RESUMO
This study demonstrates that specific bleeding tests can separate the thrombocytopathy of uremia alone from the bleeding disorders caused by uremia superimposed on preexisting platelet dysfunction. The case history of a uremic patient with exaggerated bleeding tendencies is presented. The findings in this patient are compared with the clinical characteristics and platelet function studies of nine other patients with chronic renal failure. The index and other uremic patients were similar except for the clinical bleeding and results of platelet function studies. The patient's nonocclusive bleeding time and measured blood loss during bleeding time tests were increased compared with the other uremic controls. In addition, her platelet aggregation in response to collagen was lower than that of the other uremic subjects. Repeat studies following renal transplantation were consistent with hereditary storage pool disease. An underlying platelet disorder may potentiate the hemostatic defects of uremia. The diagnosis should be suspected in patients with frequent and severe bleeding manifestations. Renal transplantation led to control of clinical bleeding.
Assuntos
Hemostasia , Deficiência do Pool Plaquetário/complicações , Uremia/sangue , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Falência Renal Crônica/complicações , Pessoa de Meia-Idade , Testes de Função Plaquetária , Deficiência do Pool Plaquetário/sangue , Deficiência do Pool Plaquetário/diagnóstico , Uremia/complicações , Uremia/etiologiaAssuntos
Eritropoetina/uso terapêutico , Síndromes Mielodisplásicas/terapia , Proteínas Recombinantes/uso terapêutico , Idoso , Contagem de Eritrócitos , Humanos , Contagem de Leucócitos , Masculino , Síndromes Mielodisplásicas/sangue , Neutrófilos/patologia , Contagem de Plaquetas , Reticulócitos/patologiaRESUMO
These studies examined the effect of an oral dose of epsilon-aminocaproic acid (EACA) on primary hemostasis. Bleeding time tests (with and without the use of a blood pressure cuff) were measured before and 2 h following EACA in 56 patients with mild bleeding disorders and/or thrombocytopenia. Preliminary studies evaluated the reproducibility of these tests in 13 patients who had bleeding times (cuff) ranging from 8.0 to greater than 20 min. Their replicate bleeding time values with cuff agreed within 2.5 min and those without cuff within 3 min. Therefore, the 56 study patients were considered to have had no change in their bleeding times after EACA, if their bleeding time with cuff was +/- 2.5 min and/or their nonoccluded value was +/- 3 min of their baseline values, respectively. An isolated increase in bleeding times was observed in 6 of 56 (11%) patients. All 6 had myelodysplasia associated with long bleeding times; their nonoccluded values increased by 5-14 min. Of the 56 study patients, 54% showed a decrease in their bleeding times following EACA. The changes were evident with venostasis in 18 of 30 (60%) and without venostasis in 12 (40%) patients. These studies suggest that EACA may improve primary hemostasis in some patients with prolonged bleeding times.