A 60-year-old man with advanced chronic kidney disease requires a renal biopsy. Bleeding time is markedly prolonged although platelet count is 180,000 per microliter and PT and aPTT are normal. Which agent given before the procedure shortens the bleeding time?
- A Fresh frozen plasma
- B Tranexamic acid
- C Desmopressin acetate ✓
- D Conjugated estrogen given intravenously over 5 days
Correct answer: C. Desmopressin acetate
Explanation
Uremic platelet dysfunction involves defective release of vWF and impaired GPIb and GPIIb/IIIa mediated adhesion and aggregation, producing a prolonged bleeding time with a normal platelet count. Desmopressin raises plasma vWF and factor VIII levels rapidly through endothelial release and corrects the bleeding time within 1 to 2 hours, making it the standard agent before invasive procedures in uremia. Conjugated estrogens also help but act slowly over days. Tranexamic acid is an adjunct for mucosal bleeding, not a bleeding-time corrector.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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