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Haemolysis due to formaldehyde-induced anti-N-like antibodies in haemodialysis patients

Hämolyse durch Formaldehyd-induzierte Anti-N-artige Antikörper bei Hämodialysepatienten

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Zusammenfassung

Während der Wiederverwendung Formaldehyd-sterilisierter Kiil-Dialysatoren war die mit51Cr bestimmte Erythrocytenüberlebenszeit bei 16 Patienten mit Anti-N-artigen Antikörpern significant (p<0,001) kürzer als bei 19 Antikörper-negativen Kontrollpatienten (MW±SD: 16,5±2,7 bzw. 22,4±3,1 Tage). Bei Antikörper-positiven Patienten (n=10) führte das Umsetzen von Formaldehyd-sterilisierten Kiil-Dialysatoren auf Ethylenoxid-sterilisierte Einmaldialysatoren vergleichbarer Effektivität zu einem sofortigen, signifikanten (p<0,002) Anstieg der Erythrocytenüberlebenszeit (MW±SD: 16,3±1,9 Tage, Kiil-Dialysator; 20,3±3,5 Tage Einmaldialysator). Die Antikörper-Titer blieben während der Messung der Erythrocytenüberlebenszeit unverändert, danach fielen sie im Verlauf von Monaten langsam ab. Bei Antikörper-negativen Kontrollpatienten (n=6) führte das Umsetzen von Formaldehyd-sterilisierten Kiil-Dialysatoren auf die Ethylenoxid-sterilisierten Einmaldialysatoren nicht zum Anstieg der Erythrocytenüberlebenszeit. Bei den Antikörper-positiven Patienten stieg der mittlere Hämatokritwert nach dem Umsetzen signifikant (p<0,05) an, dagegen kam es nach dem Umsetzen bei keinem der Antikörper-negativen Patienten zu einer gerichteten Veränderung der Hämatokritwerte. Die Untersuchungen belegen, daß die Formaldehyd-Sterilisation von Dialysatoren zu einer Antikörper-vermittelten Hämolyse führen kann, die zum Ausmaß der renalen Anämie dieser Patienten beiträgt. Diese Immunhämolyse kann, auch bei Persistenz der Anti-N-artigen Antikörper, zumindest teilweise verhindert werden, wenn eine weitere Formaldehyd-Exposition des Patienten vermieden wird.

Summary

During reuse of formaldehyde sterilized Kiil-dialysers, red cell survival, measured by means of51Cr t/2, was significantly reduced (p<0.001) in 16 patients with anti-N-like positive sera, when compared with 19 antibody negative control patients (Mean±SD: 16.5±2.7 versus 22.4±3.1 days.) In antibody negative patients (n=10) replacement of form-aldehyde sterilized dialysers by ethylene-oxide sterilized disposable dialysers resulted in a significant increase (p<0.002) of51Cr t/2 (Mean±SD, days: Kiil-dialyser 16.3±1.9; disposable dialyser 20.3±3.5). This improvement took place, although antibody titres persisted during the51Cr-measurements and declined thereafter only slowly. In antibody negative patients (n=6) red cell survival did not increase, when formaldehyde as a sterilant was avoided. In antibody positive patients mean haematocrit rose significantly (p<0.05), whereas in none of the antibody negative patients a definite change of haematocrit occurred. The data demonstrate, that formaldehyde sterilisation of dialysers may cause antibody-mediated haemolysis contributing to the extent of renal anaemia. This immunohaemolysis may be corrected, in spite of continuing antibody persistance, when formaldehyde exposure is totally avoided, or possibly when minimized.

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  1. Abteilung für Nephrologie, Zentrum der Inneren Medizin, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt a.M., Germany

    W. Fassbinder, U. Frei &  K.-M. Koch

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  1. W. Fassbinder
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  2. U. Frei
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  3. K.-M. Koch
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Fassbinder, W., Frei, U. & Koch, KM. Haemolysis due to formaldehyde-induced anti-N-like antibodies in haemodialysis patients. Klin Wochenschr 57, 673–679 (1979). https://doi.org/10.1007/BF01477668

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