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Abnormal Red Cell Metabolism Causing Hemolysis in Uremia: A Defect Potentiated by Tap Water Hemodialysis

YOSHlHlTO YAWATA, M.D.; ROBERT HOWE, M.D.; and HARRY S. JACOB, M.D.
[+] Article and Author Information

Grant support: Grant AM 15730 from the National Institutes of Health and grants from the Leukemia Research Fund of the University of Minnesota, the Graduate School of the University of Minnesota, and the Minnesota Medical Foundation.

Presented in part 1 May 1972, 64th Annual Meeting of the American Society of Clinical Investigation, Atlantic City, and published in abstract form in the Journal of Clinical Investigation 51:105a, 1972.

▸Requests for reprints should be addressed to Harry Jacob, M.D., University of Minnesota Medical School, Minneapolis, MN 55455.


Minneapolis, Minnesota


Ann Intern Med. 1973;79(3):362-367. doi:10.7326/0003-4819-79-3-362
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A plasma factor that inhibits red cell hexose monophosphate (HMP) shunt metabolism and thereby shortens red cell survival has been found to accumulate in roughly half of uremic patients. The factor is efficiently removed by frequent hemodialysis with purified water in the bath solutions. However, contaminants in tap water hemodialysis baths potentiate the red cell defect, and hemolysis may strikingly worsen in patients so dialyzed. As in patients with deficient red cell glucose-6-phosphate dehydrogenase, and thus deficient HMP shunt metabolism, explosive Heinz body hemolytic anemia may occur in affected uremic patients given oxidant drugs, such as sulfonamides, antimalarials, and the like. We urge that uremic patients be screened for red cell HMP shunt deficiency before administration of sulfonamides or other oxidant compounds and that affected patients be dialyzed only against purified water baths.

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