Patients With Liver Disease Often Have Blood Results That Give An Appearance Of A Significant Bleeding Risk

12 Mar, 2021

Dr. Rajesh Bollam

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Patients with liver disease often have blood results that give an appearance of a significant bleeding risk;
- Low platelets
- Prolonged PT/APTT
- Low fibrinogen
However...patients with liver disease often have a 'rebalancing' of haemostasis...
This occurs because when procoagulant factors reduce, so do natural anticoagulants
Some more considerations;
- Spontaneous bleeding & bleeding post minimally invasive procedures are both low
- FFP transfusion often leads to minimal improvement in PT (no impact if under 19s)
-FFP transfusion could also increase portal pressures, and this is a known risk for variceal haemorrhage
- The American association for the study of liver disease guidelines advise against checking INR or giving FFP in variceal haemorrhage
A study of ICU patients with liver disease identified that a fibrinogen of under 0.6g/L and platelet count of <30 x 10^9/L were most predictive of bleeding suggesting that these should be relied upon more than PT results.
SO...treating the numbers with FFP transfusion is unlikely to give benefit in most pts. & may➡️harm. A v. low platelet count or fibrinogen are more likely to be predictive of bleeding
See @BritSocHaem FFP guideline for more https://t.co/HPoJLeni8m

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