Pt is 50 y/f on ECMO A+ AB scene negative. We are on day 5 or 6 and she is hemolysis lime crazy. I remember something about hyper hemolysis syndrome on this site. Recheck AB screen still negative DAT is negative. LDH super high, sorry I was off a couple of days got called at home about this case. I’m writing this on my break and have to go back and work on other patients. Will try to respond when I can. Saline used was 0.9% . Patient also has impella device which we’ve seen hemolysis with but not like this. This looks like intervascular hemolysis.

Some of the worst hemolysis I have seen was in clostridium septicemia.  Both cases were fatal.

 

The mishandled ECMO can cause hemolysis. I know this can't happen in your hospital, just a little hint.

Was the patient transfused? If not, hyper hemolysis is less likely. Sounds like mechanical causes are most likely.

The last time we saw this at our institution, the ECMO team found a crack in the cannula!!! I agree with Yanxia - the clinical and surgical team needs to check the ECMO circuit for causes of mechanical hemolysis and lines.  Our team had to redo the cannulas and circuit in this case and the hemolysis went away as soon as that was completed.

My greatest apology for leaving you all hanging. We've been so incredibly busy and short-staffed that I could not even think about anything else but trying to finish up my daily duties. Anyway, seems that the patient also had an impella device that had to be "adjusted" and I believe that corrected the hemolysis. I'm only reading the responses today (2 weeks later)☹️so hats off to you all who thought mechanical causes. I would have not thought that the device would be that far-off to cause the gross hemolysis we saw. We do see slight hemolysis with impella devices but not like this one. I guess never say never. Thank you all for your responses.