Uremic platelet dysfunction

Qualitative platelet defect in advanced kidney failure due to circulating uremic toxins and altered nitric oxide or prostacyclin balance. Causes impaired adhesion and aggregation with normal platelet count.

• Common, under-recognized cause of mucosal bleeding in renal failure. Peri-procedural planning and rapid reversal options are frequently tested.

• Patients with ESRD or severe AKI with epistaxis, easy bruising, or oozing from access sites.
• Labs: platelet count normal; bleeding time prolonged; PT and PTT usually normal.
• History of missed dialysis or uremic symptoms such as nausea, pericarditis, or pruritus.

1. Best treatment is dialysis to reduce uremic toxins.
2. For urgent procedures or active bleeding: give desmopressin to raise endogenous vWF; consider cryoprecipitate.
3. Correct anemia; raising hematocrit improves platelet function. Avoid antiplatelet drugs when possible.

1. Dialysis to clear uremic toxins.
2. Desmopressin for rapid hemostasis; add cryoprecipitate if refractory.
3. Optimize hematocrit; avoid or hold antiplatelet drugs when safe.

• Normal platelet count with prolonged bleeding time in a dialysis patient points to uremic dysfunction.
• Desmopressin works within hours by releasing vWF from endothelium.

• Life-threatening hemorrhage requires urgent dialysis plus pharmacologic hemostasis.
• Consider alternative causes if PT or PTT are prolonged or if platelet count is low.

1. Renal failure patient with mucocutaneous bleeding -> check platelet count and coagulation tests.
2. If platelet count normal and PT and PTT normal but bleeding time prolonged -> uremic dysfunction likely.
3. Treat with dialysis and desmopressin; plan peri-procedural prophylaxis.

• ESRD patient with oozing from fistula site and normal platelet count before an urgent procedure; receives desmopressin.
• Missed dialysis session followed by epistaxis and prolonged bleeding time that improves after dialysis.