Marc J. Kahn, MD

Tulane University School of Medicine, New Orleans, LA

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

This case was reviewed and updated in March 2012 by Dr. Howard Liebman and members of the Teaching Cases Subcommittee.


  1. The liver is responsible for synthesis of all of the clotting factors.
  2. Patients with liver disease frequently have elevations of the prothrombin time (PT) but can also have elevations of the activated partial thromboplastin time (aPTT).
  3. The PT is usually affected first, as factor VII has the shortest half-life of the clotting factors.
  4. Thrombocytopenia is common in liver disease as a result of splenic sequestration. Hepatitis C can lead to immune mediated platelet destruction and marrow underproduction of platelets, further reducing the platelet count.
  5. Fresh frozen plasma (FFP) is a source of clotting factors.
  6. Spur cell hemolytic anemia can result from severe liver disease.

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