Skip to main content
SpringerLink
Log in

Bleeding in Uremia

  • Chapter
  • First Online:
Management of Bleeding Patients

  • 1511 Accesses

Abstract

Progressive deterioration of renal function eventually leads to uremia, which is associated with impaired function of platelets and a disturbed platelet–vessel wall interaction thus increasing the risk of bleeding in patients with renal failure. Furthermore, also anemia and anticoagulants/antiplatelet drugs contribute to the increased risk of bleeding in patients with end stage renal disease. Management of bleeding episodes in uremic patients includes an adequate dialysis, the correction of anemia with erythropoietin or erythropoetin stimulating agents, the administration of estrogens, desmopressin, fresh frozen plasma, cryoprecipitate, factor VIIa, or tranexamic acid. In severe bleeding episodes, also combinations of the above therapeutic approaches can be considered. In most cases bleeding episodes will be controlled by this approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost. 2004;30:579–89.

    Article  CAS  PubMed  Google Scholar 

  2. Jalal DI, Chonchol M, Targher G. Disorders of hemostasis associated with chronic kidney disease. Semin Thromb Hemost. 2010;36:34–40.

    Article  CAS  PubMed  Google Scholar 

  3. Kaufman JS, O’Connor TZ, Zhang JH, Cronin RE, Fiore LD, Ganz MB, Goldfarb DS, Peduzzi PN, Veterans Affairs Cooperative Study Group on Hemodialysis Access Graft Thrombosis. Randomized controlled trial of clopidogrel plus aspirin to prevent hemodialysis access graft thrombosis. J Am Soc Nephrol. 2003;14:2313–21.

    Article  CAS  PubMed  Google Scholar 

  4. Moal V, Brunet P, Dou L, Morange S, Sampol J, Berland Y. Impaired expression of glycoproteins on resting and stimulated platelets in uraemic patients. Nephrol Dial Transplant. 2003;18:1834–41.

    Article  CAS  PubMed  Google Scholar 

  5. Pavord S, Myers B. Bleeding and thrombotic complications of kidney disease. Blood Rev. 2011;25:271–8.

    Article  PubMed  Google Scholar 

  6. Parikh AM, Spencer FA, Lessard D, Emery C, Baylin A, Linkletter C, Goldberg RJ. Venous thromboembolism in patients with reduced estimated GFR: a population-based perspective. Am J Kidney Dis. 2011;58:746–55.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dager WE, Kiser TH. Systemic anticoagulation considerations in chronic kidney disease. Adv Chronic Kidney Dis. 2010;17:420–7.

    Article  PubMed  Google Scholar 

  8. Glorieux G, Cohen G, Jankowski J, Vanholder R. Platelet/Leukocyte activation, inflammation, and uremia. Semin Dial. 2009;22:423–7.

    Article  PubMed  Google Scholar 

  9. Horowitz HI. Uremic toxins and platelet function. Arch Intern Med. 1970;126:823–6.

    Article  CAS  PubMed  Google Scholar 

  10. Horowitz HI, Stein IM, Cohen BD, White JG. Further studies on the platelet-inhibitory effect of guanidinosuccinic acid and its role in uremic bleeding. Am J Med. 1970;49:336–45.

    Article  CAS  PubMed  Google Scholar 

  11. Rabiner SF, Molinas F. The role of phenol and phenolic acids on the thrombocytopathy and defective platelet aggregation of patients with renal failure. Am J Med. 1970;49:346–51.

    Article  CAS  PubMed  Google Scholar 

  12. Remuzzi G, Livio M, Marchiaro G, Mecca G, de Gaetano G. Bleeding in renal failure: altered platelet function in chronic uraemia only partially corrected by haemodialysis. Nephron. 1978;22:347–53.

    Article  CAS  PubMed  Google Scholar 

  13. Benigni A, Boccardo P, Galbusera M, Monteagudo J, De Marco L, Remuzzi G, Ruggeri ZM. Reversible activation defect of the platelet glycoprotein IIb-IIIa complex in patients with uremia. Am J Kidney Dis. 1993;22:668–76.

    Article  CAS  PubMed  Google Scholar 

  14. Di Minno G, Martinez J, McKean ML, De La Rosa J, Burke JF, Murphy S. Platelet dysfunction in uremia. Multifaceted defect partially corrected by dialysis. Am J Med. 1985;79:552–9.

    Article  PubMed  Google Scholar 

  15. Gawaz MP, Dobos G, Spath M, Schollmeyer P, Gurland HJ, Mujais SK. Impaired function of platelet membrane glycoprotein IIb-IIIa in end-stage renal disease. J Am Soc Nephrol. 1994;5:36–46.

    CAS  PubMed  Google Scholar 

  16. Sreedhara R, Itagaki I, Lynn B, Hakim RM. Defective platelet aggregation in uremia is transiently worsened by hemodialysis. Am J Kidney Dis. 1995;25:555–63.

    Article  CAS  PubMed  Google Scholar 

  17. Remuzzi G, Marchesi D, Livio M, Cavenaghi AE, Mecca G, Donati MB, de Gaetano G. Altered platelet and vascular prostaglandin-generation in patients with renal failure and prolonged bleeding times. Thromb Res. 1978;13:1007–15.

    Article  CAS  PubMed  Google Scholar 

  18. Linthorst GE, Avis HJ, Levi M. Uremic thrombocytopathy is not about urea. J Am Soc Nephrol. 2010;21:753–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Eknoyan G, Brown 3rd CH. Biochemical abnormalities of platelets in renal failure. Evidence for decreased platelet serotonin, adenosine diphosphate and Mg-dependent adenosine triphosphatase. Am J Nephrol. 1981;1:17–23.

    Article  CAS  PubMed  Google Scholar 

  20. Smith MC, Dunn MJ. Impaired platelet thromboxane production in renal failure. Nephron. 1981;29:133–7.

    Article  CAS  PubMed  Google Scholar 

  21. Bloom A, Greaves M, Preston FE, Brown CB. Evidence against a platelet cyclooxygenase defect in uraemic subjects on chronic haemodialysis. Br J Haematol. 1986;62:143–9.

    Article  CAS  PubMed  Google Scholar 

  22. Wratten ML, Tetta C, De Smet R, Neri R, Sereni L, Camussi G, Vanholder R. Uremic ultrafiltrate inhibits platelet-activating factor synthesis. Blood Purif. 1999;17:134–41.

    Article  CAS  PubMed  Google Scholar 

  23. Thekkedath UR, Chirananthavat T, Leypoldt JK, Cheung AK, Mohammad SF. Elevated fibrinogen fragment levels in uremic plasma inhibit platelet function and expression of glycoprotein IIb-IIIa. Am J Hematol. 2006;81:915–26.

    Article  CAS  PubMed  Google Scholar 

  24. Brunini TM, Mendes-Ribeiro AC, Ellory JC, Mann GE. Platelet nitric oxide synthesis in uremia and malnutrition: a role for L-arginine supplementation in vascular protection? Cardiovasc Res. 2007;73:359–67.

    Article  CAS  PubMed  Google Scholar 

  25. Janson PA, Jubelirer SJ, Weinstein MJ, Deykin D. Treatment of the bleeding tendency in uremia with cryoprecipitate. N Engl J Med. 1980;303:1318–22.

    Article  CAS  PubMed  Google Scholar 

  26. Mannucci PM, Remuzzi G, Pusineri F, Lombardi R, Valsecchi C, Mecca G, Zimmerman TS. Deamino-8-D-arginine vasopressin shortens the bleeding time in uremia. N Engl J Med. 1983;308:8–12.

    Article  CAS  PubMed  Google Scholar 

  27. Defreyn G, Dauden MV, Machin SJ, Vermylen J. A plasma factor in uraemia which stimulates prostacyclin release from cultured endothelial cells. Thromb Res. 1980;19:695–9.

    Article  CAS  PubMed  Google Scholar 

  28. Kyrle PA, Stockenhuber F, Brenner B, Gossinger H, Korninger C, Pabinger I, Sunder-Plassmann G, Balcke P, Lechner K. Evidence for an increased generation of prostacyclin in the microvasculature and an impairment of the platelet alpha-granule release in chronic renal failure. Thromb Haemost. 1988;60:205–8.

    CAS  PubMed  Google Scholar 

  29. Fernandez F, Goudable C, Sie P, Ton-That H, Durand D, Suc JM, Boneu B. Low haematocrit and prolonged bleeding time in uraemic patients: effect of red cell transfusions. Br J Haematol. 1985;59:139–48.

    Article  CAS  PubMed  Google Scholar 

  30. Galbusera M, Remuzzi G, Boccardo P. Treatment of bleeding in dialysis patients. Semin Dial. 2009;22:279–86.

    Article  PubMed  Google Scholar 

  31. Howard AD, Moore Jr J, Welch PG, Gouge SF. Analysis of the quantitative relationship between anemia and chronic renal failure. Am J Med Sci. 1989;297:309–13.

    Article  CAS  PubMed  Google Scholar 

  32. Martin W, Villani GM, Jothianandan D, Furchgott RF. Blockade of endothelium-dependent and glyceryl trinitrate-induced relaxation of rabbit aorta by certain ferrous hemoproteins. J Pharmacol Exp Ther. 1985;233:679–85.

    CAS  PubMed  Google Scholar 

  33. Noris M, Benigni A, Boccardo P, Aiello S, Gaspari F, Todeschini M, Figliuzzi M, Remuzzi G. Enhanced nitric oxide synthesis in uremia: implications for platelet dysfunction and dialysis hypotension. Kidney Int. 1993;44:445–50.

    Article  CAS  PubMed  Google Scholar 

  34. Kaw D, Malhotra D. Platelet dysfunction and end-stage renal disease. Semin Dial. 2006;19:317–22.

    Article  PubMed  Google Scholar 

  35. Fass RJ, Copelan EA, Brandt JT, Moeschberger ML, Ashton JJ. Platelet-mediated bleeding caused by broad-spectrum penicillins. J Infect Dis. 1987;155:1242–8.

    Article  CAS  PubMed  Google Scholar 

  36. Shattil SJ, Bennett JS, McDonough M, Turnbull J. Carbenicillin and penicillin G inhibit platelet function in vitro by impairing the interaction of agonists with the platelet surface. J Clin Invest. 1980;65:329–37.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Gaspari F, Vigano G, Orisio S, Bonati M, Livio M, Remuzzi G. Aspirin prolongs bleeding time in uremia by a mechanism distinct from platelet cyclooxygenase inhibition. J Clin Invest. 1987;79:1788–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. McCabe KM, Adams MA, Holden RM. Vitamin K status in chronic kidney disease. Nutrients. 2013;5:4390–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Remuzzi G, Benigni A, Dodesini P, Schieppati A, Gotti E, Livio M, Mecca G, Donati B, de Gaetano G. Platelet function in patients on maintenance hemodialysis: depressed or enhanced? Clin Nephrol. 1982;17:60–3.

    CAS  PubMed  Google Scholar 

  40. Sirolli V, Ballone E, Di Stante S, Amoroso L, Bonomini M. Cell activation and cellular-cellular interactions during hemodialysis: effect of dialyzer membrane. Int J Artif Organs. 2002;25:529–37.

    CAS  PubMed  Google Scholar 

  41. Salvati F, Liani M. Role of platelet surface receptor abnormalities in the bleeding and thrombotic diathesis of uremic patients on hemodialysis and peritoneal dialysis. Int J Artif Organs. 2001;24:131–5.

    CAS  PubMed  Google Scholar 

  42. Lindsay RM, Friesen M, Koens F, Linton AL, Oreopoulos D, de Veber G. Platelet function in patients on long term peritoneal dialysis. Clin Nephrol. 1976;6:335–9.

    CAS  PubMed  Google Scholar 

  43. Nenci GG, Berrettini M, Agnelli G, Parise P, Buoncristiani U, Ballatori E. Effect of peritoneal dialysis, haemodialysis and kidney transplantation on blood platelet function. I. Platelet aggregation by ADP and epinephrine. Nephron. 1979;23:287–92.

    Article  CAS  PubMed  Google Scholar 

  44. Hedges SJ, Dehoney SB, Hooper JS, Amanzadeh J, Busti AJ. Evidence-based treatment recommendations for uremic bleeding. Nat Clin Pract Nephrol. 2007;3:138–53.

    Article  CAS  PubMed  Google Scholar 

  45. Cardigan RA, McGloin H, Mackie IJ, Machin SJ, Singer M. Activation of the tissue factor pathway occurs during continuous venovenous hemofiltration. Kidney Int. 1999;55:1568–74.

    Article  CAS  PubMed  Google Scholar 

  46. Pawlak K, Pawlak D, Mysliwiec M. Association between tissue factor, its pathway inhibitor and oxidative stress in peritoneal dialysis patients. Blood Coagul Fibrinolysis. 2007;18:467–71.

    Article  CAS  PubMed  Google Scholar 

  47. Livio M, Gotti E, Marchesi D, Mecca G, Remuzzi G, de Gaetano G. Uraemic bleeding: role of anaemia and beneficial effect of red cell transfusions. Lancet. 1982;2:1013–5.

    Article  CAS  PubMed  Google Scholar 

  48. Moia M, Mannucci PM, Vizzotto L, Casati S, Cattaneo M, Ponticelli C. Improvement in the haemostatic defect of uraemia after treatment with recombinant human erythropoietin. Lancet. 1987;2:1227–9.

    Article  CAS  PubMed  Google Scholar 

  49. Vigano G, Benigni A, Mendogni D, Mingardi G, Mecca G, Remuzzi G. Recombinant human erythropoietin to correct uremic bleeding. Am J Kidney Dis. 1991;18:44–9.

    Article  CAS  PubMed  Google Scholar 

  50. Cases A, Escolar G, Reverter JC, Ordinas A, Lopez-Pedret J, Revert L, Castillo R. Recombinant human erythropoietin treatment improves platelet function in uremic patients. Kidney Int. 1992;42:668–72.

    Article  CAS  PubMed  Google Scholar 

  51. Zwaginga JJ, Ijsseldijk MJ, de Groot PG, Kooistra M, Vos J, van Es A, Koomans HA, Struyvenberg A, Sixma JJ. Treatment of uremic anemia with recombinant erythropoietin also reduces the defects in platelet adhesion and aggregation caused by uremic plasma. Thromb Haemost. 1991;66:638–47.

    CAS  PubMed  Google Scholar 

  52. Peng J, Friese P, Heilmann E, George JN, Burstein SA, Dale GL. Aged platelets have an impaired response to thrombin as quantitated by P-selectin expression. Blood. 1994;83:161–6.

    CAS  PubMed  Google Scholar 

  53. Tassies D, Reverter JC, Cases A, Calls J, Escolar G, Ordinas A. Effect of recombinant human erythropoietin treatment on circulating reticulated platelets in uremic patients: association with early improvement in platelet function. Am J Hematol. 1998;59:105–9.

    Article  CAS  PubMed  Google Scholar 

  54. Diaz-Ricart M, Etebanell E, Cases A, Lopez-Pedret J, Castillo R, Ordinas A, Escolar G. Erythropoietin improves signaling through tyrosine phosphorylation in platelets from uremic patients. Thromb Haemost. 1999;82:1312–7.

    CAS  PubMed  Google Scholar 

  55. Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, Schwab SJ, Goodkin DA. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med. 1998;339:584–90.

    Article  CAS  PubMed  Google Scholar 

  56. Lee HK, Kim YJ, Jeong JU, Park JS, Chi HS, Kim SB. Desmopressin improves platelet dysfunction measured by in vitro closure time in uremic patients. Nephron Clin Pract. 2010;114:c248–52.

    Article  CAS  PubMed  Google Scholar 

  57. Vigano GL, Mannucci PM, Lattuada A, Harris A, Remuzzi G. Subcutaneous desmopressin (DDAVP) shortens the bleeding time in uremia. Am J Hematol. 1989;31:32–5.

    Article  CAS  PubMed  Google Scholar 

  58. Kim JH, Baek CH, Min JY, Kim JS, Kim SB, Kim H. Desmopressin improves platelet function in uremic patients taking antiplatelet agents who require emergent invasive procedures. Ann Hematol. 2015;94:1457–61.

    Article  CAS  PubMed  Google Scholar 

  59. Franchini M. The use of desmopressin as a hemostatic agent: a concise review. Am J Hematol. 2007;82:731–5.

    Article  CAS  PubMed  Google Scholar 

  60. Horl WH. Thrombocytopathy and blood complications in uremia. Wien Klin Wochenschr. 2006;118:134–50.

    Article  PubMed  Google Scholar 

  61. Zeigler ZR, Megaludis A, Fraley DS. Desmopressin (d-DAVP) effects on platelet rheology and von Willebrand factor activities in uremia. Am J Hematol. 1992;39:90–5.

    Article  CAS  PubMed  Google Scholar 

  62. Kohler M, Hellstern P, Tarrach H, Bambauer R, Wenzel E, Jutzler GA. Subcutaneous injection of desmopressin (DDAVP): evaluation of a new, more concentrated preparation. Haemostasis. 1989;19:38–44.

    CAS  PubMed  Google Scholar 

  63. Watson AJ, Keogh JA. Effect of 1-deamino-8-D-arginine vasopressin on the prolonged bleeding time in chronic renal failure. Nephron. 1982;32:49–52.

    Article  CAS  PubMed  Google Scholar 

  64. Heunisch C, Resnick DJ, Vitello JM, Martin SJ. Conjugated estrogens for the management of gastrointestinal bleeding secondary to uremia of acute renal failure. Pharmacotherapy. 1998;18:210–7.

    CAS  PubMed  Google Scholar 

  65. Liu YK, Kosfeld RE, Marcum SG. Treatment of uraemic bleeding with conjugated oestrogen. Lancet. 1984;2:887–90.

    Article  CAS  PubMed  Google Scholar 

  66. Livio M, Mannucci PM, Vigano G, Mingardi G, Lombardi R, Mecca G, Remuzzi G. Conjugated estrogens for the management of bleeding associated with renal failure. N Engl J Med. 1986;315:731–5.

    Article  CAS  PubMed  Google Scholar 

  67. Vigano G, Gaspari F, Locatelli M, Pusineri F, Bonati M, Remuzzi G. Dose-effect and pharmacokinetics of estrogens given to correct bleeding time in uremia. Kidney Int. 1988;34:853–8.

    Article  CAS  PubMed  Google Scholar 

  68. Zoja C, Vigano G, Bergamelli A, Benigni A, de Gaetano G, Remuzzi G. Prolonged bleeding time and increased vascular prostacyclin in rats with chronic renal failure: effects of conjugated estrogens. J Lab Clin Med. 1988;112:380–6.

    CAS  PubMed  Google Scholar 

  69. Heistinger M, Stockenhuber F, Schneider B, Pabinger I, Brenner B, Wagner B, Balcke P, Lechner K, Kyrle PA. Effect of conjugated estrogens on platelet function and prostacyclin generation in CRF. Kidney Int. 1990;38:1181–6.

    Article  CAS  PubMed  Google Scholar 

  70. Shemin D, Elnour M, Amarantes B, Abuelo JG, Chazan JA. Oral estrogens decrease bleeding time and improve clinical bleeding in patients with renal failure. Am J Med. 1990;89:436–40.

    Article  CAS  PubMed  Google Scholar 

  71. Sloand JA, Schiff MJ. Beneficial effect of low-dose transdermal estrogen on bleeding time and clinical bleeding in uremia. Am J Kidney Dis. 1995;26:22–6.

    Article  CAS  PubMed  Google Scholar 

  72. Ross CS, Pruthi RK, Schmidt KA, Eckerman AL, Rodriguez V. Intranasal oestrogen cream for the prevention of epistaxis in patients with bleeding disorders. Haemophilia. 2011;17:164.

    Article  CAS  PubMed  Google Scholar 

  73. Remuzzi G, Perico N, Zoja C, Corna D, Macconi D, Vigano G. Role of endothelium-derived nitric oxide in the bleeding tendency of uremia. J Clin Invest. 1990;86:1768–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Noris M, Todeschini M, Zappella S, Bonazzola S, Zoja C, Corna D, Gaspari F, Marchetti G, Aiello S, Remuzzi G. 17beta-estradiol corrects hemostasis in uremic rats by limiting vascular expression of nitric oxide synthases. Am J Physiol Renal Physiol. 2000;279:F626–35.

    CAS  PubMed  Google Scholar 

  75. Triulzi DJ, Blumberg N. Variability in response to cryoprecipitate treatment for hemostatic defects in uremia. Yale J Biol Med. 1990;63:1–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  76. Pantanowitz L, Kruskall MS, Uhl L. Cryoprecipitate. Patterns of use. Am J Clin Pathol. 2003;119:874–81.

    Article  PubMed  Google Scholar 

  77. Gielen-Wijffels SE, van Mook WN, van der Geest S, Ramsay G. Successful treatment of severe bleeding with recombinant factor VIIa after kidney transplantation. Intensive Care Med. 2004;30:1232–4.

    Article  CAS  PubMed  Google Scholar 

  78. Moisescu E, Ardelean L, Simion I, Muresan A, Ciupan R. Recombinant factor VIIa treatment of bleeding associated with acute renal failure. Blood Coagul Fibrinolysis. 2000;11:575–7.

    Article  CAS  PubMed  Google Scholar 

  79. Ng HJ, Koh LP, Lee LH. Successful control of postsurgical bleeding by recombinant factor VIIa in a renal failure patient given low molecular weight heparin and aspirin. Ann Hematol. 2003;82:257–8.

    CAS  PubMed  Google Scholar 

  80. Revesz T, Arets B, Bierings M, van den Bos C, Duval E. Recombinant factor VIIa in severe uremic bleeding. Thromb Haemost. 1998;80:353.

    CAS  PubMed  Google Scholar 

  81. Maksimovic B, Neretljak I, Vidas Z, Vojtusek IK, Tomulic K, Knotek M. Treatment of bleeding after kidney biopsy with recombinant activated factor VII. Blood Coagul Fibrinolysis. 2012;23:241–3.

    Article  PubMed  Google Scholar 

  82. Sabovic M, Zupan IP, Salobir B, Zupan I, Cernelc P, Lavre J, Vujkovac B. The effect of long-term, low-dose tranexamic acid treatment on platelet dysfunction and haemoglobin levels in haemodialysis patients. Thromb Haemost. 2005;94:1245–50.

    CAS  PubMed  Google Scholar 

  83. Sabovic M, Lavre J, Vujkovac B. Tranexamic acid is beneficial as adjunctive therapy in treating major upper gastrointestinal bleeding in dialysis patients. Nephrol Dial Transplant. 2003;18:1388–91.

    Article  CAS  PubMed  Google Scholar 

  84. Vujkovac B, Lavre J, Sabovic M. Successful treatment of bleeding from colonic angiodysplasias with tranexamic acid in a hemodialysis patient. Am J Kidney Dis. 1998;31:536–8.

    Article  CAS  PubMed  Google Scholar 

  85. Vujkovac B, Sabovic M. Treatment of subdural and intracerebral haematomas in a haemodialysis patient with tranexamic acid. Nephrol Dial Transplant. 2000;15:107–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Nephrology, I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Jens Lutz

  2. Division of Nephrology, Department of Medicine, Universitätsmedizin der Johannes-Gutenberg University Mainz, Mainz, Rhineland-Palatinate, Germany

    Julia Weinmann-Menke

Authors
  1. Jens Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julia Weinmann-Menke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jens Lutz .

Editor information

Editors and Affiliations

  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine Division of Transfusion Medicine & Coagulation Texas Children’s Hospital, Houston, Texas, USA

    Jun Teruya

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Lutz, J., Weinmann-Menke, J. (2016). Bleeding in Uremia. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30726-8_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation