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| ==Background==
| | #REDIRECT[[Uremic bleeding syndrome]] |
| *Uremic toxins inhibit platelet aggregation
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| **Disrupts vWF
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| **PT/PTT normal, but bleeding time elevated
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| *Dialysis filter may cause thrombocytopenia
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| ==Clinical Features==
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| ==Differential Diagnosis==
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| {{Increased bleeding DDX}}
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| ==Diagnosis==
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| ==Treatment==
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| #Acute dialysis
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| #*pRBCs
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| #**Raising HCT to above 25-30% improves bleeding time
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| #*Desmopressin
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| #**Simplest and least toxic acute treatment
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| #**Increases release of factor VIII:von Willebrand factor multimers
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| #**0.3 mcg/kg IV (preferred) or SC (max 20mg). 3mcg/kg intranasaly is an option.
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| #**Onset of action ~1hr, duration of action ~4-24hr
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| #Estrogen
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| #*Unclear mechanism of action
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| #*Onset of action within 1d
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| #*Options
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| #**Conjugated estrogen 0.6mg/kg IV or 2.5-25mg PO daily
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| #Cryoprecipitate
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| #*Only indicated for life-threatening bleeding resistant to DDAVP and blood tranfusion
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| #*10 bags over 30 minutes
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| #[[Platelet transfusion]] | |
| #*Minimally effective because infused plts quickly acquire the uremic defect
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| #*Only use when uncontrolled hemorrhage
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| #Topical Hemostatic Agents
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| #*Gelatin - Gelfoam or Surgifoam
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| #*Thrombin - Floseal
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| ==Disposition==
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| ==See Also==
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| *[[Coagulopathy (Main)]]
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| ==References==
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| [[Category:Heme/Onc]]
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