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Cracking the case of reverse transmembrane pressure (TMP) in a patient with Waldenstrom's Macroglobulinemia.

This patient presented to our hemodialysis program in the autumn of 2007, with a diagnosis of Waldenstrom's Macroglobulinemia. Her initial treatments were fraught with numerous reverse TMP alarms, to the point where the dialysis machine was changed three times in one run alone.

The common causes of reverse TMP did not seem to apply to this patient. The reverse TMP alarms were so frequent that the stopping of the blood pump with each alarm resulted in the clotting of her extracorporeal circuit. Her hemoglobin would drop to the point where she required transfusions despite receiving ESA (Erythropoiesis-stimulating agents). We had to find a way to dialyze this patient.

A literature search was done, hoping that there would be an article or case study that could assist us. We found nothing related to this case in the literature. Several physicians in our program were consulted seeking both a cause and a solution.

We would like to share our experience with this patient and her disease, our theory on the cause of the problem and how we are able to provide her dialysis treatments and minimize extracorporeal clotting.

Pamela Laprise, RN, BScN, CNeph(C)
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Author:Laprise, Pamela
Publication:CANNT Journal
Article Type:Brief article
Geographic Code:1CANA
Date:Jul 1, 2008
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