MenstruationIn female patients menses accounts for around one third of cases of haemoperitoneum associated with PD. This of course varies with age. The menstrual history is an important area to ask about during history taking from female PD patients. Ovulation can also result in haemoperitoneum.
Obstetric relatedLacerations of the gravid uterus by the PD catheter have been proposed as a possible rare cause for bloody PD fluid during pregnancy.
Other intra-abdominal organ pathologyRupture cysts from ADPKD have been proposed to cause bloody PD fluid, despite their retroperitoneal location. It’s postulated that superficial cysts may form adhesions with the peritoneal cavity, allowing access after cyst rupture. Liver and splenic lesions may cause bleeding into the peritoneal cavity – e.g. tumours, cysts, rupture and trauma. Bloody dialysate has rarely been reported after colonoscopy procedures also.
SurgeryIntra-abdominal surgery has been well recognized to lead to bloody PD fluid. The tendency to bleed may be enhanced by advanced uraemia and by the coexistence of any coagulopathies.
Of note gross haematuria is rare with infectious aetiologies of peritoneal disease. However, it is important to take advantage of the relative ease of acquiring a fluid sample when a PD patient presents with abdominal pathology. Remember that we can check for more than just white cells in a PD fluid sample – we can also look for red cells, amylase and abnormal cytology as just a few examples of additional tests. Putting all these clues together may lead us to an alternative and interesting diagnosis.