Topic Discussion: Hemo peritoneum in PD

Etiologies for Bloody Peritoneal Dialysate( as little as 2ml in a 1L PD solution will make it turn fully red)

Catheter related causes: Erosion of mesenteric vessel by Tenckhoff catheter

Obstetric and gynecologic: Menstruation, Ovulation,Hemorrhagic luteal cyst,Ovarian cyst rupture, Pregnancy (uterine tear)

Intra-abdominal: Renal cyst rupture, Acquired cystic kidney disease, Autosomal dominant polycystic kidney disease ,Liver or liver cyst rupture,Hepatic tumors,Hepatocarcinoma, Liver metastasis, Splenic rupture, Splenic infarct, Aneurysm rupture, Pericardiocentesis, Radiation, Colonoscopy

Bleeding diatheses: platelet dysfunction, Anemia

Infection: Cytomegalovirus infection, Peritonitis

Other: Retroperitoneal hematoma, Iliopsoas spontaneous hematoma

What to do while determining cause?

1.      Several rapid PD exchanges are performed to determine if bleeding is persistent or is an acute event( vasoconstriction from rapid exchanges helps control bleeding)

2.      Most of the causes are menstruation related or a capillary rupture. 

3.      Correct any coagulopathy ( uremic or bleeding diathesis)

4.      Addition of heparin 500 U/L PD fluid is recommended to prevent catheter malfunction due to a clot obstructing the flow of dialysate.

5.      With persistent hemoperitoneum, imaging might be needed.

A nice review can be found here.