Читать книгу Emergency Medical Services - Группа авторов - Страница 483

Patients with kidney disease are often anemic. Their red blood cell counts tend to be low, with hemoglobin usually less than 10 g/dL upon starting dialysis [1]. The cause is multifactorial and includes renal undersecretion of erythropoietin, a hormone responsible for red blood cell production [4].

Uremic bleeding is also thought to be multifactorial, though primarily due to platelet dysfunction. The resulting prolonged bleeding time can cause complications in the trauma setting and with routine access of fistulas and grafts during hemodialysis, prompting activation of the EMS system for potentially life‐threatening hemorrhage [21]. When presented with a bleeding dialysis patient, the EMS clinician may need to be more aggressive than usual with regard to direct pressure, hemostatic agents, and tourniquet application.