Liver disease
Liver disease leads to defects of coagulation, platelets and fibrinolysis.
- Reduced synthesis of vitamin K-dependent factors (II, VII, IX, X, proteins C and S) caused by impaired vitamin K absorption (biliary obstruction).
- Impaired synthesis of other coagulation proteins (factors I and V).
- Thrombocytopenia (hypersplenism) and abnormal platelet function (cirrhosis).
- Fibrinolysis impaired.
- Reduced levels of proteins C and S, antithrombin and α2-antiplasmin lead to susceptibility to disseminated intravascular coagulation (DIC).
- Dysfibrinogenaemia may lead to haemorrhage or thrombosis.
Disseminated intravascular coagulation
Release of procoagulant material into the circulation or endothelial cell damage causes generalized activation of the coagulation and fibrinolytic pathways leading to widespread fibrin deposition in the circulation. The most frequent causes are infections, malignancy and obstetric complications (Fig. 43.1).
Clinical features
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