ABSTRACT
A variety of haemostatic abnormalities occur in patients with liver disease and, in general, the severity of these abnormalities reflects the degree of hepatic dysfunction. Aims of the study: 1- To study the haemostatic parameters among patients with liver cirrhosis. 2- To characterize the haemostatic differences among patients with liver cirrhosis and thrombosis and those with bleeding. Patients, Materials and This study included 36 patients with liver cirrhosis of various stages who were selected among those admitted to the department of Tropical Medicine and Gastroenterology. In addition 15 apparently healthy persons were selected as a control group. They were diagnosed as liver cirrhosis according to clinical, laboratory and ultrasonographic criteria. All the patients and control were subjected to the followings: history taking and clinical examination, abdominal ultrasonography and coloured - Doppler ultrasonography, laboratory investigations including: blood count, liver function tests, haemostatic parameters including: prothrombin time and concentration, activated partial thromboplastin time [aPTT], antithrombin III [AT III], fibrinogen, protein S and protein C, D- dimer, platelet aggregation tests. The patients were classified into three groups: Group I: included 11 patients with liver cirrhosis and evidence of thrombosis [portal, DVT or both], Group II: included 17 patients with liver cirrhosis and evidence of bleeding tendency and Group III: included 8 patients with liver cirrhosis and no evidence of either bleeding tendency or thrombosis. There was highly significant reduction of the mean levels of the AT III, protein C and platelets among patients with liver cirrhosis in comparison to the healthy control [P = 0.000, P = 0.001 and P = 0.000 respectively]. The mean PT and aPTT times were significantly longer among patients with liver cirrhosis in comparison to healthy controls [P = 0.000 and p = 0.003 respectively]. Similarly the mean values of serum fibrinogen and D-dimer were significantly higher among patients with liver cirrhosis healthy controls [p = 0.000 and p = 0.003 respectively]. On the other hand no significant difference was found between patients and controls regarding the mean value of protein S [p = 0.401]. Total bilirubin, PT and aPTT showed positive correlation with Child score [r = 0.465, 0.552 and 0.582 respectively], while serum albumin, ALT. AT III and protein S showed negative correlation with Child score [r = -0.813, -0.405, -0.389, and -0.415 respectively]. Fibrinogen showed negative correlation with both the serum bilirubin and PT. AT III showed positive correlation with serum albumin and negative correlation with serum bilirubin, ALT AST and PT Protein S showed negative correlation with serum bilirubin. Protein C showed positive correlation with serum bilirubin, ALT, AST and PT. D-dimer showed negative correlation with AST. aPTT showed positive correlation with serum bilirubin, AST and PT. The mean values of AT III protein S and C were significantly lower in group I in comparison to group II [p = 0.035, 0.034 and 0.021 respectively]. On the other hand, a PTT was significantly longer in group II than group I [p = 0.006]. The mean values of protein C was significantly lower in group I in comparison to group III [p = 0.030]. The mean values of protein S was significantly higher in group II in comparison to group III [p = 0.038]. On the other hand, aPTT was significantly longer in group II than in group III [p = 0.005]. Conclusions: 1- both the levels of coagulation factors and coagulation inhibitors decreased in patients with liver cirrhosis in comparison to controls and this decrease correlated with liver dysfunction. 2- The occurrence of bleeding or thrombosis among patients with liver cirrhosis depends on the balance between the degree of reduction of coagulation factors and coagulation inhibitors so screening of these factors is essential for prediction of each of them