Uraemic Platelet Dysfunction — ORE Part 1 MCQ

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HardHuman Disease & Dental ManagementUraemic Platelet DysfunctionORE Part 1

A patient with severe chronic kidney disease (eGFR 12 mL/min/1.73 m²) is clinically uraemic and has a platelet count of 95 × 10⁹/L. They require an emergency dental extraction. Which haemostatic abnormality is the principal concern?

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Correct answer: C — Qualitative platelet dysfunction associated with uraemia

Explanation lettering: E = shown as A · D = shown as B · A = shown as C · C = shown as D · B = shown as E

A is correct. Uraemia causes a qualitative defect of primary haemostasis: platelet adhesion and aggregation are impaired, producing a procedural bleeding tendency even when platelets are present. The count of 95 × 10⁹/L is mildly low and may add to risk, but it is not the characteristic principal mechanism signalled by clinical uraemia. Warfarin-related bleeding would require anticoagulant exposure and an elevated INR, neither of which is stated. Factor VIII deficiency is haemophilia and is not caused by CKD. Von Willebrand factor deficiency is also not the usual explanation for uraemic bleeding; studies describe defective platelet function in uraemia, with factor VIII activity normal and von Willebrand-related measures often elevated. In practice, an emergency extraction in this patient warrants liaison with the renal/medical team and robust local haemostatic measures.

Reference: Baaten CFMJ, et al. Platelet Function in CKD: A Systematic Review and Meta-Analysis. Journal of the American Society of Nephrology, 2021. https://pubmed.ncbi.nlm.nih.gov/33941607/