Use of cryoprecipitate in uremic bleeding

Q: Which of the following can be used in bleeding suspected secondary to uremia?

A) Dialysis 
 B) Desmopressin (DDAVP) 
 C) Estrogen 
D) Cryoprecipitate 
 E) All of the above 


 Answer: E

Objective of above question is to highlight the role of Cryoprecipitate in uremic bleeding. Dialysis, Estrogen, DDAVP and correction of anemia are known to help in uremic bleeding. Use of cryoprecipitate in this regard is less well known. It may be a very useful information in post surgical patients with baseline renal insufficiency, who remain unresponsive to DDAVP. It can start it's effect within one hour of infusion to shorten the bleeding time. Exact mechanism of action is not known but it is suspected that cryoprecipitate carries substances that enhance platelet aggregation, such as factor VIII:von Willebrand factor multimers or fibrinogen. 


Reference:

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