اختلال عملکرد پلاکت در بیماران مبتلا به بیماری مرحله پایانی کلیه (مطالعه مروری)

نوع مقاله : مقالات کوتاه

نویسندگان
سید سیف اله بلادی موسوی
محمد فرامرزی
عباس علی زراعتی
فرشته ممدوحی
چکیده
زمینه و هدف

اختلال عملکرد پلاکت یکی از عوامل عمده خونریزی در مبتلایان به بیماری مرحله انتهایی کلیه ( ESRD ) می باشد. این پژوهش بعضی از مقالات چاپ شده درباره تظاهرات آزمایشگاهی و کلینیکی، پاتوژنز و درمان اختلال عملکرد پلاکتی در این گروه را خلاصه نموده است.

مواد و روش ها

برای جمع آوری اطلاعات، بررسی های زیادی در منابع متعدد همچون PubMed و Scopus با کلمات کلیدی شامل اختلال عملکرد پلاکت، خونریزی و ESRD انجام شد. مطالعه حاضر مقالات چاپ شده در زبان های انگلیسی و فارسی بصورت مقاله کامل را شامل می شود.

یافته ها

علل اختلال در عملکرد پلاکت در بیماران مرحله انتهایی کلیه چند عاملی بوده و شامل آنمی، تجمع توکسین های اورمی، اختلال عملکرد فاکتور ون ویلبرند، افزایش تولید پروستاسیکلین و نیتریک اکساید که مهار کننده های پلاکتی هستند می باشد. اگر چه در بیماران بدون خونریزی نیاز به درمان اختصاصی وجود ندارد، با این وجود اصلاح اختلال عملکرد پلاکت در بیمارانی که مبتلا به خونریزی فعال هستند و یا کاندید بیوپسی کلیه یا کبد می باشند، منطقی است. اقدامات درمانی شامل اصلاح آنمی، انجام دیالیز، تجویز دسموپرسین که باعث افزایش آزادسازی فاکتور 8 و مولتی مرهای فاکتور ون ویلبراند از سلول های اندوتلیال می شود، کرایوپرسیپتیت و استروژن کونژوگه می باشد.

نتیجه گیری

خونریزی شدید ممکن است در بیماران اورمیک به دنبال آسیب و پروسیجرهای تهاجمی و غیرتهاجمی اتفاق بیافتد و بنابراین باید در این گروه درمان مناسب انجام شود.



* نویسنده مسئول: دانشگاه علوم پزشکی مشهد، مرکز تحقیقات عوارض پیوند کلیه.

پست الکترونیک: Zeraatia@mums.ac.ir
کلیدواژه‌ها
اختلال عملکرد پلاکت
بیماری مرحله انتهایی کلیه
خونریزی

عنوان مقاله English

Platelet Dysfunction among Patients with End Stage Renal Diseases (Review Article)

نویسندگان English

Seyed Seifollah Beladi Mousavi
Mohammad Faramarzi
Abas Ali Zeraati
Fereshteh Mamdouhi
چکیده English

Introduction and Aims

Platelet dysfunction is a major determinant of bleeding among patients with end stage renal disease (ESRD). The present article has summarized some of published articles about clinical and laboratory manifestations, pathogenesis and treatment of platelet dysfunction among these patients.

Materials and Methods

Collecting current data, many studies have reviewed with key words of platelet dysfunction, bleeding and ESRD in a variety of sources such as PubMed, Scopus, and etc. Manuscripts published in English and Persian languages as full-text articles were included in our study.

Results

The causes of platelet impairment among patients with ESRD are multifactorial and include anemia, accumulation of uremic toxins, von willebrand factor dysfunction and increase synthesis of prosthacyclin and nitric oxide which are platelet inhibitor. Although specific therapy is not required in patients without bleeding, however correction of platelet dysfunction is desirable among patients with active bleeding or patients who candidate for kidney or liver biopsy. Treatment options include correction of anemia, dialysis, administration of desmopressin which increase release of VIII factor and von willebrand factor multimers from endothelial cells, cryoprecipitate and conjugated estrogens.

Conclusion

Excessive bleeding may occur among uremic patients in response to injury or invasive and noninvasive procedures and therefore appropriate treatment should be performed among these patients.



* Corresponding Author: Mashhad University of Medical Sciences, Kidney Transplantation Complications Research Center.

Email: Zeraatia@mums.ac.ir

کلیدواژه‌ها English

Platelet Dysfunction
End Stage Renal Disease
Bleeding
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