Hemostatic Abnormalities in Patients with Liver Disease PDF

Hemostatic Abnormalities In Patients With Liver Disease Presented By Dr. Huda Ayad Mohammed Hematopathology Board Resident Doctor Supervised By Professor Dr. Israa Mohammed Baqer AL-Bayaa Consu...

Hemostatic Abnormalities In Patients With Liver Disease Presented By Dr. Huda Ayad Mohammed Hematopathology Board Resident Doctor Supervised By Professor Dr. Israa Mohammed Baqer AL-Bayaa Consultant Hematopathologist / Department Of Pathology University Of Karbalaa / Collage Of Medicine  Objectives Overview of Liver’s Roll In Hemostasis Hemostatic Alterations In Chronic Liver Disease A Rebalanced Hemostatic System In Chronic Liver Disease Routine Tests of Hemostasis In Patients With Severe Liver Disease Pros And Cons of Global Hemostasis Tests In Patients With Severe Liver Disease Case Scenario  CASE A patient with chronic liver disease related to alcohol abuse is hospitalized for acute decompensation with massive ascites. The patient has severe liver disease, evidenced by a model of end-stage liver disease score of 20 and a Child-Pugh score C10. A paracentesis is scheduled, but the treating physician is concerned about the patient’s coagulopathy with an international normalized ratio of 1.8, a plasma fibrinogen level of 1.4 g/L, and a platelet count of 61000/μL. Child – Turcotte – Pugh Score Overview of Liver’s Roll In Hemostasis  Overview Of Liver’s Roll In Hemostasis The liver plays a central role in the hemostatic system. 1. Liver parenchymal cells are the site of synthesis of: Most coagulation factors (except factor VIII [FVIII]). The natural inhibitors of coagulation, including protein C, protein S, and antithrombin. Essential components of the fibrinolytic system, such as plasminogen, α2-antiplasmin, and thrombin activatable fibrinolysis inhibitor (TAFI).  Overview Of Liver’s Roll In Hemostasis 2. The liver also regulates hemostasis and fibrinolysis by clearing activated coagulation factors and coagulation factor–inhibitor complexes from the circulation. 3. In addition, changes in primary hemostasis mediated by platelets, von Willebrand factor (vWF), and a disintegrin-like and metalloprotease with thrombospondin type 1 motif, member 13 (ADAMTS13) may occur. Therefore, if acute or chronic liver dysfunction is present in patients with liver disease, complicated hemostatic derangement may occur, which can lead to bleeding, thrombosis, or neither bleeding nor thrombosis. Hemostatic Alterations In Chronic Liver Disease  Primary Hemostasis More than 75% of patients with chronic liver disease, especially in moderate to severe cirrhosis (Child B and C), have reduced platelet counts (