COAGULATION DISORDERS IN LIVER DISEASE

• Pathological Basis:
  • The liver is the site of synthesis of all coagulation proteins (except von Willebrand factor), plasminogen, and various physiologic inhibitors such as Antithrombin III and Alpha 2-antiplasmin.
  • Pathological basis of bleeding in liver disease can be explained using the following factors:
    • Decreased production of coagulation proteins.
    • Decreased clearance of activated coagulation factors.
    • Thrombocytopenia due to decreased production of platelets or increased sequestration by the spleen.
    • Increased fibrinolysis.
    • Qualitative abnormalities of platelets.
  • It is often difficult to differentiate DIC from liver failure as the cause of coagulation disorder. Presumably, a low degree of DIC is common in patients with liver failure.
• Treatment:
  • Supportive care.
  • FFP.
  • Platelet transfusion if indicated.
  • Vitamin K if needed.