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To the Editor.—
A recent Brief Report in The Journal by Szwed et al (226:315, 1973) notes an association between renal failure and hemodialysis with the onset of hemolysis in a patient who had previously occult paroxysmal nocturnal hemoglobinuria (PNH). The authors go on to suggest that this represented a complication of the administration of blood products.We would like to suggest an alternative explanation. May et al (N Engl J Med 289:705, 1973) demonstrated the role of magnesium in initiating the alternate pathway mediated lysis of PNH cells. They found that an increase of as little as 0.6 mEq/liter in the magnesium concentration could initiate PNH lysis. The presence of calcium in normal concentrations was shown to have an inhibitory effect. Perhaps, subtle fluctuations in divalent cation concentration were involved in the PNH cell lysis associated with renal failure. Increasing magnesium concentration and falling calcium concentration and pH, all
Gelfand JA, Frank MM. Renal Failure in Paroxysmal Hemoglobinuria. JAMA. 1974;227(4):440. doi:10.1001/jama.1974.03230170056025
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