Type A Dialyser Reaction — ESENeph MCQ

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ModerateHaemodialysisType A Dialyser ReactionESENeph

A 65-year-old man on haemodialysis develops acute onset hypotension, urticaria, dyspnoea, and back pain within the first 15 minutes of starting dialysis. He was started on a new brand of dialyser membrane today. What has occurred?

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Correct answer: C — Type A dialyser hypersensitivity reaction (anaphylactic/anaphylactoid)

Type A dialyser reactions occur within the first 20-30 minutes of dialysis and present with anaphylaxis/anaphylactoid symptoms: urticaria, angioedema, dyspnoea, hypotension, and back/chest pain. They are mediated by IgE antibodies (to ethylene oxide sterilant), complement activation (by certain membranes), or bradykinin generation (with ACEi + AN69 membranes). Management: stop dialysis immediately, do NOT return blood, administer IM Adrenaline, IV antihistamines, and IV fluids. Prevent recurrence by switching membrane type, ensuring adequate rinsing, and avoiding ACEi with AN69 membranes.

Reference: ERA-EDTA 2019 – HD Complications; KDOQI 2015