How are acute liver failure (ALF)–induced hemorrhages treated?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Hemorrhage develops as a result of the profoundly impaired coagulation that manifests in patients with acute liver failure. Gastrointestinal bleeding may develop from esophageal, gastric, or ectopic varices as a result of portal hypertension. Portal hypertensive gastropathy and stress gastritis may also develop. Any minor trauma may result in extensive percutaneous bleeding or internal hemorrhage.

The first step in management is to correct coagulopathy. The transfusion requirements for coagulation products (fresh frozen plasma [FFP], platelets) may be enormous. Multiple transfusions with packed red blood cells may be needed. Consider retroperitoneal hemorrhage if large transfusion requirements are not matched by an obvious blood loss.

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