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Hematology / Bleeding in CRF

- 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