Diagnosis:
Uremic bleeding
• Uremia is associated with a bleeding diathesis with mucocutaneous bleeding, easy bruising, and bleeding in association with injury or invasive procedures.
• The cause of bleeding in these patients is multifactorial with dysfunction in platelet–platelet interactions and platelet–endothelium interactions and thrombocytopenia.
• These patients also present with thrombotic complications.
• Patients exhibit dysfunction in platelet aggregation and secretion.
• Platelets in uremic patients demonstrate decreased binding of von Willebrand factor and fibrinogen.
• The defects seen are partially reversible by removal of uremic toxins by dialysis.
• Desmopressin acetate (DDAVP) is one of the first-line agents to improve hemostasis in uremic patients. It can be used both prophylactically before invasive procedures and in the treatment of active bleeding.
• DDAVP induces the release of endogenous von Willebrand factor from endothelial cells, leading to improvements in hemostasis.
• Cryoprecipitate can also be used to provide additional von Willebrand factor, but it is not a first-line treatment due to the risks associated with allogeneic transfusions.
• Correction of anemia in these patients also improves hemostasis.
Boccardo P, Remuzzi G:
Platelet dysfunction in renal failure. Semin Thromb Hemost 2004;30:579-589.
