Acquired coagulation factor abnormalities due to severe liver disease
Introduction
Introduction to acquired clotting factor abnormalities caused by severe liver disease Severe liver disease causes abnormal clotting factor, mainly caused by liver disease. Because most clotting factors are synthesized in the liver, when the liver is sick, it is often accompanied by coagulopathy. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: purpura
Cause
Severe liver disease causes abnormal cause of acquired coagulation factor
Cause:
In addition to tissue thromboplastin and calcium ions, most coagulation factors or their intermediate products are synthesized by the liver, hepatocytes can synthesize fibrinogen, and hepatocyte microsomes can synthesize prothrombin, factor VII and factor X. Factor VIII, factor IX and factor V may also be synthesized in the liver. The synthetic organs of factor XI, factor XII and factor XIII are not determined, but in the case of liver disease, the content of these clotting factors may be reduced to varying degrees.
Pathogenesis:
The mechanisms by which liver disease affects clotting factors may be:
1. Reduced synthesis of coagulation factors, in which the content of vitamin K-dependent coagulation factors is decreased, and factor V and fibrinogen are also decreased.
2. The fibrinolytic activity is hyperactive, and the liver can synthesize inhibitors of plasminogen and plasminogen activator and have the effect of scavenging plasma.
3. The liver can remove activated coagulation factors, certain procoagulant substances and fibrin degradation products, liver disorders make these clearance functions impaired, and the synthesis of antithrombin III and plasma pro-plasma are reduced, Affect the content of coagulation factors.
Prevention
Severe liver disease causes abnormal acquisition of acquired coagulation factors
1. Prevention of hepatic hemorrhage, not only pay attention to disease, actively cooperate with treatment, but also cultivate optimistic mood; due to long illness, repeated illness and worry about prognosis, often the mental burden is heavier and emotionally unstable.
2, to prevent liver hemorrhage, to eat soft food with less slag digestible, in order to prevent food from scratching the curved venous plexus. Vegetables should be chopped and soft. Avoid the use of high fiber roots and vegetables. The meat is softened with tender pork minced meat and steamed. Without frying the fried food, the staple food is easily digested with fermented soft food such as bread, hair cake and steamed bread. Avoid hard and rough foods such as coarse grains, lettuce and fruit, and chicken food with bones. Eat less acid-producing foods: such as sweet potatoes can increase stomach acid, gas-producing foods such as radish and garlic seedlings can easily cause flatulence. Fasting strong irritating condiments such as peppers.
3, to prevent liver hemorrhage, to maintain smooth stool, avoid forced bowel movements, cough and other increased abdominal pressure; at the same time, to quit smoking and alcohol, pay attention to rest, avoid overwork, it is important to do liver function tests regularly.
Complication
Severe liver disease causes abnormal complications of acquired coagulation factors Complications
Hepatic disease face, bleeding gums, cyanosis, dysfunction of clotting factors, and menstrual flow.
Symptom
Severe liver disease causes abnormal symptoms of acquired coagulation factors Common symptoms Menstrual flow more nosebleeds Gingival bleeding thrombocytopenia cutaneous black skin mucosal bleeding
Hemorrhagic manifestations of patients with liver disease are more common with skin and mucous membrane bleeding, but these bleeding symptoms often occur in minor trauma, natural bleeding is still rare, if the patient is accompanied by thrombocytopenia and dysfunction, bleeding can be obvious, clinical Mainly manifested as nosebleeds, bleeding gums, cyanosis, menorrhagia and other symptoms, but also due to esophageal varices and hematemesis and / or black stools.
Examine
Severe liver disease caused by abnormal clotting factor
Patients with mild liver disease may have partial thromboplastin time and prothrombin time prolonged, clinically no bleeding symptoms, severe liver disease patients have clotting factor synthesis disorders, especially vitamin K-dependent clotting factor reduction is more obvious, among which factors The activity is reduced. Some people think that the biological half-life of factor VII is very short, so the change of its concentration can be used as an indicator of liver synthesis of blood coagulation factors.
According to the condition, clinical manifestations, symptoms, signs, choose ECG, B-ultrasound, X-ray, CT, MRI, liver, kidney function and biochemistry.
Diagnosis
Diagnosis and diagnosis of acquired clotting factor abnormalities caused by severe liver disease
A history of liver disease can be diagnosed in combination with clinical manifestations and laboratory tests.
The reduction of vitamin K-dependent clotting factors caused by liver disease must be differentiated from the reduction caused by other diseases. The history, symptoms and signs of primary disease should be emphasized. The vitamin K test (koller test) can help identify the Koller test: Injection of water-soluble vitamin K3 1mg, after 24 to 48h, review the activity dependent on vitamin K clotting factor, if its activity increased by more than 30% than before the test, suggesting that the liver synthesis of clotting factor is good, can distinguish the cause of biliary obstruction.
When the bleeding symptoms are obvious, it must be differentiated from diffuse intravascular coagulation (DIC) with liver disease. The number of DIC platelets is below 50×109/L (50,000/mm3), and prothrombin time (PT) is prolonged at 25s. 13s), the fibrinogen content is below 1250mg / L, and the degree of reduction of these indicators in patients with liver disease is not so significant, if the thrombin clotting time is prolonged, and toluidine blue can be corrected to normal or partially corrected, suggesting heparin-like The substance has increased.
