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Science 3 August 1973:
Vol. 181. no. 4098, pp. 463 - 464
DOI: 10.1126/science.181.4098.463
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Articles

Chlorinated Urban Water: A Cause of Dialysis-Induced Hemolytic Anemia

John W. Eaton 1, Charles F. Kolpin 2, Harold S. Swofford 2, C M. Kjellstrand 3, and Harry S. Jacob 3

1 Department of Medicine, University of Minnesota Medical School, Minneapolis 55455
2 Department of Chemistry, University of Minnesota
3 Department of Medicine, University of Minnesota Medical School

Unexplained acute hemolytic anemia is sometimes seen in uremic patients undergoing hemodialysis. Chloramines, which are oxidant compounds made up of chlorine and ammonia and are widely used as bactericidal agents in urban water supplies, have been found responsible for two recent epidemics, in dialyzed uremic patients, of acute hemolytic anemia characterized by Heinz bodies. Chloramines produce denaturation of hemoglobin, both by their direct oxidizing capacity and their ability to inhibit red cell reductive (hexose monophosphate shunt) metabolism.


THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
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Haemolysis in haemodialysis patients: evidence for impaired defence mechanisms against oxidative stress.
T. Weinstein, A. Chagnac, A. Korzets, M. Boaz, Y. Ori, M. Herman, T. Malachi, and U. Gafter (2000)
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Chloramine, a sneaky contaminant of dialysate.
R. Perez-Garcia and P. Rodriguez-Benitez (1999)
Nephrol. Dial. Transplant. 14, 2579-2582
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Erythropoietin resistance due to dialysate chloramine: the two-way traffic of solutes in haemodialysis.
D. Richardson, C. Bartlett, E. Goutcher, C. H. Jones, A. M. Davison, and E. J. Will (1999)
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Liver Failure and Death after Exposure to Microcystins at a Hemodialysis Center in Brazil.
E. M. Jochimsen, W. W. Carmichael, J. An, D. M. Cardo, S. T. Cookson, C. E.M. Holmes, M. B. Antunes, D. A. de Melo Filho, T. M. Lyra, V. S. T. Barreto, et al. (1998)
N. Engl. J. Med. 338, 873-878
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Good News, Bad News, Good News.
H.T.R. (1973)
JAMA 226, 67
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