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A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM)
Patient: Female, 36-year-old Final Diagnosis: Liver failure Symptoms: Coagulopathy Medication:— Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Fulminant hepatic failure (FHF) is commonly associated with elevated prothrombin time (PT) and international...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900458/ https://www.ncbi.nlm.nih.gov/pubmed/36718100 http://dx.doi.org/10.12659/AJCR.938500 |
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author | Yoon, Uzung Lai, Manny Nguyen, Tho Elia, Elia |
author_facet | Yoon, Uzung Lai, Manny Nguyen, Tho Elia, Elia |
author_sort | Yoon, Uzung |
collection | PubMed |
description | Patient: Female, 36-year-old Final Diagnosis: Liver failure Symptoms: Coagulopathy Medication:— Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Fulminant hepatic failure (FHF) is commonly associated with elevated prothrombin time (PT) and international normalized ratio (INR). There is a commensurate decline in pro- and anti-hemostatic factors, and hemostatic function is rebalanced, not reflected in INR. This report presents the case of a 36-year-old woman with FHF following acetaminophen overdose, an increased INR above 8.7, and normal blood viscosity measured by rotational thromboelastometry (ROTEM). CASE REPORT: A 36-year-old woman presented with FHF following an acetaminophen overdose. On arrival, she was lethargic but arousable and followed commands. Her King’s College Criteria for acetaminophen toxicity was 2 and her MELD score was 36. Her INR was unmeasurably high (>8.7). To evaluate whole-blood coagulation, a ROTEM analysis was performed. All parameters (CT, CFT, alpha-angle, A10, MCF) of the NATEM were within reference range. Despite the normal ROTEM, spontaneous bleeding was a concern. The patient received 5 units of cryo-precipitate and 9 units of FFP prior to a central venous line placement. She was started on molecular adsorbent recirculating system and continuous veno-venous hemodialysis, but died on day 7. CONCLUSIONS: Patients with FHF can have normal whole-blood coagulation based on ROTEM even if INR levels are unmeasurably high. Viscoelastic tests such as ROTEM, which assesses whole-blood coagulation properties, are preferrable for coagulation monitoring in these patients. Blood product transfusion to correct coagulation abnormality, like FFP and cryoprecipitate, may be used based on the result of viscoelastic testing over conventional coagulation testing. |
format | Online Article Text |
id | pubmed-9900458 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-99004582023-02-08 A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) Yoon, Uzung Lai, Manny Nguyen, Tho Elia, Elia Am J Case Rep Articles Patient: Female, 36-year-old Final Diagnosis: Liver failure Symptoms: Coagulopathy Medication:— Clinical Procedure: — Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Fulminant hepatic failure (FHF) is commonly associated with elevated prothrombin time (PT) and international normalized ratio (INR). There is a commensurate decline in pro- and anti-hemostatic factors, and hemostatic function is rebalanced, not reflected in INR. This report presents the case of a 36-year-old woman with FHF following acetaminophen overdose, an increased INR above 8.7, and normal blood viscosity measured by rotational thromboelastometry (ROTEM). CASE REPORT: A 36-year-old woman presented with FHF following an acetaminophen overdose. On arrival, she was lethargic but arousable and followed commands. Her King’s College Criteria for acetaminophen toxicity was 2 and her MELD score was 36. Her INR was unmeasurably high (>8.7). To evaluate whole-blood coagulation, a ROTEM analysis was performed. All parameters (CT, CFT, alpha-angle, A10, MCF) of the NATEM were within reference range. Despite the normal ROTEM, spontaneous bleeding was a concern. The patient received 5 units of cryo-precipitate and 9 units of FFP prior to a central venous line placement. She was started on molecular adsorbent recirculating system and continuous veno-venous hemodialysis, but died on day 7. CONCLUSIONS: Patients with FHF can have normal whole-blood coagulation based on ROTEM even if INR levels are unmeasurably high. Viscoelastic tests such as ROTEM, which assesses whole-blood coagulation properties, are preferrable for coagulation monitoring in these patients. Blood product transfusion to correct coagulation abnormality, like FFP and cryoprecipitate, may be used based on the result of viscoelastic testing over conventional coagulation testing. International Scientific Literature, Inc. 2023-01-31 /pmc/articles/PMC9900458/ /pubmed/36718100 http://dx.doi.org/10.12659/AJCR.938500 Text en © Am J Case Rep, 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Yoon, Uzung Lai, Manny Nguyen, Tho Elia, Elia A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title | A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title_full | A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title_fullStr | A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title_full_unstemmed | A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title_short | A 36-Year-Old Woman with Acute Liver Failure Following Acetaminophen Overdose, Raised INR of 8.7, and Normal Blood Viscosity Measured by Rotational Thromboelastometry (ROTEM) |
title_sort | 36-year-old woman with acute liver failure following acetaminophen overdose, raised inr of 8.7, and normal blood viscosity measured by rotational thromboelastometry (rotem) |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900458/ https://www.ncbi.nlm.nih.gov/pubmed/36718100 http://dx.doi.org/10.12659/AJCR.938500 |
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