In Reply: We agree with Drs Bieber and Ahmad that the original phenomenon was described in a single center. However, that does not discount the fact that the phenomenon was observed across 2 provinces and was substantially reduced when electron-beam sterilized dialyzers were eliminated. We agree that there are many possible etiologies for thrombocytopenia in patients receiving hemodialysis; however, we systematically excluded patient-specific factors in the index cases and demonstrated that the thrombocytopenia was related to the hemodialysis procedure itself.
Kiaii M, Levin A, MacRae J. Electron-Beam Sterilized Hemodialyzers and Thrombocytopenia—Reply. JAMA. 2012;307(7):665–666. doi:10.1001/jama.2012.145
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