I agree this is most likely to be benign and further investigations in the absence of other symptoms are not warranted in a young patient

is the patient male or female? A pink bag is very common in female young PD patients every 4 weeks. Another benign cause of pink dwell is the use of calcium channel blockers.

Is she/he on antiplatlets or on oral anticoagulation treatment?

Is he doing heavy exercises daily? If so what time of the day he does his exercises?

Is he or she have a same position in the night sleep? Check the hematocrit of drained fluid.

Remember that the effluent provides a "window" to the peritoneum that normally we do not have. That said, it does seem a benign symptom since the pink bag represents perhaps 1-2ml of blood. 5ml would make the effluent red. As a 40 year old man, perhaps sexual activity at night would account for a slight trauma although I've never seen this reported.

Thanks for this. By way of further info, it is a male patient, not on any aspirin or other anticoagulants and not heavy weight lifting. i could not retrieve any info about his sleeping habits. Why did you ask that Jamshid ?

I agree with the most of you that I should not worry about it. As the fluid is only pink, the haemacrit must be very very low, i would say.

Will keep you posted.

I do not want to repeat the right questions done by other colleagues in their replies. You would be so kind to give the requested informations for a greater help for eventually suggestions. Certainly it is fundamental to know if the patient is a female , but it is difficult to link a daily bleeding to the sexual physiological activity .At moment , avoiding complicated investigations the firs suggestion that I think it could be possibly useful is an accurate echography of the abdomen cavity and organs , and this only if you have at your disposal a very skilled operator in this kind of echography , giving particular attention to : the regularity of the gut walls ( possibility of doubled line ) , and the possibility of little angiomas on the surface of the bowels and of liver and of the sexual organs, if a female. Finally ,have you checked the presence of blood in spent solution by day and eventually the amount of red cells ? It think that a numerical comparison of counts of red cells during day versus nighttime could give some useful information more.

Thanks Giancarlo, as per above, the patient is a male. I also do not think that intermittent bloody PD bags in females are not so much related to sexual activity, but merely to ovarian events, like the rupture when the ovum is released once a month, or potentially small ovarian cysts that rupture and in a healthy woman the blood would go unnoticed in the peritoneum.

this is however a male. I followed him up for an extended period now without doing any further investigations and he just does fine. there was one recurrence. personally I think there is a 'vascular vulnerability' somewhere from where may intermittently have tiny bleeds and it is all very harmless.

I would agree with the first response by David Mudge that there is no reason for further testing.

Dear Johan , I do not agree that there is no reason for further investigation in time, because in my personal experience and according to other opinions in medical literature, the sign of a recurrent bleeding in drained solutions may be an alert of a starting peritoneal sclerosis, so I think that it could be useful and suitable to repeat PET with a greater frequency than usual, and to repeatedly study by echography the conditions of the gut walls, searching for double lines, as I said in a previous intervention. In case of doubt, I think also that it could be a wise decision to drop out the peritoneal dialysis, taking into account the possible deadly outcome of that condition, being a pathology with a very poor possibility of a useful treatment.