We are currently trying to standardise the assessment of haemodialysis extracorporeal blood circuits and filters when evaluating the correct dose of LMWH (fragmin) for haemodialysis patients. I am looking for a standardised assessment tool to score the level of clot formation in the above mentioned circuit and filter when haemodialysis is complete.
Does anyone know of an existing assessment tool?
Many thanks,
Johnny Hooper
Dialysis Unit
Horsens Hospital
Denmark
Dear Dr. Hooper,
In general, I am not aware of any widely used standardized scoring yet, for circuit clotting.
Some papers I have read could be some reference to compare, consider and adapt with necessary adjustment.
Tubing:
- Blood Purif 2012;34:213–218. DOI: 10.1159/000342596
(This paper used a scoring to investigate a new design of tubing, which was believed to have potential impact on circuit clotting.)
- ClinicalTrials.gov Identifier: NCT02086682
(From this trial, although no sufficient details available now, it looks the manufacturer provided the clotting scale for the researcher.)
Tubing + Filter:
- Nephrol Dial Transplant. 1999 Aug;14(8):1943-7.
- Nephrol Dial Transplant (2006) 21: 444–449
(These papers assessed both tubing and filter by visual inspection with a defined scoring.)
- Int J Artif Organs. 2008 Apr;31(4):323-8.
(This paper, just read, has a very clearly defined quantitative scoring.)
[ *** To Note: this kind of scoring for filter clotting in these 3 papers, is very similar to the way we recommend.]
Filter:
- Article Effect of anticoagulation on blood membrane interactions dur...
The way to score in this paper, you can judge if it is as good as the above one...
- Saudi J Kidney Dis Transpl 2010;21(3):466-470
This one is then also similar to the one in above 3 papers, but much less quantitative.
[Last notes: More accurate comparison of clotting severity could and has been done also in our laboratory, mainly using hemolysis first, then measure and compare hemoglobin amount, calculate accordingly the residual blood volume within the filters. But of course it is much more complicated and needs additional procedure and effort.
In fact, this shall be a much more accurate way to assess clotting than visual inspection, because visual inspection not only can vary a lot by individuals' judgement, but also normally being difficult to assess the clotting in the fibers in the middle of the filter compared to the fibers in the most outer layer of the filter. ]
FYI, hope it could be helpful.
BR,
Albert
Hi Albert,
Many thanks for your very comprehensive answer to my question.
With warm regards,
Johnny Hooper
- Badges
- Science topic
- Similar topics
- Medicine
- Disease
- Infectious Diseases
- Immunization
- Vaccination