Anaemia in Renal Failure Patients Undergoing Dialysis: Are Blood Losses from Repeated Femoral Cannulation Significant?

Abstract

Anaemia is one of the major complications of renal &ilure with significant effects on the quality of life, morbidity and mortality of patients with renal failure. The aetiology of anaemia in renal failure is generally thought to result from inadequate erythropoietin production, reduced life span of erythrocytes in uraemic serum and bone marrow suppression by yet unidentified uraemic toxins. The role of blood losses from access route cannulation has however not been adequately evaluated. The aim of this study was to evaluate the amount of blood loss during repeated
femoral cannulations and correlate this with haematocrit changes in our dialysis population.One hundred and forty-two dialyzed patients (87 males
and 55 fem-Jes with a mean age of 40.7 ± 15.6yrs [SD]) who had repeated femoral cannulations as their access route were studied during their first 5
haemodialysis sessions. The volume of blood loss during each femoral cannulation procedure was derived by comparing the weight of blood in soaked gauze and drape used for cannulation with the weight of 10mls of the patient's blood during the same procedure. Their haematocrit at the end of the salvage dialysis was compared with the expected PCV values from the blood transfusion details, to evaluate the effect of repeated blood losses during access route cannulation. Mean blood loss during cannulation was 36.52mls ± 2.70 SD. Range 6.47m:s - 100.20 ml. Mean PCV at the onset of dialysis was 20.54± 6.5 % compared with 18.36 ± 4.8 % at the end of the salvage session. When compared with the expected mean of23.29% ± 5.45 SD derived from the transfusion details of the patients, the results were statistically significant t =4.6, P < 0.05. There was also a positive correlation between blood loss and PCV changes, however, this did not reach a statistically significant level (r = +0.63, p>0.05). It was concluded that repeated femoral cannulation could be a clinically important cause of blood loss and failure of haematocrit response to multiple blood transfusions, in haemodialysis patients. It is hoped that this finding would encourage dialysis units to review their policies on access route practices for
dialysis.