Uremic bleeding syndrome: Difference between revisions
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==Background== | ==Background== | ||
*Bleeding diathesis | *Bleeding diathesis | ||
**Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired | **Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired platlet function | ||
==Clinical Features== | |||
*Wide range of presentations | |||
**Ecchymosis, purpura, epistaxis, fistula bleeding, venipuncture bleeding | |||
**GI bleeding | |||
**Intracranial bleeding | |||
==Differential Diagnosis== | |||
==Diagnosis== | |||
*Bleeding time extended past 1-7 min (small incision on finger) | *Bleeding time extended past 1-7 min (small incision on finger) | ||
*Mild thrombocytopenia but plts rarely fall below 80k | *Mild thrombocytopenia but plts rarely fall below 80k | ||
| Line 18: | Line 24: | ||
**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 | **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 | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:Nephro]] | [[Category:Nephro]] | ||
Revision as of 11:35, 8 November 2015
Background
- Bleeding diathesis
- Increased risk for of bleeding (GI, ICH, liver hematoma) due to impaired platlet function
Clinical Features
- Wide range of presentations
- Ecchymosis, purpura, epistaxis, fistula bleeding, venipuncture bleeding
- GI bleeding
- Intracranial bleeding
Differential Diagnosis
Diagnosis
- 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
References
- ↑ 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.