Factors favoring bleeding:
(1) anemia
(2) thrombocytopenia
(3) acquired platelet dysfunction
(4) telangiectasia
(5) increased fibrinolysis
(6) concurrent anticoagulation (heparin during hemodialysis, etc.)
(7) concurrent defects in coagulation factors (vitamin K deficiency, other)
Therapy for anemia targets keeping the hematocrit > 30%:
(1) with packed RBC transfusions
(2) erythropoietin
Therapy for platelet quantitative and qualitative defects:
(1) dialysis
(2) platelet transfusion
(3) von Willebrand factor availability: cryoprecipitate or desmopressin (DDAVP)
(4) avoiding medications causing platelet dysfunction
Therapy if bleeding from telangiectasia:
(1) estrogens, either conjugated or transdermal low dose
Therapy to reduce fibrinolysis:
(1) aminocaproic acid (EACA, Amicar)
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Therapy
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Disadvantages
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RBC transfusion
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infection, iron overload
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erythropoietin
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hypertension, thrombotic events
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dialysis
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access complications, infection
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platelet transfusions
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transfused platelets quickly become dysfunctional
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cryoprecipitate
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risk of infection
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desmopressin
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tachyphylaxis after 2-3 doses
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estrogens
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onset takes several days; hot flashes with high doses
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aminocaproic acid
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thrombotic events, hypertension
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