Coagulation Studies in Acute Hepatic Necrosis

Summary

In 2 patients with post-hepatitic acute hepatic necrosis, a complex coagulation defect characterized by low levels of prothrombin, factor V, and factor IX, hypofibrinogenemia, thrombocytopenia, and pathologic thrombin time was present. Levels of factor VIII were abnormally elevated. Exchange blood transfusions led to striking but shortlasting improvement in coagulation and were found to be an efficient means in control of bleeding. Extracorporal perfusion of the livers of pigs, and of a human liver raised the levels of the liver-synthesized clotting factors prothrombin, factor V, and factor IX in the patient’s blood. Increase of fibrinogen level occurred solely after 36 h perfusion of a human liver. Adverse effects of extracorporeal liver perfusion were decrease of platelets, fibrinogen, and factor VIII.

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