ACQUIRED abnormalities of platelet function are very common. Platelet function, as assessed by in vitro studies or the bleeding-time test, is affected by a vast number of drugs, common foods, vitamins, and spices; by systemic conditions such as chronic renal disease and surgery requiring cardiopulmonary bypass; and by hematologic disorders such as myeloproliferative and lymphoproliferative diseases, dysproteinemias, and the presence of antiplatelet antibodies. The possibility that these abnormalities may underlie an increased risk of bleeding is an important issue when bleeding occurs without a clear cause or when invasive procedures are required. However, the clinical importance of platelet dysfunction is . . .

The clinical importance of acquired abnormalities of platelet function

Thrombosis and hemostasis in renal disease

Uremic bleeding syndrome is a recognized consequence of renal failure and can result in clinically significant sequelae. Although the pathophysiology of the condition has yet to be fully elucidated, it is believed to be multifactorial. This article is a review of both the normal hemostatic and homeostatic mechanisms that operate within the body to prevent unnecessary bleeding, as well as an in-depth discussion of the dysfunctional components that contribute to the complications associated with uremic bleeding syndrome. As a result of the multifactorial nature of this syndrome, prevention and treatment options can include one or a combination of the following: dialysis, erythropoietin, cryoprecipitate, desmopressin, and conjugated estrogens. Here, these treatment options are compared with regard to their mechanism of action, and onset and duration of efficacy. An extensive review of the clinical trials that have evaluated each treatment is also presented. Lastly, we have created an evidence-based treatment algorithm to help guide clinicians through most clinical scenarios, and answered common questions related to the management of uremic bleeding.

https://www.researchgate.net/profile/Sarah_Dehoney/publication/6483286_Evidence-based_treatment_recommendations_for_uremic_bleeding/links/55cca82308aef0f1078357fc.pdf

Evidence-based treatment recommendations for uremic bleeding

Uremic bleeding : Pathogenesis and therapy

Nonvitamin K Anticoagulant Agents in Patients With Advanced Chronic Kidney Disease or on Dialysis With AF

Quantitation of the thrombocytopathy of uraemics may be one useful way of evaluating forms of therapy. 24 patients treated by haemodialysis and peritoneal dialysis at two different times had platelet aggregation studies whose parameters were compared with those of 24 normal persons, 5 successful transplants or 13 untreated uraemics. Renal transplantation and peritoneal dialysis improved platelet function. The haemodialysis procedure itself impaired platelet function: this was not due to heparin.

Effect of peritoneal dialysis, haemodialysis and kidney transplantation on blood platelet function. I. Platelet aggregation by ADP and epinephrine.

The short- and long-term effect of hemodialysis with two different membranes -- cuprophan and polyacrilonytrile -- on platelet aggregation has been investigated in 12 uremic patients undergoing extracorporeal dialysis, passing from one treatment to the other. Cuprophan membranes failed to correct the defective platelet aggregation of uremia, and their thrombogenicity was documented by a fall in platelet count and further impairment of platelet aggregation during dialysis. On the contrary, polyacrilonitrile membranes showed the capacity to correct completely but transiently the platelet aggregation, without changes in platelet count. The results indicate that polyacrilonytrile membranes show a better biocompatibility toward platelets than cuprophan membranes.

U. Buoncristiani

Papers

Effect of peritoneal dialysis, haemodialysis and kidney transplantation on blood platelet function. I. Platelet aggregation by ADP and epinephrine.

Polyacrilonytrile versus cuprophan membranes for hemodialysis: evaluation of efficacy and biocompatibility by platelet aggregation studies.