A person with end-stage liver disease may have a number of hemostatic defects. These need to be taken into account prior to surgery, including liver transplantation.
Defects underlying the coagulation defects:
(1) nutritional deficiencies
(2) portal hypertension
(3) failure in hepatocellular function (synthetic and elimination/excretion)
(4) medications
(5) effects of underlying cause for hepatic injury (toxic, infectious, metabolic)
Problem
Defect
acquired platelet dysfunction
medications, fibrin split products
thrombocytopenia
splenomegaly associated with portal hypertension, hypoplastic marrow, DIC
multiple factor deficiencies
vitamin K deficiency, failure of hepatic synthesis, DIC
dysfibrinogenemia
defective hepatic synthesis
vascular fragility, impaired healing
vitamin C deficiency (scurvy), protein malnutrition
increased fibrinolysis
decreased synthesis of antiplasmin, decreased clearance of tissue plasminogen activator
thrombosis
decreased antithrombn III, decreased protein S and C associated with vitamin K deficiency
DIC
infection
dilutional effects
ongoing bleeding with inadequate replacement
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