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Hemolytic Anemia with Fragmented Red Blood Cells Following Vascular Access Grafting for Hemodialysis in a Patient with Chronic Kidney Disease

Tohru Inaba, Yu Okamoto, Satoshi Yamazaki, Tohru Takatani, Nodoka Satoh, Masaya Nishida, Masato Nishimura, Tetsuya Hashimoto and Hiroyuki Kobayashi

A 57-year-old male who had been treated with hemodialysis due to end-stage chronic kidney disease for 3 years received arterio-venous bypass grafting with a polyurethane vascular access graft in his left upper arm. Two months later, he was diagnosed with hemolytic anemia with fragmented red blood cells (RBC). He had never shown clinical symptoms such as fever or neurological abnormalities characteristic of thrombotic thrombocytopenic purpura (TTP). Moreover, neither thrombocytopenia nor coagulation abnormality was found on routine laboratory examination. He received arterial banding to reduce the blood flow entering the artificial vascular access graft, which led to rapid recovery from hemolytic anemia, without recurrence. This was an extremely rare case of angiopathic hemolytic anemia with fragmented RBC caused by unfavorable bypass grafting, successfully treated with simple reoperation to reduce the blood flow entering the vascular access graft.