I have a patient that developed cloudy fluid post pd catheter placement. He was asymptomatic, no belly pain, fever ect. Total WBC was 450, PMN 3, Eosinophils 1 but Mononuclear cells were 97 Gram Stain was NOS and so far nothing has grown on the Culture after 3 days. This is not the first time I have seen a higher total WBC (greater than 100), normal polymorph cells and eosinophils but very high mononuclear cells (greater than 90%). What could be the cause?

Questions About PD

Amy O, Nurse from USA asked
I have a patient that developed cloudy fluid post pd catheter placement. He was asymptomatic, no belly pain, fever ect. Total WBC was 450, PMN 3, Eosinophils 1 but Mononuclear cells were 97 Gram Stain was NOS and so far nothing has grown on the Culture after 3 days. This is not the first time I have seen a higher total WBC (greater than 100), normal polymorph cells and eosinophils but very high mononuclear cells (greater than 90%). What could be the cause?

1 answer

In the early 2000’s, two separate case series (Gokal, PDI 2002, Seow et al. NDT 2003) described monocyte predominant sterile peritonitis related to icodextrin use.  This was ultimately found to be due to a peptidoglycan introduced during the manufacturing process.  Once the contaminant was removed, this phenomenon vanished.   Teitelbaum (Contrib Nephrol 2006) describes the observation of cloudy dialysate with monocytic predominance in several patients with recent diarrheal illnesses, thought related to viral gastroenteritis, and in one patient with acute rejection of a previously failed renal allograft. 

A report in the late 1980’s described that injection of air into the peritoneum of five patients resulted in two patients with a monocytosis of ~ 80%, and three patients with a monocytosis of ~ 30% in conjunction with an eosinophil predominance (Daugirdas et al. Am J Neph 1987).
TB peritonitis is also a rare cause of PD fluid monocytosis.

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