Diagnosis and Treatment of Haematological Disorders in Hepatic Failure

Overview

The cause of impaired haemostasis in hepatic failure are:
1. thrombocytopenia and thrombocytopathies, 2. impaired synthesis and clearance of coagulation factors, 3. hyperfibrinolysis and dysfibrinogenaemia, 4. activation of endothelial cells and possibly also 5. disseminated intravascular coagulation.The basis of the laboratory examination is a haemogram with a manual differential count where we pay attention to the size and skape of thrombocytes and possibly to the presence of schistocytes. Bleeding time (preferably according to Ivy) will show the functional state of thrombocytes. Next it is important to assess the prothrombin time, aPTT, the fibrinogen and anithrombin III level. Euglobulin fibrinolysis indicates the fibrinolytic plasma activity. D-dimers should be assessed quantitatively. It is useful to examine also the levels of different factors (II, V, VII, VIII) and protein C. It is very important to make the examinations repeatedly and follow up the dynamics of changes and effectiveness of therapeutic operations.In treatment in the particular the following are used: 1. transfusion of platelets, 2. fresh frozen plasma, 3. vitamin K, 4. inhibitory coagulation, 5. inhibitory fibrinolysis, 6. heparin.

Key words:
hepatic failure - thrombocytopenia - thrombocytopathies - thrombocyte concentrate - prothrombin time - fibrinolysis - antithrombin.