QUALITATIVE ABNORMALITY OF PLATELETS
(Secondary to renal insufficiency)

• Pathological Basis:
  • In acute and chronic renal insufficiency, there is a bleeding tendency that is often multifactorial. A qualitative abnormality of platelet function is perhaps the most common finding. This defect is extrinsic and appears to parallel the level of retained metabolites in the blood (guanidinosuccinic acid, phenolic acid, and urea).
  • Recently, an increase in prostacyclin like activity in endothelial cells in uremia has been suggested as an alternative explantion for the pathogenesis of bleeding in renal failure.
  • It has also been noted that the bleeding time of patients with a hematocrit of less than 30% is appreciably prolonged. Thus, it would appear that red cells may enhance hemostasis by having a favorable effect on the platelet-vessel wall interaction.
• Treatment:
  • Dialysis to remove metabolites.
  • Cryoprecipitate for bleeding patients with severe uremia.
  • DDAVP: is a "one-shot" treatment only. After repeated doses, patients become refractory to further treatment.
  • Packed red cells if there is severe anemia.