Chapter 475 Liver Disease
Because all of the clotting factors except factor VIII are produced exclusively in the liver, coagulation abnormalities are very common in patients with severe liver disease. Only 15% of such patients have significant clinical bleeding states. The severity of the coagulation abnormality appears to be directly proportional to the extent of hepatocellular damage. The most common mechanism causing the defect is decreased synthesis of coagulation factors. Patients with severe liver disease characteristically have normal to increased (not reduced) levels of factor VIII activity in plasma. In some instances, disseminated intravascular coagulation (Chapter 477) or hyperfibrinolysis may complicate liver disease, making laboratory differentiation of severe liver disease from disseminated intravascular coagulation difficult.
