Abstract
A 65-year-old female underwent maintenance hemodialysis in 1983 due to idiopathic renal failure. Thereafter she underwent a renal transplant from a living donor. Maintenance hemodialysis was re-instituted in 2001. In July 2007, synthetic vascular prosthesis was implanted on her left forearm, due to occlusion of the right native arterioveous fisutula. There was limited bleeding during the operation (less than 50mL). Ten days after, the hemoglobin level decreased from 10.7g/dL to 7.7g/dL. Increase of erythropoietin and iron injection improved anemia. Fifty days later, the hemoglobin level began to decrease again gradually. Ninety days later, the hemoglobin level decreased to 6.6g/dL. The diagnosis of hemolysis was based on elevated serum aspartate aminotransferase (AST 43 IU/L) and lactate dehydrogenase (LDH 974 IU/L), and decreased serum haptoglobin (3mg/dL). The Coombs test and cold agglutinin were negative. Ultrasonography and angiography showed a dissociation of the arterial wall in the upper arm and a pseudo cavity at the anasotomosis. Blood was flowing backward in the pseudo cavity. Blood transfusion was performed by 4 units. About 3 months later, hemolytic anemia has improved by administration of erythropoietin only. Despite persistent dissociation of the artery, there has not been any recurrence of hemolytic anemia during 1-year follow-up.
