Already before the start of a haemodialysis session patients have a low normal platelet count and a reduced staining density of the platelet granule content. Also, platelet surface expression of p-selectin is absent. Results may reflect impaired megakaryopoiesis. The chronic depletion of granule content is most likely due to repeated platelet activation during the haemodialysis treatment. After a haemodialysis session a slight decrease in PLT count is observed, which is probably a result from adherence to the dialyzer membrane and a decreased influx from the storage pools.
Prior to a haemodialysis session patients already reveal an activated coagulation system. During a session, extensive activation of the coagulation system is observed in spite of the anticoagulant regime and the relative bio-compatibility of the dialyzer membranes. Activation of the coagulation system seems to be especially initiated via the factor XII dependent pathway. Some evidence of an impaired integrity of the endothelium was obtained.
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