The underlying mechanisms may involve impaired platelet function and platelet endothelial interaction,22 among a number of other factors, including abnormalities in coagulation and fibrinolysis, inflammation and oxidative stress, reduced nitric oxide synthesis, inadequate erythropoietin production, anemia, uremic toxin accumulation and malnutrition, among others, which have also been suggested as causes of excessive blood transfusion in patients undergoing surgery for chronic kidney disease.22, 23, 24. This evidence concerns the gene EPO and nutritional deficiency disease.