Berty R M, Zeigler Z R, Bruns F J
Department of Medicine, Montefiore University Hospital, University of Pittsburgh School of Medicine, PA.
Am J Kidney Dis. 1992 Apr;19(4):326-30. doi: 10.1016/s0272-6386(12)80448-3.
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.
本研究表明，特定的出血试验能够将单纯的尿毒症血小板病与尿毒症叠加既往存在的血小板功能障碍所引起的出血性疾病区分开来。本文介绍了一名出血倾向严重的尿毒症患者的病例史。将该患者的检查结果与其他九名慢性肾衰竭患者的临床特征及血小板功能研究结果进行了比较。除了临床出血情况及血小板功能研究结果外，该指标患者与其他尿毒症患者相似。与其他尿毒症对照相比，该患者的非闭塞性出血时间及出血时间试验期间的实测失血量增加。此外，她对胶原的血小板聚集反应低于其他尿毒症受试者。肾移植后的重复研究结果符合遗传性储存池病。潜在的血小板疾病可能会加重尿毒症的止血缺陷。对于有频繁且严重出血表现的患者应怀疑有此诊断。肾移植使临床出血得到了控制。
