🩸 Chapter 530 · Coagulopathy in Liver Disease

Nelson Textbook of Pediatrics 22nd Edition | Coagulopathy in liver disease is multifactorial: decreased synthesis of coagulation factors (except factor VIII which is elevated), vitamin K deficiency, disseminated intravascular coagulation (DIC), hyperfibrinolysis, and thrombocytopenia (portal hypertension). Laboratory findings: prolonged PT/PTT, normal or increased factor VIII, low platelets, elevated D-dimer. Treatment: vitamin K trial, FFP (10-15 mL/kg) for bleeding, cryoprecipitate for hypofibrinogenemia, and recombinant factor VIIa (off-label) for refractory bleeding.

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📋 30 Clinical Scenarios — Coagulopathy in Liver Disease

📇 High‑Yield Review Cards (Liver Disease Coagulopathy)

🩺 Clinical Recognition: Coagulopathy in Liver Disease

Select a presentation for diagnostic clues and management.

📋 Stepwise Management of Coagulopathy in Liver Disease

🔑 Key Principles — Nelson Chapter 530
• Mechanisms: Decreased synthesis (factors II, V, VII, IX, X, XI), vitamin K deficiency (functional), DIC, hyperfibrinolysis, thrombocytopenia (portal hypertension).
• Laboratory: Prolonged PT/PTT, normal or increased factor VIII (distinguishes from DIC), low platelets, elevated D-dimer, hypofibrinogenemia (late).
• Treatment of bleeding: Vitamin K (1-10 mg IV) trial → if no correction, treat with FFP (10-15 mL/kg). Cryoprecipitate for fibrinogen <100 mg/dL. Recombinant factor VIIa (off-label) for refractory bleeding (contraindicated in DIC).
• Prophylaxis: Do not correct coagulopathy for invasive procedures unless high risk of bleeding or INR >1.5.

    ⚡ Reflex Prompts — Clinical Decisions in Liver Disease Coagulopathy

    📖 Summary: Coagulopathy in Liver Disease — Nelson Ch 530