms are anorexia, nausea, vomiting, abdominal pain, diarrhea, and back pain.
T21 2761-2981 Sentence denotes Patients with hemolysis can also present with headache, lethargy, malaise, chills, diaphoresis, hypotension, hypertension, dyspnea, chest pain, palpitation, leg cramps, cyanosis, dark urine (and death can be associated).
T22 2982-3010 Sentence denotes Pancreatitis can also occur.
T23 3011-3247 Sentence denotes Laboratory fi ndings include a low hemoglobin concentration, an elevated serum bilirubin level, reticulocytosis, the presence of Heinz bodies, the presence of methemalbumin in the serum, and an elevated serum lactic dehydrogenase value.
T24 3248-3415 Sentence denotes Other laboratory evidences of hemolysis comprise low haptoglobin levels, a reduced Cr 15 erythrocyte survival with splenic sequestration, and an abnormal Coomb's test.
T25 3416-3497 Sentence denotes The onset of clinical manifestations varies, depending on the cause of hemolysis.
T26 3498-3702 Sentence denotes Occurrence of symptoms within 2 hours of starting dialysis (e.g., hemolysis due to defective blood tubing) and 8 to 24 hours after the onset of dialysis (e.g., copper-induced hemolysis) has been reported.
T27 3703-3750 Sentence denotes Refer to Table 30 .1 in regard to this section.
T28 3751-3854 Sentence denotes Chloramine Chlorine is the most commonly used antiseptic agent for water supplies in the United States.
T29 3855-3976 Sentence denotes Unfortunately, chlorine can react with other compounds in water to form undesirable byproducts (such as trihalomethanes).
T30 3977-4206 Sentence denotes A growing practice is to combine chlorine and ammonia to form chloramine (a compound con-taining NCl groups and produced by the attachment of chlorine to nitrogen) and to use this chemical as an alternative bactericidal compound.
T31 4207-4364 Sentence denotes Despite being much less reactive than chlorine, chloramine has been found to cause hemolysis outbreaks among dialysis patients in various parts of the world.
T32 4365-4553 Sentence denotes Most recently, in a dialysis unit in Brazil 16 patients who developed hemolysis after having been exposed to high concentrations of chlorine and chloramine in product water were described.
T33 4554-4705 Sentence denotes Deionization tanks can only remove undesirable ions in exchange for hydrogen or hydroxyl ones but cannot remove nonionic substances such as chloramine.
T34 4706-4852 Sentence denotes Similarly, reverse osmosis removes 99% of ionic contaminants, 100% of colloidal material, and 100% of microorganisms-but cannot remove chloramine.
T35 4853-4921 Sentence denotes Chloramine is ordinarily removed by passage through carbon fi lters.
T36 4922-4992 Sentence denotes Often such passage is adequate to prevent chloramineinduced hemolysis.
T37 4993-5254 Sentence denotes However, if the chloramine-contaminated water is pumped through a carbon fi lter too forcefully the elevated water pressure generated can create artifi cial channels within the device-thus allowing the passage of chloraminecontaminated water into the dialysate.
T38 5255-5435 Sentence denotes In addition, traditional carbon fi lters may not have enough capacity to prevent hemolysis when tap water chloramine concentrations are inordinately high-as in the case of drought.
T39 5436-5539 Sentence denotes An alternative method of removing chloramine from dialysate is to enrich the latter with ascorbic acid.
T40 5540-5654 Sentence denotes However, serum ascorbic acid levels should be monitored to prevent hypervitaminosis C and secondary hyperoxalosis.
T41 5655-5711 Sentence denotes This ascorbic acid approach has not been widely adopted.
T42 5712-5829 Sentence denotes Chloramine concentrations are determined indirectly by subtracting free chlorine levels from total chloramine values.
T43 5830-5994 Sentence denotes The Association for the Advancement of Medical Instrumentation (AAMI) has set a level of 0.1 mg/L as the maximum concentration of chloramine allowed in a dialysate.
T44 5995-6154 Sentence denotes Chloramine levels as low as 0.25 mg/L have been reported to bring about shortened erythrocyte life span, manifested by an increased erythropoietin requirement.
T45 6155-6315 Sentence denotes Chloramine-induced hemolysis can present as methemoglobinemia, Heinz body anemia, or acute intravascular hemolysis (if chloramine levels are markedly elevated).
T46 6316-6409 Sentence denotes In the early days of hemodialysis, an often-reported cause of hemolysis was copper poisoning.
T47 6410-6635 Sentence denotes The leakage of copper from copper-containing dialysis equipments leads to hemolysis, especially in the face of exhausted deionizers whose effective ion-binding sites are too depleted to be able to remove the metal adequately.
T48 6636-6717 Sentence denotes More recently, the use of copper in dialysis equipment has dramatically lessened.
T49 6718-6822 Sentence denotes Less frequently, zinc-contaminated dialysate has been reported to induce hemolysis in dialysis patients.
T50 6823-6986 Sentence denotes These compounds have engendered hemolysis in home hemodialysis patients who used nitrate-and nitrite-rich well water as their water supply to generate a dialysate.
T51 6987-7134 Sentence denotes Formaldehyde is used as a sterilant for reprocessing used dialyzers and for the disinfection of the dialysate circuit of certain dialysis machines.
T52 7135-7219 Sentence denotes The chemical has also been found in the fi lters used in a water fi ltration system.
T53 7220-7383 Sentence denotes If faulty rinsing procedures are employed or formaldehyde-tainted water fi ltration fi lters are used, formaldehyde can inadvertently be introduced into the blood.
T54 7384-7545 Sentence denotes Formaldehyde in the blood may lead to the development of auto-antibodies against erythrocytes in the form of anti-N-like antibodies that can result in hemolysis.
T55 7546-7672 Sentence denotes These anti-N-like antibodies are cold agglutinins and show a preference for agglutinating erythrocytes with the NN blood type.
T56 7673-7952 Sentence denotes In addition to its other myriad detrimental effects on the body, formaldehyde is a reducing agent and capable of converting NAD to NADH-thus bringing about an inhibition of glycolysis at the level of glyceraldehyde 3-phosphate dehydrogenase and a resultant decline in ATP stores.
T57 7953-8060 Sentence denotes This reduction in ATP availability (as well as the sterilant's other harmful effects) can foster hemolysis.
T58 8061-8243 Sentence denotes Other sterilizing agents that have been implicated in inducing hemolysis are glutaraldehyde, sodium hypochlorite, and a mixture of acetic acid, peracetic acid, and hydrogen peroxide.
T59 8244-8444 Sentence denotes A recent report describes an outbreak of hemolysis in 19 children in a pediatric dialysis unit as a result of disinfecting the water treatment system with a concentrated solution of hydrogen peroxide.
T60 8445-8500 Sentence denotes There was a mean reduction in hemoglobin levels of 12%.
T61 8501-8607 Sentence denotes A reduction of serum osmolality to 260 mmoles/kg does not seem to affect erythrocyte mechanical fragility.
T62 8608-8695 Sentence denotes However, if osmolality is lowered further a signifi cant degree of hemolysis may occur.
T63 8696-8792 Sentence denotes Hemodilution can be caused by misadventures such as administering hypo-osmolal plasma expanders.
T64 8793-8920 Sentence denotes It can also result from dialyzing against hypo-osmolal dialysates, as a result of using a faulty conductivity-measuring device.
T65 8921-9117 Sentence denotes For instance, in 1994 (in a dialysis center) human error caused a central dialysate delivery machine to be switched to the "rinse and water" mode instead of being directed to the "dialysate" mode.
T66 9118-9211 Sentence denotes As a consequence, several patients were inadvertently dialyzed with a hypo-osmolal dialysate.
T67 9212-9300 Sentence denotes The affl icted patients developed symptoms within only 3 minutes of initiating dialysis.
T68 9301-9340 Sentence denotes One of these patients died as a result.
T69 9341-9455 Sentence denotes A dialysate temperature in excess of 42ºC has been associated with hemolysis that may last for days or even weeks.
T70 9456-9612 Sentence denotes When blood is forced to fl ow through a narrow orifi ce or channel, the formed elements are subjected to substantial turbulence and immense shearing strain.
T71 9613-9734 Sentence denotes As a result, red blood cells can become damaged and fragmented-a phenomenon known as the red cell fragmentation syndrome.
T72 9735-9839 Sentence denotes Such damaged cells, often shaped like triangles or helmets (for example), are very susceptible to lysis.
T73 9840-9944 Sentence denotes In 1998, an outbreak of hemolysis took place in three different states-affecting a total of 30 patients.
T74 9945-10055 Sentence denotes The hemolysis was attributed to the use of defective blood tubing sets containing abnormally narrow apertures.
T75 10056-10155 Sentence denotes Of the 25 patients affected in Nebraska and Maryland alone, more than 90% required hospitalization.
T76 10156-10258 Sentence denotes Of the admitted patients, 32% required intensive unit care-and 36% had to be given blood transfusions.
T77 10259-10875 Sentence denotes Other causes of obstruction in the vascular circuit that can foster hemolysis include partial occlusion of a vascular catheter (e.g., at its tip, by a thrombus, development of a thrombus at a dialyzer blood port, wide disproportion between the caliber of a dialysis needle or of a cannula (both being too small) and the blood fl ow rate (being too high), malocclusion of a roller pump with its consequent constricting effect on the blood path within the pump segment of an "arterial" blood tubing, impingement of the bevel of an "arterial" needle against the wall of a vascular access, and kinking of a blood tubing.
T78 10876-11024 Sentence denotes The abutting of an "arterial" needle against the wall of a vascular access can obstruct the needle's bevel and reduce the caliber of the blood path.
T79 11025-11247 Sentence denotes If the blood pump now keeps on pumping at the original speed, a vacuum can be created that can lead to "arterial" tubing collapse as well as a highly turbulent and often to-and-fro movement of the blood within that tubing.
T80 11248-11386 Sentence denotes This scenario most often occurs when the delivery of blood through the "arterial" needle is inadequate, as in the case of access stenosis.
T81 11387-11548 Sentence denotes Kinking can be the result of the improper manner in which blood tubing is routed over a hard and narrow support, especially if easily collapsible tubing is used.
T82 11549-11629 Sentence denotes Hemolysis associated with blood path problems is mainly intravascular in nature.
T83 11630-11810 Sentence denotes However, milder stimuli may lead to less signifi cant damage to red blood cells-causing them to be removed subsequently by the reticuloendothelial system (extravascular hemolysis).
T84 11811-11923 Sentence denotes It has been found that the smaller the diameter of a hemodialysis blood cannula the higher the hemolytic effect.
T85 11924-12033 Sentence denotes Moreover, the position of the apical and lateral holes of a cannula determines the magnitude of blood damage.
T86 12034-12181 Sentence denotes Even with catheters that are available commercially today, if the blood fl ow is 500 mL/min or higher there is a higher risk of erythrocyte damage.
T87 12182-12260 Sentence denotes Thus, when high blood fl ows are required larger-size cannulas should be used.
T88 12261-12320 Sentence denotes Single-needle dialysis is also a risk factor for hemolysis.
T89 12321-12395 Sentence denotes Whether a high ultrafi ltraion rate can foster hemolysis is controversial.
T90 12396-12512 Sentence denotes Dialysis with a negative arterial chamber pressure greater than -350 mmHg, has been found to cause a mild hemolysis.
T91 12513-12607 Sentence denotes The latter is not severe enough to lead to an increased requirement for erythropoietin dosage.
T92 12608-12798 Sentence denotes However, one study found that during ultrafi ltration even at negative pressures as high as -710 mmHg on the blood side of the ultrafi ltering membrane no measurable hemolysis was discerned.
T93 12799-12989 Sentence denotes A recent report describes a patient with mechanical hemolysis secondary to a traumatic carotid-jugular arteriovenous fi stula that manifested as hyporesponsiveness to erythropoietin therapy.
T94 12990-13055 Sentence denotes The hemolysis resolved after surgical correction of the fi stula.
T95 13056-13144 Sentence denotes Most commonly, low-grade hemolysis is seen with prosthetic or calcifi ed cardiac valves.
T96 13145-13289 Sentence denotes Patients on hemodialysis are more prone to develop hemolysis than patients with normal renal function when exposed to the same offending agents.
T97 13290-13421 Sentence denotes In one study, the combination of uremia and bacteremia led to signifi cantly more hemolysis than either uremia or bacteremia alone.
T98 13422-13591 Sentence denotes It has been suggested that there may be an increased susceptibility of uremic erythrocytes to lysis as a result of the presence of noxious agents or of oxidative stress.
T99 13592-13966 Sentence denotes Lipid peroxidation of the red blood cell membrane (caused by increased free radical formation that occurs in uremia alone and by exposure of polymorphonuclear leucocytes to artifi cial materials in the extracorporeal circuit during hemodialysis), along with the consequent lack of cell deformability and the presence of splenic sequestration, may be an underlying mechanism.
T100 13967-14099 Sentence denotes Whether antioxidants that reduce free radical production can prevent red blood cell damage in uremic patients is at present unknown.
T101 14100-14288 Sentence denotes Many trials have evaluated the effectiveness of vitamin E-coating of the dialyzer membrane and glutathione and vitamin C infusion on both oxidative damage to red blood cells and hemolysis.
T102 14289-14414 Sentence denotes Although most studies have found a benefi t, the fi ndings were not yet extensive enough to warrant universal implementation.
T103 14415-14737 Sentence denotes Recently, the use of electrolyzed-reduced water that contains active hydrogen and possesses a lower redox potential (to prepare dialysates for hemodialysis) has been suggested to reduce hemodialysis-enhanced production of reactive oxygen species and proinfl ammatory cytokines, peroxidation of erythrocytes, and hemolysis.
T104 14738-15014 Sentence denotes The benefi cial effects on erythrocytes (including that of the reduction of erythropoietin dosage because of the amelioration of hemolysis) are believed to be related to the scavenging of reactive oxygen species by the electrolyzed-reduced water used to prepare the dialysate.
T105 15015-15143 Sentence denotes Electrolyzed-reduced water is generated by passing compressed water into a compartment of electrolysis through a solenoid valve.
T106 15144-15260 Sentence denotes Treatment with erythropoietin may not only augment red cell generation but reduce hemolysis in patients with uremia.
T107 15261-15377 Sentence denotes Withdrawal of erythropoietin has been found to lead to neocytolysis (selective hemolysis of the youngest red cells).
T108 15378-15452 Sentence denotes Insuffi cient dialysis may also lead to hemolysis, as revealed by the U.S.
T109 15453-15489 Sentence denotes National Cooperative Dialysis Study.
T110 15490-15703 Sentence denotes In this study, the hematocrit value in the group with a mid-week blood urea nitrogen (BUN) level of 105 to 115 mg/dL was signifi cantly lower than the value in the group with a corresponding BUN value of 76 mg/dL.
T111 15704-15924 Sentence denotes Although this difference in hematocrit may partly be due to reduced red cell production or more occult bleeding, some investigators have observed an inverse relationship between BUN concentrations and red cell life span.
T112 15925-16056 Sentence denotes Others have shown that the osmotic resistance of the red cells to hemolysis is impaired with uremia and is improved after dialysis.
T113 16057-16157 Sentence denotes Other causes of hemolysis include medications, co-existing illnesses, and electrolyte abnormalities.
T114 16158-16288 Sentence denotes Medications are a wellknown cause of hemolysis in dialysis patients, especially in those with glucose-6-dehydrogenase defi ciency.
T115 16289-16505 Sentence denotes Some common offending agents include aspirin, penicillins, cephalosporins (especially cefotetan), sulfonamides, sulfones, nitrofurantoin, phenacetin, primaquine, quinidine, hydralazine and some vitamin K derivatives.
T116 16506-16594 Sentence denotes One case report describes massive hemolysis after intramuscular injection of diclofenac.
T117 16595-16749 Sentence denotes Another report reviewed a patient with severe acute respiratory syndrome on long-term dialysis who developed hemolysis after being treated with ribavirin.
T118 16750-17038 Sentence denotes Systemic disease states such as systemic lupus erythematosus, scleroderma, periarteritis nodosa, thrombotic thrombocytopenic purpura, the hemolytic uremic syndrome, malignant hypertension, and certain malignant tumors all predispose to the occurrence of microangiopathic hemolytic anemia.
T119 17039-17207 Sentence denotes Hyperslenism due to causes such as chronic hepatitis, transfusion hemosiderosis, marrow fi brosis, and silicone deposition is well documented to cause hemolytic anemia.
T120 17208-17302 Sentence denotes A low serum phosphorus concentration from any cause may lead to a predisposition to hemolysis.
T121 17303-17390 Sentence denotes With severe hemolysis, a profound anemia may occur that may require blood transfusions.
T122 17391-17486 Sentence denotes However, the more immediate danger in end-stage renal disease patients is that of hyperkalemia.
T123 17487-17579 Sentence denotes This problem is exacerbated if hemolysis occurs after blood has passed through the dialyzer.
T124 17580-17673 Sentence denotes After the diagnosis of hemolysis is confi rmed, one needs to fi nd and then remove the cause.
T125 17674-17772 Sentence denotes Obviously, discontinuation of dialysis is important if intradialytic acute hemolysis is suspected.
T126 17773-17927 Sentence denotes The blood present in the dialyzer and in the blood tubing should not be returned to the patient, as this blood may contain excessive amounts of potassium.
T127 17928-18066 Sentence denotes In addition, it is imperative to monitor the electrocardiogram frequently in these patients so that hyperkalemia can be detected promptly.
T128 18067-18207 Sentence denotes Further management should follow available guidelines intended for the treatment of hyperkalemia (if present) and for that of severe anemia.