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