On Coagulation and Fibrinolysis in Uraemic Patients on Maintenance Haemodialysis

Twenty cases of chronic uraemia, on maintenance haemodialysis, have been examined in respect of their coagulation and fibrinolytic status immediately before, 18 and 42 hours after a routine haemodialysis (mean duration 6.4 hours). In two of the cases the same determinations were made also after a prolonged (10 hours) dialysis. The examinations before dialysis showed, as in conservatively treated cases, a prolonged Ivy bleeding time, increased content of factor VIII, P & P and fibrinogen, low fibrinolytic activity and increased content of inhibitors of plasminogen activation in high frequency. After dialysis one fourth of the cases showed transient shortening of the bleeding time, and about half of the cases an increase of factor VIII, fibrinogen and inhibitors of plasminogen activation, while the low fibrinolytic activity remained unchanged. The platelet adhesiveness, which was primarily low in five cases, increased in four. In both of the two cases treated with dialysis for 10 hours the Ivy bleeding time was normal 18 hours after dialysis. It is concluded that the presence of haemorrhagic diathesis in uraemia indicates an intensification of treatment with haemodialysis and that the tendency to clotting in certain cases with an external shunt is probably due largely to local endothelial damage, with release of thromboplastic substances, in combination with the generally low fibrinolytic activity in uraemia.