Uremic Bleeding: A Concise Review

Abstract

Almost all uremic patients have a bleeding diathesis which becomes a problem during in-vasive procedures such as surgery, biopsy and catheter placement. Intracranial bleeding, per-kardial tamponade and gastrointestinal bleeding are the other life threatening elinical presentations. Pathogenesis of uremic hemorrhagic diathesis is not totally clear. A complex platelet dysfunction with abnormal platelet vessel wall interaction is claimed to be the main cause. Uremic toxins are shown to be responsible. Adequate dialysis may correct prolonged bleeding time, but fails at times. The ineidence of uremic bleeding has been reduced by kidney transplantation, belter management of anemia with recombinant human erythropoietin, and the use of desmopressin (DDA VP), cryoprecipitate, conjugated estrogens. In this article underlying pathophysiology; prophylactic and therapeutic approaches are reviewed. (