中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (04): 281-283.doi: 10.3969/j.issn.1671-4091.2018.04.018

• 透析查房 • 上一篇    下一篇

严重冷球蛋白血症患者行CVVHD 发生过早凝血原因分析及改进1 例

邹华1,樊蓉1,孔凌1,龚德华1   

  1. 1. 南京总医院国家肾脏疾病临床医学研究中心全军肾脏病研究所
  • 收稿日期:2017-11-02 修回日期:2018-01-04 出版日期:2018-04-12 发布日期:2018-04-12

Diagnosis, Nursing and intervention of premature clotting during continuous veno-venous hemodialysis in a patient with type I cryoglobulinemia

  • Received:2017-11-02 Revised:2018-01-04 Online:2018-04-12 Published:2018-04-12

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摘要： 【摘要】患者诊断为单克隆免疫球蛋白病(IgM，K 型)，I 型冷球蛋白血症，冷球蛋白血症肾损害。患者行肾活检穿刺后血红蛋白进行性下降，B 超下右肾下极出现108mm × 76mm 的血肿，行DSA 检查后立即床旁行连续性静脉静脉血液透析 (CVVHD) 治疗清除造影剂，减少肾功能损伤。引血上机后即出现滤前压升高至450 mmHg，诊断为冷球蛋白异常凝集导致滤器过早凝血，因此对滤器前管路适当加热，保证CVVHD 的连续开展。

关键词: 冷球蛋白血症, 连续性静脉静脉血液透析, 滤器, 过早凝血

Abstract: 【Abstract】An elderly male was diagnosed as monoclonal immunoglobulin (IgM, kappa), type I cryoglobulinemia and renal failure due to cryoglobulinemia. After renal biopsy, his hemoglobin decreased progressively, and renal ultrasound showed a hematoma of 108×76mm around right kidney. After DSA examination, he was immediately treated with continuous veno-venous hemodialysis (CVVHD). During the treatment, pre-filtration pressure rose to 450mmHg, and premature clotting in filter due to cold agglutination of cryoglobulin was identified. The clotting disappeared after external heating of the circuit before the filter. We report this case her to be aware of the similar patients clinically and to treat this situation appropriately in the future.

Key words: Cryoglobulinemia, Continuous veno- venous hemodialysis therapy, Premature filter clotting, Nursing