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제목	Polysulfone Dialyzer-Induced Thrombocytopenia with Neurological Manifestations in a Multiple Myeloma Patient: The Critical Role of Pre- and Post-Dialysis Platelet Monitoring
저자	Hwa Jeong Kim
출판정보	2026; 2026(1):
키워드	Dialyzer-related thrombocytopenia, Polysulfone membrane, Polymethylmethacrylate, Intradialytic platelet count reduction, Complement activation
초록	Case Study: Sudden-onset thrombocytopenia during hemodialysis (HD) often raises suspicion of heparin-induced thrombocytopenia (HIT). However, bioincompatibility-induced complement activation by the dialyzer membrane can also cause severe platelet consumption. We report a rare case of severe dialyzer-related thrombocytopenia (DRT) mimicking HIT in a patient with multiple myeloma, which was successfully managed by switching to a polymethylmethacrylate (PMMA) membrane. A 64-year-old male with a history of IgA nephropathy and multiple myeloma (post-autologous stem cell transplantation) initiated HD in April 2025. Two weeks later, he developed acute-onset diplopia and severe thrombocytopenia (nadir, 12×10³/μL). Comprehensive neurological and ophthalmological evaluations, including brain MRI, ruled out the recurrence of a prior pituitary adenoma or other structural abnormalities. HIT was initially suspected with a 4T score of 4; however, PF4-heparin IgG antibodies were negative. Systematic intradialytic monitoring revealed a dramatic 78% drop in platelet count (from 27×10³/μL to 6×10³/μL) when using a polysulfone (PS) membrane. Concurrent laboratory tests showed a reduction in serum complement C3 (65 mg/dL; normal 90–180), suggesting membrane-induced complement activation. Sequential trials of different dialyzers showed persistent but moderate reduction with cellulose triacetate (CTA) membranes (36% drop). Ultimately, switching to a PMMA membrane—noted for superior biocompatibility and protein adsorption properties—achieved immediate stabilization with an intradialytic loss of <14%. The platelet count normalized to 116×10³/μL within two weeks, and the diplopia completely resolved. This case demonstrates that DRT can present with neurological symptoms mimicking HIT, particularly in patients with underlying hematologic malignancies. The distinct response to the PMMA membrane confirms that the thrombocytopenia was membrane-dependent and complement-mediated. Monitoring pre- and post-dialysis platelet kinetics and complement levels is essential for diagnosing DRT and guiding the selection of highly biocompatible membranes to ensure patient safety.
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