Patients with severe liver disease may bleed for a variety of reasons. Careful use of blood products and drugs can often control the bleeding in most patients.
Hemostatic problems in patients with severe liver disease:
(1) prolongation of the PT and PTT (due to vitamin K deficiency, failure of hepatic synthesis, hypofibrinogenemia, DIC)
(2) hypofibrinogenemia (dysfibrinogenemia. DIC)
(3) thrombocytopenia (sequestration in spleen, DIC, sepsis, decreased production from bone marrow)
(4) platelet dysfunction
within 3 seconds of upper limit of normal
(1) parenteral vitamin K
(2) FFP 12-20 mL per kg body weight
(3) prothrombin complex if the patient is unable to handle the FFP volume
fibrinogen < 150 mg/dL
> 150 mg/dL
platelet count < 100,000 per µL
> 100,000 per µL
abnormal bleeding time
reduce to or near normal
desmopressin acetate 0.3 µg/kg IV
• The dose of FFP represents about 33-50% of an adult's plasma volume.
• Dosing of products in the bleeding patient has to be continuously adjusted since s/he may not be stable.
• Desmopressin = diamino-8-D-arginine vasopressin. It increases the high molecular weight multimers of von Willebrand's factor, which appears to be beneficial in reversing an elevated bleeding time.
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Specialty: Hematology Oncology, Clinical Laboratory, Gastroenterology