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Bleeding in Acute and Chronic Liver Disease

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Abstract

The liver plays a central role in hemostasis. In liver disease, hemostasis is deranged but precariously balanced. Different pathophysiological mechanisms form an underlying basis for bleeding in acute and chronic liver disease. In acute liver failure, there is severe reduction in circulating procoagulant and anticoagulant factor levels. However, patients with chronic liver disease more often exhibit systemic hyperfibrinolysis. The common laboratory coagulation tests such as prothrombin time/international normalized ratio (INR) are poor predictors of spontaneous bleeding or during invasive procedures in patients with liver disease. Although clinically significant spontaneous bleeding is not common, a sudden onset of massive bleeding can happen without a trigger. Therefore, the target of each coagulation parameter needs to be clearly defined to prevent catastrophic bleeding. If the patient is bleeding, appropriate therapeutic interventions including transfusions of blood components and factor concentrates are indicated without delay.

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Authors and Affiliations

  1. Division of Transfusion Medicine & Coagulation, Baylor College of Medicine, Texas Children’s Hospital, 6621 Fannin St., Suite WB1100, Houston, TX, 77030, USA

    Esther Paula Soundar M.D., M.P.H.

  2. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine, Division of Transfusion Medicine & Coagulation, Texas Children’s Hospital, 6621 Fannin St., Suite WB1100, Houston, TX, 77030, USA

    Jun Teruya M.D.,D.Sc.,F.C.A.P.,F.A.S.C.P.

Authors
  1. Esther Paula Soundar M.D., M.P.H.
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  2. Jun Teruya M.D.,D.Sc.,F.C.A.P.,F.A.S.C.P.
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Corresponding author

Correspondence to Jun Teruya M.D.,D.Sc.,F.C.A.P.,F.A.S.C.P. .

Editor information

Editors and Affiliations

  1. Departments of Pathology & Immunology, Pediatrics, and Medicine, Baylor College of Medicine Division of Transfusion Medicine & Coagulation Texas Children’s Hospital, Houston, Texas, USA

    Jun Teruya

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© 2016 Springer International Publishing Switzerland

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Soundar, E.P., Teruya, J. (2016). Bleeding in Acute and Chronic Liver Disease. In: Teruya, J. (eds) Management of Bleeding Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-30726-8_11

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  • DOI: https://doi.org/10.1007/978-3-319-30726-8_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30724-4

  • Online ISBN: 978-3-319-30726-8

  • eBook Packages: MedicineMedicine (R0)

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