A 60-year-old patient with chronic kidney disease (GFR 18 mL/min) has prolonged bleeding time and mucocutaneous bleeding. Platelet count, PT, aPTT, and fibrinogen are all normal. Platelet aggregation shows decreased response to ADP and collagen. Which agent is most appropriate to improve hemostasis before a renal biopsy?
- A Vitamin K
- B Desmopressin (DDAVP) ✓
- C Cryoprecipitate
- D Recombinant factor VIIa
Correct answer: B. Desmopressin (DDAVP)
Explanation
Uremia causes platelet dysfunction due to accumulation of guanidinosuccinic acid and other toxins that impair platelet aggregation. Desmopressin releases endothelial von Willebrand factor stores, improving platelet adhesion and shortening bleeding time within 1-2 hours. It is the first-line agent for uremic bleeding. Vitamin K is unnecessary with normal PT; cryoprecipitate is for fibrinogen deficiency.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.