Coagulopathy: Liver Disease, Renal Disease, DIC, Massive Blood Loss

Question 1

What is coagulopathy associated with liver disease?

Answer 1

Impairment of the clotting and fibrinolytic systems

This condition leads to issues with blood coagulation and can result in excessive bleeding.

Question 2

What is a common cause of thrombocytopenia in liver disease patients?

Answer 2

Decreased TPO synthesis and bone marrow suppression

Bone marrow suppression may occur if liver disease is caused by high alcohol intake or hepatitis C.

Question 3

What condition is common due to cirrhosis in patients with liver disease?

Answer 3

Accelerated fibrinolysis

This leads to excessive clot breakdown and can result in bleeding.

Question 4

What are the two types of fibrinogen abnormalities associated with liver disease?

Answer 4

• Hypofibrinogenemia
• Dysfibrinogenemia

Hypofibrinogenemia refers to reduced fibrinogen levels, while dysfibrinogenemia refers to the production of abnormal fibrinogen.

Question 5

How do patients with chronic liver disease typically present in terms of coagulation?

Answer 5

Normal or increased coagulation

This occurs due to a balanced reduction of clotting factors.

Question 6

What is the typical coagulation presentation in acute liver disease?

Answer 6

Excessive bleeding

Acute liver disease usually results in a more pronounced bleeding tendency.

Question 7

What factor is more likely to decrease if the synthesis of clotting factors is impaired?

Answer 7

Clotting

Decreased synthesis of clotting factors leads to a higher risk of bleeding.

Question 8

What happens to clotting if the synthesis of natural anticoagulants decreases?

Answer 8

Increased clotting

Natural anticoagulants include Protein C, Protein S, and antithrombin.

Question 9

What happens to Factor 8 in liver failure due to cirrhosis?

Answer 9

Tends to be upregulated

This upregulation can affect coagulation dynamics.

Question 10

What is the management for severe coagulopathy and active bleeding in liver disease patients?

Answer 10

Fresh Frozen Plasma (FFP)

FFP is used to provide clotting factors to manage bleeding.

Question 11

What is recommended for non-cirrhotic patients regarding anticoagulation?

Answer 11

Anticoagulant prophylaxis

This approach helps prevent thromboembolic events in patients without cirrhosis.

Question 12

What is coagulopathy associated with renal disease?

Answer 12

Bleeding diathesis occurs due to uremia, which reduces platelet adhesion and decreases platelet count.

Commonly occurs in end-stage renal disease.

Question 13

What is the common cause of thrombosis in Nephrotic Syndrome and CKD?

Answer 13

Thrombosis occurs due to the excretion of antithrombin in urine.

This can lead to a hypercoagulable state.

Question 14

What is the preferred management for stages 1-3 CKD?

Answer 14

Direct Oral Anticoagulants (DOACs) are preferred.

Warfarin is first-line for end-stage CKD.

Question 15

What is the role of haemodialysis in end-stage renal disease?

Answer 15

Haemodialysis prevents uremia but increases the risk of thrombosis.

Enoxaparin or unfractionated heparin (UFH) is also administered.

Question 16

What is Disseminated Intravascular Coagulation?

Answer 16

A rare blood disorder where clotting proteins become overactive, leading to a hypercoagulable state and potential organ dysfunction.

Can cause bleeding diathesis after depletion of platelets and clotting factors.

Question 17

What is the management for severe bleeding in Disseminated Intravascular Coagulation?

Answer 17

Transfusion of platelets, coagulation factors in fresh frozen plasma, and fibrinogen in cryoprecipitate.

Question 18

What is coagulopathy associated with massive blood loss?

Answer 18

Loss of one blood volume over 24 hours.

Rapid consumption and dilution of clotting factors and platelets can eventually lead to bleeding diathesis, which is progressively worsened by acidosis and hypothermia.

Question 19

What is the management for coagulopathy due to massive blood loss?

Answer 19

Red cell and platelet transfusions, along with FFP transfusions to maintain sufficient fibrinogen and clotting factor levels.

Cryoprecipitate can be used instead if fibrinogen levels remain critically low.