Dic

t PT, APTT , F/XDPs 5 fibrinogen, platelets

low grade common in CLD rarely fulminant

Management

Asymptomatic patients do not require treatment other than that directed at the underlying condition. Give vit K to exclude added vit K deficiency. Complete correction of the PT confirms this diagnosis; partial correction indicates combined hepatocellular dysfunction and vit K deficiency. Further doses of vit K for 1-2d may be given.

Liver biopsy—aim to get the INR <1.4 and platelet count >70 x 109/L. Check on day of biopsy. Give FFP 10mL/kg ; check INR and repeat FFP dose until PT is satisfactory—not always achieved. PCC contraindicated as may cause DIC and/or thrombosis. Platelet transfusion to 4 platelets to >70 x 109/L if necessary.

Active bleeding—blood transfusion as required. Give vit K, FFP, platelets as set out for liver biopsy and monitor the response. FFP only temporary correction; repeat 6-12 hourly as indicated. Surgical manoeuvres to control oesophageal bleeding (Sengstaken tube, etc.) will be explored. DIC is a feature of fulminant liver failure and after liver surgery and transplantation. Control underlying condition, support with platelet/FFP as required. The use of aprotinin, tranexamic acid, AT concentrates, and heparin has varying success.

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