Thick blood clotting machine and lines

[houndawg]

We have a relatively new patient in our dialysis unit. He has thick blood which clogs up the machine causing it to be broke down and cleaned during the dialysis.  He is currently on no blood thinners because of suspected internal bleeding.  He has had to have blood transfusions twice in the three months he's been on dialysis.  So far no reason for the blood loss has been found, despite a colonoscopy. Doctors so far have suggested nothing else as far as the blood issue is concerned.  Could the thickness and loss of blood be due to kidney failure or should  other avenues be explored?  Also could the blood issue be the cause of his kidney failure which was sudden?  Nobody has come up with a definite answer to why the kidney failed.  any suggestions?
Thanks, Houndawg

[cassandra]

I would think that if the patient is conscious there would be pain if there is an internal bleeding. A CT scan would show up a bleeding in the brain, but dialysis without bloodthinners is just not possibles cos the blood reacts with the plastic of the tubes. Sorry no suggestions further. But throwing a set of full line of clotted up blood from the machine sort of counteract the transfusions doesn't it?

good luck Cas

[boswife]

Dont know about the blood clotting, but i do know about transfusions.  Bo has been having 'suspected' bleeding as well and has been going through so many tests and having transfusions every two weeks.  they have done endoscopys, colonoscopys, bone scrapes, swollowed the camera pill,   etc and not found sugnificant bleeding to cause this.  BUT........ we were in the hospital for 6 days and during that time he was taken off his 81 asprin, and put on fluids (yea a dialysis patient needing protien and NOT fluids) because they kept having to do procedures that required emptyness of those areas.  It was tough but in the meantime, he had a large black poop and that was that!! seems that the fluids let the body heal and after nearly 6 months his hemoglobin finally has come up and he's feeling so much better.  Soooo, what does that have to do with what you asked?? not much probably but just that NOW i do see a difference in the color of his poop.  It is now definatly brown which i thought it was before but now seeing the diffeence, well, i see the difference.  I wish him well, and keep digging.  Sorry if this is scrambled,, been inturupted numerious times, and now have starving hubby so cant even go over it and clear up some probably nonsence...   one more thing, just read the just posted post........ hubby uses no thinners/heperin (never has)  and now no asprin.  so far so good but doesnt sound like this other guy is doing ok with it...

[lmunchkin]

I would have him see a Hemotologist or possibly an Endocrinologist.  Endo's can find out alot through the whole endocrin system. The hole system is very complex, but someone who has studied this and specializes in it, could probably get to the root of the problem!  Or possibly a vascular doctor could too, but I would go with Hemotalogist, then Endocrinologist!

Not much more I can offer here, Sorry!

lmunchkin

[sullidog]

yes, he does need to get down to the route of the problem as it sounds like he does need to be on blood thinners of some kind, I know if I don't get any heperon my blood will clot.

[Hemodoc]

We have a relatively new patient in our dialysis unit. He has thick blood which clogs up the machine causing it to be broke down and cleaned during the dialysis.  He is currently on no blood thinners because of suspected internal bleeding.  He has had to have blood transfusions twice in the three months he's been on dialysis.  So far no reason for the blood loss has been found, despite a colonoscopy. Doctors so far have suggested nothing else as far as the blood issue is concerned.  Could the thickness and loss of blood be due to kidney failure or should  other avenues be explored?  Also could the blood issue be the cause of his kidney failure which was sudden?  Nobody has come up with a definite answer to why the kidney failed.  any suggestions?
Thanks, Houndawg

Actually the most common cause of bleeding in patients with this presentation is AVM's. Arterio-venous malformations in the GI system are very hard to detect and can bleed profusely. Finding the bleeding site is very difficult. If the patient is actively bleeding, you can attempt to do a bleeding scan to see if you can isolate the source. We had one patient who bled over and over and over again, but by the time we would do the bleeding scans, it had stopped.

They were finally able to locate the general area where it was located and a surgeon took that chunk of small bowel out. It seemed to work, but that took a lot of time to find the location. They do not have endoscopic cameras that you can swallow and then collect on the other end so to speak that is useful for patients like this.

As far as the blood clotting, I suspect that folks have this man on a high does of EPO which is causative in many cases of thrombosis while on the dialysis machine. You might consider backing off of the EPO a bit if that is the case. Also, change to every half hour IV saline boluses instead of every hour are some of the things that may help in this situation. On the other hand, heparin is a short acting molecule. If he is not actively bleeding in the unit and he continues to have clotting issues, you may consider a small bolus of heparin, not a heparin drip to get him through dialysis. There is some point where all of his continued blood loss from bleeding and from the thrombosis during dialysis that also cuts dialysis short is not good since poorly controlled uremia also predisposes to bleeding by platelet dysfunction.

Patients in this situation often are very difficult to diagnose and then if AVM's are confirmed, at times the treatment is to put the patient on estrogen even if they are male.

http://patients.gi.org/topics/small-bowel-bleeding-and-capsule-endoscopy/