Eliminating international normalized ratio threshold for transfusion in pediatric patients with acute liver failure

2020 ◽  
Vol 34 (4) ◽  
Author(s):  
Angela Lee ◽  
Julianne Mendoza ◽  
Aleah L. Brubaker ◽  
Daniel J. Stoltz ◽  
Rebecca McKenzie ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Pediatric Patients ◽  
International Normalized Ratio

Basiliximab treatment for steroid-resistant rejection in pediatric patients following liver transplantation for acute liver failure

2014 ◽  
Vol 18 (8) ◽  
pp. 860-867 ◽  
Author(s):  
Takanobu Shigeta ◽  
Seisuke Sakamoto ◽  
Hajime Uchida ◽  
Kengo Sasaki ◽  
Ikumi Hamano ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Pediatric Patients ◽  
Steroid Resistant

A Prospective Clinical Trial Shows That Intravenous N-Acetylcysteine (NAC) Does Not Improve Survival in Pediatric Patients With Non-Acetaminophen Acute Liver Failure

2011 ◽  
Vol 140 (5) ◽  
pp. S-897 ◽  
Author(s):  
Robert Squires ◽  
Anil Dhawan ◽  
Estella M. Alonso ◽  
Michael R. Narkewicz ◽  
Norberto Rodriguez-Baez ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Pediatric Patients ◽  
Prospective Clinical Trial

scholarly journals Hemostatic Balance in Pediatric Acute Liver Failure: Epidemiology of Bleeding and Thrombosis, Physiology, and Current Strategies

2020 ◽  
Vol 8 ◽  
Author(s):  
Yonca Bulut ◽  
Anil Sapru ◽  
Gavin D. Roach
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Cell Activation ◽  
Protein S ◽  
Bleeding Risk ◽  
International Normalized Ratio ◽  
Clinical Syndrome ◽  
Low Grade ◽  
Endothelial Cell Activation ◽  
Pediatric Acute Liver Failure

Pediatric Acute Liver Failure (PALF) is a rapidly progressive clinical syndrome encountered in the pediatric ICU which may rapidly progress to multi-organ dysfunction, and on occasion to life threatening cerebral edema and hemorrhage. Pediatric Acute Liver Failure is defined as severe acute hepatic dysfunction accompanied by encephalopathy and liver-based coagulopathy defined as prolongation of International Normalized Ratio (INR) >1.5. However, coagulopathy in PALF is complex and warrants a deeper understanding of the hemostatic balance in acute liver failure. Although an INR value of >1.5 is accepted as the evidence of coagulopathy and has historically been viewed as a prognostic factor of PALF, it may not accurately reflect the bleeding risk in PALF since it only measures procoagulant factors. Paradoxically, despite the prolongation of INR, bleeding risk is lower than expected (around 5%). This is due to “rebalanced hemostasis” due to concurrent changes in procoagulant, anticoagulant and fibrinolytic systems. Since the liver is involved in both procoagulant (Factors II, V, IX, XI, and fibrinogen) and anticoagulant (Protein C, Protein S, and antithrombin) protein synthesis, PALF results in “rebalanced hemostasis” or even may shift toward a hypercoagulable state. In addition to rebalanced coagulation there is altered platelet production due to decreased thrombopoietin production by liver, increased von Willebrand factor from low grade endothelial cell activation, and hyperfibrinolysis and dysfibrinogenemia from altered synthetic liver dysfunction. All these alterations contribute to the multifactorial nature of coagulopathy in PALF. Over exuberant use of prophylactic blood products in patients with PALF may contribute to morbidities such as fluid overload, transfusion-associated lung injury, and increased thrombosis risk. It is essential to use caution when using INR values for plasma and factor administration. In this review we will summarize the complexity of coagulation in PALF, explore “rebalanced hemostasis,” and discuss the limitations of current coagulation tests. We will also review strategies to accurately diagnose the coagulopathy of PALF and targeted therapies.

scholarly journals A case of cryptogenic pseudocirrhosis causing acute liver failure: when clinic and radiology work together

2019 ◽  
Vol 13 (2) ◽  
pp. 121-123
Author(s):  
Martina Finocchi ◽  
Ombretta Para ◽  
Giacomo Zaccagnini ◽  
Lorenzo Corbo ◽  
Lucia Maddaluni ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Systemic Chemotherapy ◽  
Acute Liver Injury ◽  
Metastatic Breast ◽  
International Normalized Ratio ◽  
Caudate Lobe ◽  
Oncologic Patients ◽  
Liver Changes

It is known that a wild spectrum of hepatic manifestations can be common presentations of metastatic breast cancer. Pseudocirrhosis pattern has been often described as almost always secondary to systemic chemotherapy and it is defined by morphological liver changes that mimic cirrhosis including capsular retraction, nodularity, parenchyma atrophy and caudate lobe, radiologically identifiable. Acute liver injury is an occasional complication in oncologic patients, and it outlines an organ failure when there is evidence of encephalopathy and coagulopathy (international normalized ratio >1.5) in the absence of pre-existing liver disease, with an illness of <26 weeks duration. The two most common etiologies are leukemia/lymphoma followed by breast cancer but also in this case, liver is involved almost always after chemotherapy, hormonotherapy or radiotherapy. Here we present a case of rapid evolving acute liver failure presented as cryptogenic pseudocirrhosis without any evidence of primitive breast cancer but an incidental demonstration.

scholarly journals An Analytical Study on Acute Liver Injury in Patients Caused by Classic Heat stroke

2021 ◽  
pp. 219-223
Author(s):  
Kirti Mishra ◽  
Pallavi Srivatava
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Hospital Stay ◽  
Analytical Study ◽  
Heat Stroke ◽  
International Normalized Ratio ◽  
The Body ◽  
Medical Emergency ◽  
Time Period ◽  
Risk Of Mortality

Heat Stroke is a kind of medical emergency that can cause severe dehydration and neurological changes as a result multi-organ injuries or failure could be possible. Heat strokes occur when the body temperature exceeds 40 0C due to external heat and humidity. The liver is widely affected by heatstroke that’s why taking care of patients suffering from heatstroke is very important. Various studies have been reported in the literature regarding acute liver failure but none of the studies discussed acute liver failure during the hospital stay. Patients during their hospital stay will have a higher risk of mortality due to heatstroke. In this paper, an analytical study has been done on admitted patients to a government hospital in India. These patients are suffered from heatstroke from April 2007 to September 2011 and a second time period from July 2018 to September 2019. The sample includes 60 patients with 58 (97%) males having a totaled number of 12 fatalities. The observed International Normalized ratio (INR) parameter is greater than 1.6 and no increased mortality has been noticed, aspartate aminotransferase (AST), as well as alanine aminotransferase (ALT) levels, were not associated with an increased mortality rate.

scholarly journals A Learning Collaborative Approach Increases Specificity of Diagnosis of Acute Liver Failure in Pediatric Patients

2018 ◽  
Vol 16 (11) ◽  
pp. 1801-1810.e3 ◽  
Author(s):  
Michael R. Narkewicz ◽  
Simon Horslen ◽  
Regina M. Hardison ◽  
Benjamin L. Shneider ◽  
Norberto Rodriguez-Baez ◽  
...  
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Pediatric Patients ◽  
Collaborative Approach ◽  
Learning Collaborative

Acute liver failure

2011 ◽  
Author(s):  
R. Mark Beattie ◽  
Anil Dhawan ◽  
John W.L. Puntis
Keyword(s):  
Liver Function ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
International Normalized Ratio ◽  
Multisystem Disorder ◽  
Liver Support ◽  
Liver Support System ◽  
Hepatocellular Necrosis ◽  
Severe Impairment ◽  
Underlying Chronic Liver Disease

Definition 476Aetiology 476Therapy 480Complications 480Transplantation 484Liver support system 484Prognosis 485Acute liver failure (ALF) in children is defined as ‘a rare multisystem disorder in which severe impairment of liver function, with or without encephalopathy, occurs in association with hepatocellular necrosis in a patient with no recognized underlying chronic liver disease’. Liver function is considered severely impaired if prothrombin time (PT) is >15 s or international normalized ratio (INR) is >1.5 and not corrected by vitamin K, in the presence of hepatic encephalopathy (HE) or a PT >20 s or INR >2.0 in the absence of HE....

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