Treatment of the Bleeding Tendency in Uremia with Cryoprecipitate

Abstract

We gave cryoprecipitate to six patients with uremia and bleeding times prolonged to more than 15 minutes. After the infusion, all patients had shortened bleeding times; the times of five became normal. In four patients control of major bleeding episodes was attained, and five underwent major surgical or invasive procedures, with good hemostasis. After infusion the time before the nadir of the bleeding time was reached was between one and 12 hours. The bleeding time returned to pretreatment levels by 24 hours after infusion in five patients, and by 36 hours in the other patient. Platelet-aggregation studies before infusion gave normal results in three patients and abnormal results in three. There wasno change after infusion. Before infusion, levels of Factor VIII coagulant activity and Factor VIII von Willebrand activity were normal, Factor VIII-related antigen was increased, and crossed immunoelectrophoresis of Factor VIII-related antigen was normal. Our findings suggest that cryoprecipitate can temporarily correct the bleeding tendency in patients with uremia.

Expression of von Willebrand Factor by Human Pulmonary Endothelial Cells in vivo<footref rid="foot01">¹</footref>

“…In patients with vascular diseases or denudation of the endothelium and exposed subendothelium (e.g. in myocardial infarction, acute respiratory failure, acute and chronic renal insufficiency, hypertension, diabetic nephropathy, vasculitis) [5, 28, 29, 30, 31, 32, 33]vWf is regarded as a marker of endothelial dysfunction [34]. …”

von Willebrand Factor

“…8 Subsequently, several investigators found that vWF was high in an array of clinical situations, all characterized by vascular damage with denudation of the endothelium and exposure of the subendothelium (for instance, acute respiratory failure, acute and chronic renal insufficiency, hypertension, diabetic nephropathy, and vasculitis). [23][24][25][26][27][28][29] To interpret these findings, it has been postulated that in patients with large-and small-vessel disease, the membranes of damaged endothelial cells would "leak" vWF, leading to an increase of the plasma levels of this protein. Clinicians became attracted by this simple approach to the evaluation of the degree of endothelial damage in vascular disease, because it reminded them of the usefulness and widespread adoption in clinical practice of the measurement of serum enzymes to evaluate the degree of hepatic and cardiac cell damage.…”

Complications of Percutaneous Needle Biopsy of the Kidney

“…The risk of arteriovenous fistulae, hemorrhage and hematuria [7,8,31] have all been positively corre lated with blood pressure elevation. The year of biopsy, use of fluoroscopy or the presence of systemic disease [48]. However, patients with the clinical presentation of end-stage renal disease often have little to gain from a kidney biopsy.…”