Uremic bleeding syndrome
Background
- Bleeding diathesis
- Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired plt function
- Wide range of presentations
- Ecchymosis, purpura, epistaxis, fistula bleeding, venipuncture bleeding
- GI bleeding
- Intracranial bleeding
- Bleeding time extended past 1-7 min (small incision on finger)
- Mild thrombocytopenia but plts rarely fall below 80k
- PT and aPTT typically remain normal
Management
- Treatment = desmopressin, cryoprecipitate, conjugated estrogen, EPO, dialysis[1]
- Limited evidence for dialysis (peritoneal vs. hemodialysis) in management of acute uremic bleeding
- DDAVP 0.4 mcg/kg IV over 10 min - effects within 1 hr but increased bleeding time returns within 24 hrs[2]
- Cryoprecipitate 10 bags over 30 min - benefit seen within 4-12 hrs in most[3]
- Recombinant EPO 50 - 150 u/kg IV 3x/wk
- Conjugated estrogens at 0.6 mg/kg IV over 30 min QD for 5 days - time to effect ~ 6 hrs, max effect at 1 wk, duration of action 2 wks
Sources
- ↑ Hedges SJ et al. Evidence-based treatment recommendations for uremic bleeding. Nature Clinical Practice Nephrology (2007) 3, 138-153.
- ↑ Desmopressin (Rx) - Dosing and Uses. Medscape. http://reference.medscape.com/drug/ddavp-stimate-desmopressin-342819.
- ↑ Cryoprecipitate - Dosing and Uses. Medscape. http://reference.medscape.com/drug/cryo-cryoprecipitate-999498.