Hemostasis and rheology

The prothrombin and activated partial thrombin times should normalize by the third postoperative day if the graft is working. Preoperative thrombocytopenia does not always respond to platelet transfusion and usually takes longer (up to a week or more) to recover. Hemoglobin concentration should not exceed 10 g/dl to avoid increasing blood viscosity and the risk of portal or hepatic arterial occlusion. Clotting factors should not be given routinely because the prothrombin time is a valuable guide to graft function. In the presence of continued blood loss, thromboelastography should be used to determine the cause. Aprotinin should be continued if there is evidence of continuing fibrinolysis and cryoprecipitate given if fibrinogen levels are low. Reasonable clotting indices suggest a surgical cause and should prompt re-exploration; intra-abdominal clot may cause the abdominal compartment syndrome, clotting factor consumption, clot expansion, and hyperbilirubinemia.

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