A patient with end-stage renal disease and uremia may develop a coagulopathy which can result in significant morbidity and mortality.


Clinical findings:

(1) ecchymoses

(2) prolonged bleeding from puncture sites, incisions and wounds

(3) bleeding from mucosal surfaces:

(3a) epistaxis

(3b) gastrointestinal bleeding

(3c) hematuria

(3d) menorrhagia in the female

(4) hemorrhagic effusions (pleural, pericardial)

(5) subdural and/or intracranial bleeding (especially if hypertensive)

(6) retroperitoneal bleeding


The bleeding tendency worsens with increasing azotemia and improves after dialysis.


Findings unusual in uremic bleeding:

(1) hemarthroses

(2) intramuscular hematomas

(3) delayed bleeding


Laboratory findings:

(1) elevated BUN (typically > 100 mg/dL)

(2) prolonged bleeding time

(3) abnormal platelet function tests


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