Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 9-10, Pages: 608-614
https://doi.org/10.2298/SARH1310608N
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Laboratory monitoring of the haemostatic system changes during orthotopic liver transplantation
Novaković-Anučin Sladjana (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad)
Gnip Sanja (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad)
Čanak Višnja (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad)
Jurišić Đurđina (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad)
Radović Pavica (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad)
Erdeljan Svetlana (Klinički centar Vojvodine, Klinika za anesteziju i intenzivnu terapiju, Novi Sad)
Milošević Zoran (Klinički centar Vojvodine, Klinika za abdominalnu, endokrinu i transplantacionu hirurgiju, Novi Sad + Medicinski fakultet, Novi Sad)
Mitić Gorana (Klinički centar Vojvodine, Centar za laboratorijsku medicinu, Odeljenje za trombozu, hemostazu i hematološku dijagnostiku, Novi Sad + Medicinski fakultet, Novi Sad)
Introduction. In liver diseases, all components of the haemostatic system are
changed and the degree of dysfunction is proportional to hepatocellular
damage. During the liver transplantation, values of haemostatic parameters
show substantial changes, while postoperatively there is a gradual
normalisation of the haemostatic system function. Objective The aim was to
monitor the changes of the haemostatic system intraoperatively and
postoperatively, including the dynamics at which physiological values of
parameters are reached after transplantation. Methods. There were 17
cadaveric transplantations performed at the Clinical Centre of Vojvodina in
the period from June 2008 to February 2012. The following parameters were
tested: platelets, activated partial thromboplastin, prothrombin and thrombin
time, fibrinogen, euglobulin clot lysis time, D-dimer, antithrombin and
heparinemia. The results were presented intraoperatively in phases of
transplantation, and postoperatively from day 1 to day 7, ending with
postoperative day 14. Results. During transplantation, the most pronounced
disorders among those observed are: thrombocytopenia (96±66.1×109/L),
prolonged activated partial thromboplastin (1.80±0.8 R), prothrombin
(1.59±0.4 R) and thrombin time (2.03±1.7 R), hypofibrinogenemia (2.13±0.5
g/L), hyperfibrinolysis (29±12.0 min), increase of D-dimer (1393±1220.4
ng/mL) and decrease of antithrombin (61±18.0%). Further monitoring after
transplantation from postoperative day 1 revealed a gradual normalisation in
the values, reaching physiological values for all parameters on postoperative
day 14, except for the sustained high value of D-dimer (2606±1055.1 ng/mL).
Heparinemia was within the prophylactic range (0.26±0 IU/mL). Conclusion.
Thorough monitoring of the haemostatic system parameters in liver
transplantations is of great importance, as it enables the use of optimal
substitution therapy during and after transplantation, as well as an adequate
postoperative thromboprophylaxis. Our study has shown normalisation of
investigated laboratory parameters within 7-14 days after transplantation.
Keywords: haemostasis, haemostatic parameters, fibrinolysis, orthotopic liver transplantation