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The page below is a sample from the LabCE course Fundamentals of Hemostasis. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Coagulation Disorders and Liver Disease

The liver is the site of production for the vast majority of our clotting factors. Therefore, impaired liver function could adversely affect these hemostatic proteins.

Indicators of a potential liver problem include:
  1. A decrease in the vitamin K-dependent factors, starting with factor VII, followed by reductions in factor II and X levels. Factor V levels are decreased in both acute and chronic liver disease, while factor IX levels are typically slightly reduced until advanced stages of liver disease.
  2. An increase in factor VIII. There is an increased production of factor VIII by the sinusoidal endothelial cells when the liver is damaged.
  3. The PT is sensitive to liver function, so an unexpected, prolonged PT should be evaluated.
  4. A lack of fibrinogen is often indicative of severe liver disease.
  5. It is difficult to treat liver disease, so therapy typically centers around replacing the missing factors by way of administration of fresh frozen plasma.