new_n_lost
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A 65-year-old woman on hemodialysis for chronic renal failure requires an urgent dental extraction for an abscessed tooth. Of the following, the most appropriate agent to administer to reduce the risk of significant bleeding would be
A) desmopressin
B) conjugated estrogen
C) erythropoietin
D) fresh-frozen plasma
E) -Aminocaproic acid
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| Ancylostoma
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I think its Aminocaproic acid. E
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| Luckyall
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A ? desmopressin
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| new_n_lost
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Explain Ur Answers PLZ
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| epica
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Desmopressin-induced improvement in bleeding times in chronic renal failure patients
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| me007
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it is desmopressin for sure, but why - there is a question
in chronic renal failure there are
1. mild anemia due to erithropietin deficiency
2. platelet disorder - qualitative, platelet phospholipid inhibited (by toxic something -?)
that platelet disorder reversed with desmopressin acetate and birth control pills.
What is the mechanism, does anyboody know?
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| new_n_lost
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A is correct
Chronic uremia produces a complex abnormality of hemostasis, but patients generally have a prolonged bleeding time due to abnormal platelet function. Desmopressin given before the planned dental extraction is a reasonably safe and rapid way to decrease the risk of bleeding.
Both conjugated estrogens and erythropoietin can also reduce the risk of bleeding in patients with uremia undergoing surgical procedures. However, since the effect is delayed, they would not be appropriate in an acute setting.
The use of fresh-frozen plasma will not ameliorate prolongation of the bleeding time.
The use of the fibrinolysis inhibitor -aminocaproic acid may have some utility in primary mennorhagia, genitourinary tract bleeding after prostate surgery, mild hemophilia, or profound thrombocytopenia or to reduce blood loss after cardiac or joint surgery.
Edited by new_n_lost on 03/09/07 - 09:54 PM
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| new_n_lost
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Desmopressin is a synthetic analog of the natural human hormone arginine vasopressin (antidiuretic hormone), which is produced by the posterior pituitary gland. Desmopressin elicits a greater antidiuretic response, on a weight basis, than does arginine vasopressin; it also causes a dose-dependent increase in plasma factor VIII (antihemophilic factor) activity.
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| new_n_lost
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Normochromic normocytic anemia principally develops from decreased renal synthesis of erythropoietin, the hormone responsible for bone marrow stimulation for red blood cell (RBC) production. It becomes more severe as GFR progressively decreases with the availability of less viable renal mass. No reticulocyte response occurs. RBC survival is decreased, and tendency of bleeding is increased from the uremia-induced platelet dysfunction.
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| new_n_lost
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Bleeding time is generally very prolonged in patients with uremia, signifying a major defect in platelet function, which improves after dialysis. A number of dialyzable platelet-inhibitory factors have been shown to inhibit platelet function. Furthermore, uremic platelets synthesize less thromboxane A2, and the blood vessels taken from patients with uremia produce greater quantities of platelet-inhibitory prostaglandin. Nitric oxide produced by the endothelial cells inhibits platelet function. Because the prolonged bleeding time and the hemostatic abnormalities are partly corrected by red blood cell transfusion or erythropoietin therapy, the failure of hemoglobin to quench excess nitric oxide synthesis has been suggested as partly responsible for the platelet dysfunction.
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| epica
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Let me add more explanation.
Why not Aminocaproic acid?
This acid helps achieve hemostasis when FIBRINOLYSIS is the cause of bleeding
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