Mechanical hemolysis in a hemodialysis patient with carotid-jugular arteriovenous fistula

Renal anemia is mainly caused by inadequate synthesis of erythropoietin from diseased kidneys. At the present time, recombinant human erythropoietin (rHuEPO) is used to correct anemia successfully in most patients with end-stage renal diseases. Nevertheless, poor response to rHuEPO still exists in some hemodialysis patients and its mechanism in some cases remains obscure. Herein, we describe a rare case of rHuEPO hyporesponsiveness due to mechanical hemolysis induced by a traumatic carotid-jugular arteriovenous fistula (AVF) in the presence of subclinical aluminum intoxication. Following surgical resection of the traumatic AVF and 8 months of desferrioxamine treatment, the responsiveness to rHuEPO was restored and the rHuEPO dose requirements reduced.