Monday, September 21, 2015

Platelet Dysfunction in Uremia


  • Clinical bleeding in uremia may involve the skin, resulting in easy bruising, or the oral and nasal mucosa, gingiva, gastrointestinal and urinary tracts, and respiratory system. 
  • Excessive bleeding may also occur in response to injury or invasive procedures
  • Uremic patients may display increased bleeding sensitivity to aspirin as there is a transient, cyclooxygenase-independent prolongation of the bleeding time
Cause
  • Causes of platelet impairment include intrinsic platelet defects, abnormal platelet-endothelial interaction, uremic toxins, and anemia

Treatment

  • Either hemodialysis or peritoneal dialysis can partially correct the bleeding time and other in vitro tests of platelet function in approximately two-thirds of uremic patients
  • most rapidly acting, and probably least toxic acute treatment for platelet dysfunction in the uremic patient is the administration ofdesmopressin, an analog of antidiuretic hormone with little vasopressor activity
  •  Raising the hemoglobin to approximately 10 g/dL or higher will reduce the bleeding time in many patients, occasionally to a normal level, but, as with desmopressin, there has not been demonstration that bleeding or risk of bleeding is ameliorated with correction of anemia
  • The infusion of cryoprecipitate (10 units intravenously every 12 to 24 hours) can shorten the bleeding time in many uremic patients

Reference:

  1. www.uptodate.com

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