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Abstract This study was done on twenty patients suffering from chronic renal failure with bleeding tendency. They were divided into two groups : (1) Group (A) of patients to whom D.D.A.V.P (Minirin) was given by intranasal inhalation in a dose of 0.1 ml of the solution. (2) Group (B) of patients to whom D.D.A.V.P {Minirin) was given by intravenous infusion in a dose of 0.4 ug/kg body weight in 20 ml saline over 20 - 30 min. All cases were clinically examined and investigated by estimation of : blood urea, serum creatinine, platelet count, platelet aggregation and bleeding time before and 90 minutes after D.D.A.V.P (Minirin) inhalation and/or infusion. Our results were summarized as follows (I) Group (A) of Patients to Whom D.D.A.V.P was Given by Inhalation : 1, Blood urea level ranged from 112 to 300 mgm/dl with a mean value of 186.8 mgm/dl and ±S.D of 55.02 • Serum creatinine level ranged from 2.5 to 17.7 mgm/dl with a mean value of 4.43 mgm/dl and±S.D of 4.67. 3. Bleeding time estimated before D.D.A.V.P inhalation was found to range from 6 to 14 minutes with a mean value of 9.5 minutes and ±S.D of 2.8, as compared with the same group 90 minutes post D.D.A.V.P. inhalation which ranged from 4 to 11 minutes with a mean value of 6.8 and±S.D of 2.57 The mean difference of bleeding time before and 90 minutes after D.D.A.V.P inhalation was found to be- 2.7 and ±S.D of the difference was 0.8232 • S.E of the difference was 0.26 • 4. Platelet count estimated before D.D.A.V.P inhalation was found to range from 190 X 10• to 380 X 10 3 /cmm blood with a mean value of 280 X 10 3 /cmm blood and ±S.D 54.49 as compared with the same group 90 minutes after D.D.A.V.P inhalation which ranged from 198 X 10• to 365 X 103 /cmm blood with a mean value of 277.9 X 10’/ cmm blood and ±S.D of 58.56 The mean difference of platelet count before and 90 minutes after D.D.A.V.P inhalation was found to be 3 ±S.D of the difference was 39.288 and S.E of the difference was 12.424 • 5. Platelet aggregation estimated before D.D.A.V.P inhalation was found to range from 70 to 91.1 % with a mean value of 77.3 %, and tS.D 9.57, as compared with the same group 90 minutes post D.D.A.V.P inhalation which ranged from 64 to 85.6 %, with a mean value of 77.27% andtS.D of 6.28 . The mean difference of platelet aggregation before and 90 minutes after D.D.A.V.P inhalation was found to be - 2.73 and tS.D of the difference was found to be 9.593 and S.E of the difference was 3,033. (II) Group {B) of Patients to Whom D.D.A.V.P {Minirin) was Given by Intravenous Infusion : 1. Blood urea level ranged from 150 to 290 mgm/dl with a mean value of 198.9 mgm/dl and ±S,D of 52.99 • 2. Serum Creatinine level ranged from 2.5 to 11 mgm/dl with a mean value of 4.8 mgm/dl and ±S.D of 2.65 • 3. Bleeding time estimated before D.D.A.V.P infusion was found to range from 7 to 16 minutes with a mean value of 9,9 minutes and S.D of 2.998, as compared with the same group 90 minutes post D.D.A.V.P infusion which ranged from 4 to 10 minutes with a mean value of 5.9 minutes and ±S.D of 2. 08 • The mean difference of bleeding time before and 90 minutes after D.D.A.V.P infusion was found to be - 4 and ±S.D of the difference was 1.633 • The S.E of the difference was 0.516 . 4. Platelet count estimated before D.D.A.V.P infusion was found to range from ll4 X 10 3 to 347 X 103 /cmm blood with a mean value of 240.6 X 103 /cmm blood and ±S.D of 69.45, as compared with the same group 90 minutes after D.D.A.V.P infusion which ranged from 112 X 103 to 412 X 103 /cmm blood with .a mean value of 270 X 10 3 /crnm blood and±S.D of 100.61. The mean difference of platelet count before and 90 minutes after D.D.A.V.P infusion was found to be 19.4 and±S.D of the difference was 41.258 difference was 13.047 • S.E of the 5. Platelet aggregation estimated before D.D.A.V.P infusion was found to range from 45 to 92.6 % with a mean value of 72.66 % and±S.D of 12.86, as compared with the same group 90 minutes after D.D.A.V.P infusion which ranged from 49.1 to 91.1 %with a mean value of 75.33 % and ±S,Dof 14.27 The mean difference of platelet aggregation before and 67 90 minutes after D.D.A.V.P infusion was found to be 4.47 and±S.D of the difference was 5.999 • The S.E of the difference was 1.897 . In comparison between the differences of bleeding times for inhalation and infusion, t-test was found 2.878, p < 0.01) = 2.101, P < 0.05] = 4.165 from these results we concluded that {I) Group (A) of Patients, i.e, Inhalation Group 1. There is a statistically significant shortening (P < 0.01) of the bleeding time 90 minutes after D.D.A.V.P inhalation, as compared with the same group before inhalation. 2. There is a statistically insignificant increase in platelet count (P < 0.01} 90 minutes after D.D.A.V.P inhalation, as compared with the same group before inhalation. 3. There is a statistically insignificant decrease in platelet aggregation (P < 0.01} 90 minutes after D.D.A.V.P inhalation as compared with the same group before inhalation. (II) Group (B) of Patients, i.e, Infusion Group 1. There is a statistically significant shortening (P < 0.01) of the bleeding time 90 minutes post D.D.A.V.P infusion, as compared with the same group in the preinfusion state. 2. There is a statistically insignificant increase (p < 0.01) of platelet count 90 minutes post D.D.A.V.P infusion, as compared with the same group in the preinfusion state. 3. There is a statistically significant increase (P < 0.05) of platelet aggregation 90 minutes post D.D.A.V.P infusion, as compared with the same group in the preinfusion state. Comparatively, there is a statistically significant shortening (P < 0.01) of the bleeding time in group (B) of patients to whom D.D.A.V.P was given intravenously as compared with group (A) of patients who had been given the drug intranasally. from these results we concluded that D.D.A.V.P shortens the bleeding time in chronic uremic patients with bleeding tendency by enhancing platelet aggregation while platelet count increased when the drug was given to these patients insignificantly. Nevertheless, these results showed that the bleeding time in those patients was found to be shortened when D.D.A.V.P was given by intravenous infusion rather than been given by intranasal inhalation. This accounts for the beneficial effect of D.D.A.V.P in shortening of the bleeding time in chronic uremic patients with bleeding tendency, especially when it is given to those patients by intravenous infusion as it increases the platelet aggregation, a process that participates in shortening of the abnormally increased bleeding time in those patients. |