- See:
Uremic Bleeding:
- Discussion:
- w/ bleeding consider need for DDAVP, additional transfusions
(which may decr bleeding in RF), and aggressive
dialysis;
- intravenous administration of
erythropoietin in doses ranging from
25 to 500 U /kg of body wt 3 times a week causes a dose-dependent
rise in the hematocrit and eliminates need for transfusion;
- in approx 50% of uremic pts, there is shortened red cell survival
- toxic inhibition of glycolytic enzymes (HMP shunt) reduces production
of red cell ATP;
- this predisposes cells to damage by sulfonamides, antimalarials, and
other oxidizing agents and results in HbS, (videsupra);
- Uremic Bleeding:
- consider use of
DDAVP
- Blood Transfusion:
- see:
blood product menu:
- it is important that administration of blood products be coordinated
with the
dialysis treatments;
- fluid may be removed during
dialysis to create space for blood products;
- banked blood is often a source of free potassium, owing to leakage
from within the erythrocytes;
- administration during
dialysis can provide an exit for this
exogenous potassium load;
- transfusions given outside of dialysis may cause pulmonary edema
and hyperkalemia, necessitating an early return to
dialysis unit;
