Daily Bolus of LR: Uremic Bleeding

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June 9, 2011 by dailybolusoflr

Uremic Bleeding

* Uremic bleeding is a well known complication of renal failure
* The most well known pathophysiologic mechanism is due to von Willebrand factor dysfunction in the uremic environment
* The most common source of major hemorrhage is the GI track
* Bleeding risk is also increased in this patient population due to their higher incidence of cardiac and vascular disease and the concurrent use of aspirin and other anticoagulation agents
* In patients with active bleeding, possible therapies to consider include:

1. Platelet transfusion (replacement of platelets)
2. Cryoprecipitate (rich in factor 7, vWF and fibrinogen; 1 hour onset)
3. Whole Blood (PRBCs, factors, platelets- patients must be able to tolerate the volume associated with this)
4. Desmopressin/DDAVP (unclear but believed to release factor 8 from storage sites, rapid onset)
5. Estrogens (complicated pathway involving nitric oxide and cGMP; onset about 6 hours- long lasting)

For more information, see the article below:

http://www.uphs.upenn.edu/renal/important%20pdf%20II/Uremic%20bleeding.pdf


Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions
1830 East Monument Street
Suite 6-110
Baltimore, MD 21287
410-955-5107
lregan@jhmi.edu

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