Thromboelastometry Identified Alteration of Clot Stabilization and Factor XIII Supplementation Need in a Patient with Decompensated Liver Disease Undergoing Liver Biopsy

Case Reports in Gastrointestinal Medicine
Tomaz Crochemore, Felicio Aragão Savioli

Abstract

Liver disease has been considered the prototype of hemorrhagic disease. Disorder in any component of coagulation system can lead to hemorrhage. Deficiency of factor XIII may impair clot strength and clot stabilization and can be accessed by thromboelastometry. We report a case of a patient with a rapid evolution of liver disease who underwent a liver biopsy. Thromboelastometry was performed, evidencing impairment of clot stability. This clotting disorder was corrected with factor XIII concentrate after unsuccessful administration of antifibrinolytic drugs and hepatic biopsy was performed without hemorrhagic complications. Case Presentation. We report the case of a previously healthy 38-year-old man, who presented to our emergency department with clinical signs of rapid progression of acute liver failure. The laboratory tests revealed platelets of 142x103/mm3, plasma fibrinogen concentration of 221 mg/dl, increased international nationalized ratio (INR 1.9), total bilirubin of 3.9mg/dl, direct bilirubin of 2.3mg/dl, ALT 751U/l, and AST 540U/l without acute bleeding. A liver biopsy was indicated. Based on the results of the thromboelastometry, Tranexamic Acid was administered to correct hyperfibrinolysis followed by factor XIII c...Continue Reading

References

Sep 13, 2003·Chest·Kenneth G Mann
Dec 20, 2005·Blood Reviews·Christopher C Silliman, Nathan J D McLaughlin
Aug 27, 2009·Gastroenterology·Armando TripodiPier Mannuccio Mannucci
May 1, 2010·Thrombosis and Haemostasis·Oliver M TheusingerDonat R Spahn
Feb 16, 2017·Seminars in Liver Disease·Armando Tripodi
Jun 15, 2017·Einstein·Tomaz CrochemoreThiago Domingos Corrêa

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BETA
biopsy

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ROTEM

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