Patients with uremia often have a coagulopathy with oozing from puncture sites and bleeding from mucosal surfaces. The causes of the bleeding are often multifactorial. A variety of therapeutic maneuvers can help control the bleeding, but some may only be effective for a short period of time.


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)




RBC transfusion

infection, iron overload


hypertension, thrombotic events


access complications, infection

platelet transfusions

transfused platelets quickly become dysfunctional


risk of infection


tachyphylaxis after 2-3 doses


onset takes several days; hot flashes with high doses

aminocaproic acid

thrombotic events, hypertension


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