RESUMO
Pediatric acute liver failure(PALF)is a severe liver damage caused by multiple factors, resulting in severe impairment of hepatic synthesis, excretion, detoxification and biotransformation.It was thought that PALF patients had coagulation disorders that predisposed them to bleeding.Now it is noted that due to the simultaneous reduction of anticoagulant and procoagulant factors, the body is in a state of rebalanced hemostasis.The risk of thrombosis is nearly equal to hemorrhage.Appropriate laboratory tests can better assess the coagulation status of children with PALF and guide appropriate blood product transfusions to improve coagulation and reduce the risk of transfusion-related fluid overload and other adverse prognosis.
RESUMO
Pediatric acute liver failure(PALF)is a severe liver damage caused by multiple factors, resulting in severe impairment of hepatic synthesis, excretion, detoxification and biotransformation.It was thought that PALF patients had coagulation disorders that predisposed them to bleeding.Now it is noted that due to the simultaneous reduction of anticoagulant and procoagulant factors, the body is in a state of rebalanced hemostasis.The risk of thrombosis is nearly equal to hemorrhage.Appropriate laboratory tests can better assess the coagulation status of children with PALF and guide appropriate blood product transfusions to improve coagulation and reduce the risk of transfusion-related fluid overload and other adverse prognosis.
RESUMO
The coagulation profile of patients with end-stage liver disease (ESLD) is different from that of healthy individuals. Because hemostasis is rebalanced in chronic liver disease, prophylactic transfusion of blood products may be not necessary for these patients even if they show severe coagulation dysfunction in conventional coagulation results. A 44-year-old man with hepatocellular carcinoma, cholangiocarcinoma and liver cirrhosis was scheduled for extra-hepatic mass excision under general anesthesia. His preoperative tests showed severe thrombocytopenia 19 × 10⁹/L. The patient underwent extrahepatic mass excision surgery under general anesthesia without transfusion of blood products. The post-operative course was uneventful without requiring any further hemostatic therapy. In this case report, we focus on the concept of rebalanced hemostasis in ESLD, and coagulation management based on rotational thromboelastometry.